Everyone needs healthcare at some point in their lives. People fall ill, or suffer debilitating accidents or injuries at one time or another, and will seek care and treatment from a competent physician or other medical practitioner. At a time when costs for medical and hospital care have soared through the roof, health insurance coverage has become a necessity for all Americans.
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Nevertheless, not all Americans are insured. It is estimated that nearly 44 million Americans, more than 15% of the U.S. population, have no health insurance coverage at all. An additional 38 million Americans have some coverage, but are considered to be under-insured.
What is being done about this?
Since the Clinton Administration in the 1990s, it has been the goal of the federal government to see that every American is protected by adequate health insurance coverage. Just how to achieve this goal, has been a hotly debated topic in Congress and across America.
After more than 20 years, there have been few victories, with only limited success in increasing the number of insured U.S. citizens. Universal health coverage is still only a distant dream, but progress is being made.
However, there is encouraging news. Many state governments have joined the cause, enacting legislation that has sharply decreased the numbers of uninsured individuals in their states.
Which states have been successful with new health care legislation?
One example of success at the state level is Massachusetts. In just five short years, the number of insured in Massachusetts has risen from 94% to more than 98%! In 2006, the Massachusetts General Court, or state legislature, passed laws requiring all state residents to have at least basic health insurance coverage.
Massachusetts created a new state agency, the Health Connector, to manage the various insurance providers in the state and to help residents transition to the new regulations. The Health Connector acts as an insurance broker, a go-between, in the process of enrolling Massachusetts residents in available insurance programs.
Depending on eligibility, the Health Connector will help place each resident in the insurance program that best suits their needs using their Commonwealth Choice programs. For residents who have limited resources or are unable to pay, Massachusetts has established several subsidized or free programs grouped under the Commonwealth Care moniker.
For those at the lowest income levels, there is Mass Health, the Massachusetts version of the federally mandated Medicaid program. There are penalties for failure to comply with these new laws, including increased income tax assessments. This has helped motivate citizens in Massachusetts to comply with these new regulations.
Are other states making progress?
The state of Ohio is also claiming to see higher percentages of insured citizens following the enactment of several new laws in the past few years. These laws have extended coverage to children on their parent’s health policies, up to age 28, and capped insurance rates for citizens with pre-existing conditions.
Ohio has also passed laws favoring businesses that provide health coverage to their employees, and extended their own “mini COBRA” program to cover more individuals who are out of work, and for longer periods of time.
New York has created the Healthy New York program, designed to provide basic health coverage to lower income individuals and families at significantly lower rates. Child Health Plus has been available for several years and protects children from lower income families that may not have other insurance coverage.
What insurance alternatives are generally available?
As discussed previously, available health insurance options can vary dramatically from state to state. For those with employers who offer health benefits, or who can afford private coverage on their own, the usual options include a choice of HMO, or managed care plans and PPO or preferred provider plans. Both programs provide comprehensive coverage for policyholders.
Once a citizen reaches age 65, he or she is eligible for coverage under the federal Medicare program. The nominal premiums for this program are usually deducted from participants’ Social Security checks. Basic Medicare only covers a portion of medical expenses. Usually, additional coverage is desired and a supplemental plan is purchased to cover out-of-pocket expenses.
For others unable to pay, the federally mandated Medicaid program is administered in each state, providing full coverage for necessary and needful medical services to its eligible recipients.
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