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- The individual mandate requires health insurance coverage for every eligible resident
- The Affordable Care Act requires insurers to accept all applicants on equal terms without regard to pre-existing medical conditions
- The alternative to coverage is payment of the individual shared responsibility tax
- Persons that fail or refuse to get and keep coverage must pay a penalty unless exempt
Given a choice, many Americans would decline the offer of health care through health insurance. While some plans offer low premiums, the best plans provide extensive coverage at high premium costs.
Healthy people sometimes rationalize that the expense is unnecessary. After all, in recent years they may not have seen a doctor because they felt symptom-free and well. The nature of disease and illness is not so simple.
Healthy young people often contain the beginnings of disease and illness that could cut short their lives in early middle age. For example, women that develop breast cancer often are in their child-bearing years. Obesity and poor levels of activity predict diabetes risks and heart problems.
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In the US, there have been fundamental traditions that respect the right of the individual to make decisions about their personal affairs including medical care.
Some advocates of alternatives to Obamacare point to the individual mandate and describe it as a loss of freedom of choice. This argument may be powerful to many residents, and no one can reject their right to decide that question.
When people get sick and particularly in peril of death, they usually accept medical care and likely reach out for the best opportunity to heal and continue living. The society cannot wait until the last illness to train doctors and build medical facilities with modern infrastructure.
The governments take into account the potential that every resident will require medical care at some point and it builds resources accordingly. Personal freedom does not avoid the inevitable costs of medical care as humans fade and experience the end of life.
Wellness and prevention services make up a key set of benefits of Obamacare. Many of these prevention services have no added costs for the user.
Prevention offers the nation a chance to finally control its healthcare expenditures and bring them more in line with other advanced nations. Prevention avoids human suffering that doctors can easily resolve in early stages.
Prevention is the most effective form of medical care, and it can extend and improve the quality of life while reducing the costs of healthcare in the US.
Wellness services are another no-cost feature of Obamacare.
Wellness describes the condition of living symptom-free. Wellness counseling provides medical information to reinforce positive and healthful lifestyles. They promote active lifestyles, no tobacco use, moderate alcohol consumption, and healthy eating.
The Individual Mandate
The individual mandate requires that every eligible resident must get and keep qualified health insurance. His requirement is the key to the national health insurance program. The Obamacare model proceeds on the idea of universal participation and universal acceptance.
The law cannot force people to use their insurance benefits including the no added cost prevention services that Obamacare provides.
The education process is an important element of national health policy. Understanding risks and rewards are the best reason to get insurance and use healthcare services.
Exemptions from the Mandate
The most effective way to avoid getting health care is to get an exemption from the individual mandate. This will leave one free to go without health insurance or health care. There are exemptions for many special circumstances such as individuals living abroad. The below-listed items describe some of the common basis for an exemption from the individual mandate.
- Income below the Filing Threshold – Residents that do not have income above the minimum level to file a tax return do not have to get and keep qualified health insurance.
- Income that is not Taxable – Residents that have non-taxable income do not have to get and keep qualified health insurance. Income such as Social Security for severely disabled persons does not qualify as taxable income. Those that rely upon this and similar types of income do not have to meet the mandate. They are exempt.
- Hardship exemptions are the most common form of exemption. The rules provide a waiver for up to three months without insurance.
- Affordability is a requirement for the individual mandate. Obamacare exempts persons that cannot find individual or family insurance that costs eight percent or less of the annual family income.Employer-sponsored plans must cost less than nine and six-tenths percent of family income. When there is no affordable insurance, the resident can claim an exemption from the mandate and tax penalty.
Reducing the Costs of Healthcare
Controlling costs was a primary purpose of health care reform through the Affordable Care Act. The legislative options included a single-payer system to maximize the group purchasing of a national purchasing group. They included using a government entity to administer services directly or through contractors such as in the Original Medicare.
The least cost effective method involved private insurance. The Affordable Care Act sought to improve competition and increase the number of medical care insurers.
Medicaid and the CHIP
In the current law, Medicaid accepts many people that cannot afford to pay for insurance or healthcare. The Children’s Health Insurance Program protects infants, children and young adolescents up to age 18.
When costs prohibit getting regular medical care, the state and federal governments provide a low or no cost alternative to those that qualify by annual income and need. These need-based programs do not have a limited enrollment period, and residents can enter at any time of the year.
Why Everyone Needs Healthcare
Data from every part of the scientific and medical communities supports the conclusion that persons with regular medical care live longer and live healthier lives.
The health and longevity arguments are not the primary cause of the Affordable Care Act; the primary driver was the uncontrolled rise in national health care costs in the decade before passage.
The data supports the conclusion that nearly every person will encumber a substantial amount of medical expenses during life and in the final illness or event.
Those without resources to pay the average medical costs will leave that burden to the general public; or worse to the private providers that suffered economic losses due to unpaid bills.
Why Everyone Needs Adequate Healthcare Insurance
Having healthcare coverage is not by itself sufficient under the Affordable Care Act. The law requires qualified health plans.
Qualified plans have prevention services at no extra cost, and these valuable services may help healthy young persons stay that way for a much longer time than if they did not use these services including screenings and vaccinations.
- Essential health benefits
- Minimum essential coverage
- Minimum actuarial value of 60 percent
Going without Healthcare
The decision to forego healthcare and insurance coverage is a risky position. In the US today, medical expenses are steep and small hospital stays can cost tens of thousands of dollars.
The principle of national health insurance is to reduce the amounts of unnecessary disease and illness and to avoid unpaid medical expenses that can cripple medical institutions.
Going without healthcare can increase the likelihood of an unnecessary illness and economic devastation from medical costs. Residents that opt to go without healthcare have essentially decided to force the public to bear the costs of their medical expenses and lifetime of care up to and including the final illness.
While it is an easy or pleasing choice for an individual, it does not balance well with civic responsibilities and parenting. In the question of healthcare, convenience is rarely the best policy for an individual or nation.
People can opt out of healthcare and pay the penalty. That solves the issue of the mandate but does not provide needed coverage.
Residents that Do Not Want Healthcare
Those that refuse to get health care can do so. They can accept the risks of a shortened life span and human suffering that comes from untreated illness or undiagnosed diseases.
People who willingly go uninsured can choose to pay the tax penalty or get an exemption from the individual mandate. They can do without the assistance that could help reduce the risks of disease such as smoking cessation, mental health screenings, and drug and alcohol abuse treatment.
The unfortunate side-effect of going without healthcare and insurance is that the costs of treating these individuals will fall upon the public or become part of the large volume of unpaid medical expenses.
Policy Against Denying Healthcare
Currently, there is no device for avoiding the medical services that a resident might need whether there is insurance or not. The policy of the United States contained in the Affordable Care Act does not permit leaving sick people to suffer because they cannot pay medical costs.
The insurance industry approach that Obamacare replaced did permit individuals to go without medical care if they could not afford to pay.
Comparison shopping is the proven method for finding the best values in Obamacare health insurance. Comparison shopping goes beyond premiums to reveal the short and long-term costs of health insurance and medical care.
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