An Innovative Approach to America’s Health-Care Crisis
Addressing the Health-Care Crisis: A unique approach to tackle the extensive population lacking health insurance coverage while maintaining the privacy of the healthcare industry.
A major concern in the nation revolves around the absence of health insurance for approximately 41 million individuals.
Health-Care
Despite the majority of elderly Americans being covered by Medicare and around two-thirds of non-elderly Americans benefiting from employer-sponsored plans, a considerable number of workers and their families still lack insurance. This is either because their companies don’t offer coverage or they cannot afford it. Programs like Medicaid and the State Children’s Health Insurance Program (SCHIP), known as HAWK-I in Iowa, play a crucial role in assisting low-income children and some parents in bridging these gaps.
The absence of health insurance coverage for nearly 41 million people stands as one of the country’s most significant issues.
Medicaid, the State Children’s Health Insurance Program (SCHIP), and HAWK-I in Iowa play a crucial role in assisting low-income children and some parents in filling the gaps of health coverage.
Various proposals from politicians on both sides of the aisle have been suggested to address the healthcare crisis, ranging from socializing healthcare akin to the Canadian system to endorsing health savings accounts and addressing frivolous lawsuits against the medical community.
While these proposals have positive aspects, they also come with significant downsides. For instance, a socialized national healthcare program would eliminate the need for health insurance, with costs covered by taxes—an idea that may seem reasonable in theory.
However, potential drawbacks include a shortage of new doctors entering the field due to anticipated reductions in compensation, coupled with increased demand resulting from the lack of personal responsibility. If individuals didn’t have to worry about deductibles or copays, which would typically deter them from seeking medical treatment for minor ailments, they might seek medical attention more frequently, contributing to the healthcare crisis.
Consequently, we are witnessing prolonged queues for patients with severe health issues as everyone schedules appointments, yet we are losing professionals due to a lack of incentive.
The current focus of the Bush administration is on advocating for Health Savings Accounts (HSAs). HSAs combine a low-cost, high-deductible health insurance plan with a tax-deferred savings account, generating a small interest on the side that you contribute to alongside your monthly premiums.
Withdrawals from the savings account for qualified medical expenses are tax-free. Unlike a flex spending account in employer-based plans, any unused money in the savings account isn’t lost. If you never utilize the funds, you can withdraw or roll them over for retirement after reaching the age of 62 1/2.
While this may be a viable option for some, others find the premiums still too high. The challenge persists that major treatments in the initial policy years may deplete the savings account, leaving individuals responsible for a substantial portion of the costs.
Now, let’s address a critical issue from the perspective of a health insurance agent—the difficulty individuals with pre-existing health conditions face in obtaining coverage.
Approximately half of the clients seeking health insurance have a condition leading to a carrier’s denial or an amendment rider excluding coverage for related claims. Hypertension is a common example.
Even with other factors present, this condition may result in an outright application rejection or, more commonly, an amendment exclusion rider. While some might think this isn’t a major concern, such a rider excludes anything related to the illness, including heart attacks, strokes, and aneurysms, incurring substantial out-of-pocket expenses.
For instance, if an individual recently underwent double bypass surgery with a bill of $150,000, and without a hypertension rider, they would have to cover the entire amount and additional costs during recovery, potentially leading to financial distress, especially on a lower income.
How can we tackle this issue? The proposed solutions have been fraught with challenges from the outset. Even if one of these approaches garners widespread public support, the likelihood of it becoming law is slim due to political discord. One side advocates for maintaining privatized healthcare, while the other pushes for socialization, each with its own set of pros and cons.
It might seem that we are stuck in a deadlock with no viable solutions or a way forward. Is there no hope for a resolution?
Perhaps not. Let me share a story about a client I assisted a few years ago in my office. A young woman entered seeking to compare health insurance policies for herself and her family. With several children, she relied on Title 19 Medicaid and was attending a state-funded college. Despite recently graduating and securing a position with the local school district, she was ineligible for health insurance benefits for some inexplicable reason.
Unable to afford a plan priced at $500 or $600 per month, she returned to the assistance office to explain her predicament
They eventually collaborated with us to identify a suitable private health insurance plan, and to my surprise, the government compensated her for a portion of the cost—something I hadn’t realized was possible!
Just imagine the increased accessibility to coverage if more individuals could receive a government reimbursement based on their income percentage, helping to offset premium costs.
Consider a scenario where a young married couple in their 20s with one child, having a family income of $25,000, opts for a health insurance plan with a $500 deductible and an average premium of $450.
Assuming the government offers a 50% reimbursement on the premium for a three-person family with an annual income of $25,000, the family’s total cost would be reduced to $225 per mont
This becomes a cost-effective premium for the family to consider.
This blend of private insurance and government assistance offers the best of both worlds. The inevitable question, of course, concerns the cost: how much additional burden would this impose on the American taxpayer, and would taxes need to rise significantly?
I believe the impact on taxpayers would not be substantial, and here’s why: Firstly, by reducing the number of uninsured individuals who can’t afford their medical care, we lower the overall cost of healthcare.
Secondly, the decrease in people facing bankruptcy and turning to Medicaid Title 19 for assistance due to medical expenses resulting from catastrophic health conditions without insurance coverage would be substantial.
This is crucial because, once on Medicaid, a person’s healthcare is essentially 100 percent funded by the government, eliminating the hesitancy to seek treatment for minor or non-existing ailments.
Conversely, many conditions that might have gone unnoticed before becoming severe, as individuals who didn’t seek treatment due to lack of insurance coverage would now be detected before turning into catastrophic claims.
Finally, if the government allocates a specific amount to assist in covering claims for individuals with pre-existing conditions, private insurance companies could eliminate exclusions and denials based on existing health problems.
Health-Care Insurance
Several states, including Iowa with its HIPIOWA Iowa Comprehensive Plans, have already taken steps to ensure coverage for residents who cannot find it elsewhere.
While you might consider these ideas wishful thinking and believe they will never be implemented, they are currently in practice.
The issue is that only a handful of states are involved in such programs, and many health insurance agents are unaware that certain low-income families may be eligible for premium reimbursement.
If all these services were standardized and implemented on a nationwide scale with widespread publicity, I believe the uninsured population in our country would significantly decrease.
I don’t claim to have all the answers about reimbursement amounts for different income levels, but I do believe that something is better than nothing, and this, in my opinion, is the best middle ground we could find.
The socialized component of the reimbursement would appeal to Democrats, while Republicans should appreciate that healthcare remains privatized, making this idea more likely to receive bipartisan support.
Despite my efforts to share my concept with multiple senators and congressmen, I received the same generic response about their concern for healthcare and their commitment to finding a solution, with no real engagement with my suggestions.
To bring these ideas to the public’s attention, I urge those who read this to spread the word through word of mouth, email, or by linking to this webpage from your own site.
If enough buzz is generated, these ideas can receive the attention they deserve, and if people demand a solution, politicians may be pressured to act.
The number of uninsured Americans is on the rise, and healthcare costs continue to increase. Without action now, health insurance premiums will only continue to escalate.
As a health insurance adviser, my role is to evaluate all your options and present you with the best among the available choices, even if, in many cases, it means considering the option of going without coverage.
