The American Problem: Health Insurance

1
The American Problem Health Insurance

• Jennifer Bernstein
• Michael Berry
• Tom Chiang
• Ryan Lubitz
• Leanne Lundby

2
History The roots of American Health Care

• Problems beginning in the early 1900s
• The Great Competition among firms
• The System of Reimbursement and high Health care
  expenditures
• No Federal or State Law regulations
• all leading to the biggest problem of all

3
History The development of current Health Care
practices

• Social Security Act, 1938
• Coverage of hospitalization and serious illness
  (1940s-1950s)
• 3 Major movements
• Higher wages and better benefits offered by
  employers (1945-1969)
• Passage of government funded Health care programs
  (1960-1970s)
• Employee Retirement and Income Security Act
  (ERISA)
• Movement to control costs
• Hospitals and State government administer funds
• Laws of 1980s-1990s

4
Types of Health Care Coverage

• Employer sponsored
• Preferred Provider Organization (PPO)
• Health Maintenance Organization (HMO)
• Government sponsored
• Medicare
• Medicaid

5
The Main Players

• The Employers
• The Health Care Providers and Professionals
• The Government

6
The Issues

• Increase in Premiums
• Federal Health Benefits Program
• 10 increase
• California Public Employees Retirement System
• 25 increase
• Approximately 6 in every 10 employees are
  currently covered by Health care benefits
  provided by their employer

7
Factors associated with coverage

• Industry type
• Public v. Private
• 25 of workforce is in the Private sector
• 87 of the private sector employees are covered
  by their employer
• Small business v. Large Business
• Small (under 100 employees)
• 71 are covered by their employer
• Large (over 100 employees)
• 82 are covered by employer

8
more factors

• Union v. Non-Union
• 92 of Union workers are covered by their
  employer
• 75 of Non-union workers are covered by their
  employer
• Contingent and Part time employees
• 17 of the workforce are part time
• Only 16 of part time employees are covered by
  their employer
• Dependents
• Includes spouse, children, parents and others

9
Current Problems

• Rising Costs - wages decreasing, prices for good,
  services, taxes increasing
• Quality No accountability
• Logic - Reactive vs. Proactive
• Complicated hard to find appropriate policy for
  company employees
• Lots of limitations and exclusions lead to
  abusive practices
• Security 2 million Americans lose their health
  insurance every month

10
Clinton Health Security Plan

• guaranteed comprehensive health benefits for all
  American citizens and legal residents, regardless
  of health or employment status. Health coverage
  is seamless it continues with no lifetime limits
  and without interruption if Americans lose or
  change jobs, move from one area of the country to
  another, become ill or confront a family crisis.
  

11
Clintons Principles to Address Current Problems

• Control rising costs
• Improve Quality
• More Choices for consumers
• Simplified system
• Make everyone responsible

12
LOSER Why it Failed

• Most everyone was in support of universal health
  reform BUT,
• Bipartisan Congress
• Didnt agree on the approach the plan was taking
• Too many groups with different interests involved
• Lobbyists

13
Possible solutionsWhat the Individual can do

• Be proactive!
• Take responsibility for your own Health, try to
  solve the problem before it occurs and becomes
  more serious
• If your employer does not provide coverage, seek
  out Union coverage
• Support government and other officials who are
  proactive in helping to solve Americas Health
  care problems

14
Possible solutionsWhat the Employer can do

• Defined Contribution Plan
• Set allowance for employees health care benefits
• Can choose amongst various plans with different
  levels of coverage and price
• Supporters Forces employees to educate
  themselves to make smart decisions
• Critics employees lose the abilities and
  purchasing powers their employers do for them on
  their behalf
• Cooperative agreement to form a Unified coverage
  plan

15
Possible solutionsWhat the Government can do

• Focus on the declining quality of Health care
  coverage
• Maybe focus on the your own country instead of
  Iraq for a second
• Reform current laws to be more lenient on
  employers
• Defined Contribution Plan
• Federal Patients Bill of Rights
• Refund more money to individuals so the ability
  of people in lower income brackets to purchase
  insurance increases

16
Case Study on Children and Health Insurance

• Case study created to see how to affect number of
  children without health insurance
• 4 states involved, California, New Mexico,
  Georgia, and Ohio
• Govt money provided CHIP (Childrens Health
  Insurance Program) passed by Congress

17
Case study cont.d

• Basis of case was built to see how many children
  in the four states could be provided insurance
• Major difficulties due to
• Outreach programs
• Eligibility and Enrollment strategies
• Implementation Issues
• Numerous problems within states

18
Conclusions to Case Study

• Difficult to build new infrastructure
• Each state must use own system to build in order
  to have statewide benefits, and local ones
• Health care coverage still a major issue for
  U.S., funding, eligibility, and implementation
  all problems

19
In conclusion

• No matter what choices are made and reforms
  occur, there is no way to satisfy all parties in
  the Health care battle, thus Health care coverage
  will remain an ongoing game between the
  employers, government and providers for many
  years to come

20
Questions CommentsWhat do you think??

• How many of you are actually covered under your
  own Health care plan? (not a dependent)
• Do you think Health care coverage is an important
  part when considering taking a new job? (since we
  are all in this predicament right now)
• What role do you think the government should play
  regarding this issue?