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Abolishing Out of Pocket Healthcare Insurance

Introduction

Out-of-pocket healthcare refers to a mode of healthcare payment that entails using one’s own money to purchase health services; there is no support from insurance companies. US healthcare is costly and complicated and is paid for through premiums. The policy brief aims to bring to the government and the associated stakeholders that paying for services by a person has led to huge numbers lacking access to healthcare. It has also led to many mortality and morbidity rates due to a lack of consistent healthcare provision. The larger population cannot cater to their health and keep waiting for the government to intervene in their health actions (Jones et al., 2019). The United States system lacks universal health coverage, thus making it difficult for those living below the poverty line to access the services. The only public programs available are Medicare and Medicaid associated and designed for the aged population, low-earning families, and people living with disabilities.

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The rest of the individuals have to ensure they have access to private planes, and even in case of emergency, the client has to cater for their expenses. The proposal has been produced to bring to action and attention that all persons have the right to access healthcare without being exposed to financial exploitation. Individual payment scheme needs integration with other public and private sector intervening. The federal government has to pay fully for health care rather than the average half paid. These actions make the United States the last in terms of healthcare.

Statement of The Issue

The main problem being addressed is the abolishment of out-of-pocket healthcare delivery in the United States. The policy explains that healthcare is only accessed by the royal class citizens who can support their healthfully. The government should take full responsibility for the overall healthcare of the population. The financial exploitation needs to be interfered with and aborted; only limited-service fees require payment. The out-of-pocket should only apply to where the medical bill and expenditures need splitting.

Background Explanation

The United States healthcare system is a combination of private and public for-profit gain and non-profit insurers together with associated healthcare benefactors. The federal government only covers the nation’s Medicare and Medicaid programs. The personal insurance model, the maximum health coverage, is offered purely by employers and employees. The private insurers set their health packages that are paid for in form of premiums. They can be paid weekly, monthly, or even annually, depending on the payer’s choice. The United States lacks universal health coverage which means health for all. Statistics show that 92% of the population poses health coverage by 2018, leaving 8% without insurance, but this has not been achieved (Dagnan, 2018). The private system has been there since the 1920s, and nothing seems to take place; it is a dormant transition. The private health care system gained support after the Second World War, and it took place after the government led to the introduction of wage and salary controls.

It also leads to the declaration of marginal benefits, including the insurance of health services. All of this was attained by 2018, whereby half of the population was under the private module (Dagnan, 2018). All the recipients were eligible for an outdated Medicare program that was a fee-for-service activity that offered hospital insurance together with medical coverage. For instance, the Medicaid package was mandatory for the low-income population, the blind, and low-income pregnant women. The rest of the pregnant women were supposed to cater for their healthcare. The healthcare sequence continues further in 2019 when the Medicaid payees enrolled in the managed care organization (MCOs).

According to the Affordable Care Act, the passage of the article was a representation of significant expansion to date of the federal government’s part in sponsoring, regulating, and controlling healthcare. The act entailed; that majority of the citizens acquire health insurance and failure to that a penalty was installed, outspreading the universal health coverage the teens by giving them a chance to use their parent’s insurance plan until 26 years. Additionally, the introduction of the health insurance marketplace places is expected to provide premium actions to low and middle-class individuals, the extension of the Medicaid allowance with the assistance of governmental subsidies.

The employers get into a contract with the private health providers and plan to administer welfare. The bosses have to ensure that their plans cover workers and those depending on them. The affordable care act introduced federal marketplace opportunities for procuring personal primary health insurance and other healthcare plans through private schemes. The out-of-pocket strategy has been linked majorly with the private sector, and it is most common in all monthly paid premiums.

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The importance of the policy brief is to give a detailed explanation and analysis of how the citizen in the United States faced challenges of health service even during the colonial period. There has been transferred to the modern way of life. These out-of-pocket actions have brought about living risky lives and dependence on individuals’ income and wealth to cater to their health. The nation needs a transition from the old ways of providing healthcare to a cost-sharing method that lessens the cost of health services. It brings a clear focus on the function of the government in allocating specific budgets to health care. For instance, the Abuja declaration came up with strategies for each country to give at least 15% of their country’s budget to healthcare. The exact sequence should apply to the United States, and this policy brief proves that more is needed and a lot to be done.

The Need for Pertinent Change

The current debate on healthcare has been based on the fact that the Affordable Care Act needs revision or it should remain unchanged. The primary law objectives were to minimize the number of those lacking insurance coverage and make healthcare affordable in line with a significant extension on care. The laws also developed the eligibility for Medicaid and the creation of new opportunities, market places that allowed citizens who lacked their bosses’ coverage to purchase policies straight from insurers. After the act’s adoption, an excellent population has been fully repaid, and the rest of the people have been given a chance to access reduced or free healthcare (Devictor & Do 2017). All these actions were marked by Medicaid extension and market tax credits. There have been struggles that the political group to repeal the laws and undertake a replacement with cognitive reforms or even change the rules to cater to other policies—they need to re-structure and revise the healthcare insurance plans.

Response and Policy Options

The Reasonable and Non-Discriminatory act (RAND) that replaced the ACA and included the set licensing terms of healthcare got established to minimize expenses. The researchers have performed a detailed analysis of the pertinent issues about the ACA and stipulated the impact of the RAND act. It included maintenance of the affordable care act without changes or further implications—the law abolishment with no replacement and fixing the principal with a single-payer system like the government. There should also ensure substituting the law with other possible measures and means to cater for coverage extension due to Medicaid and individual market insurers. The RAND has also explained the impact of holding back the affordable care act while undertaking the significant provisions that include; the modification of the credit subsidies, and conducting detailed revision of the market regulation and controls. It also entailed the canceling of the single insurance mandates and changing the Medicaid expansion.

The affordable care act got completely and instantly dismantled without being replaced. The out-of-pocket expenses for an enrolee increased and led to a rise in the status quo. The abolishment would increase the federal government deficit because of the purging of ACA’s revenue-raising plans. The replacement of ACA with a single-payer system led to the adoption of other acts that included the American Health Security Act which meant Medicare for all proposals and would replace all other insurers. The plan ensures the elimination of private sector insurance and no cost-sharing for enrollees. Some countries have already developed and achieved free expanded Medicaid. For instance, Australia and Belgium have achieved universal medication for their citizens.

The patient care act also replaced the ACA and proposed eliminating the taxes. User fees implied, loosening insurer regulations and withdrawal of affordable care act for personal and employer obligations (Nexon, 2020). It allowed the age plan to set the definition of their health benefits at a higher rate than the ACA reforms. It also allowed the insurers to set affordable premium prices for those allowing their coverage to delay. The amendment also allowed additional financing for countries to get waivers as a form of support to high-risk and cost enrolees to get coverage in the private market.

The premium tax insurance needs revision that entails the enrolees contributing to their premiums depending on the income levels. It also leads to the Implementation of changes likely to reduce the financial exploitation from payers, bearing in mind subsidizing out-of-pocket insurance. There is also a needs the replacement the premiums and healthcare act with consistent and workable coverage provisions. When the citizen re-enters the market, the insurers are likely to raise their prices and be reluctant to cover particular health conditions or even deny coverage for any service. The continuous range ensures that individuals stay enrolled, and in case of any health condition, the insurers have the role and mandate to take part. The urge is for citizens to ensure their enrolment in continuous health coverage since it minimizes the out-of-pocket insurance means that are incredibly high.

Recommendations

The government has a crucial role in ensuring that regulatory measures and controls limit financial exploitation. Laws need revision and the involvement of different stakeholders who have a suggestion and critical points. The states should also abolish private insurers who do not adhere to the rules and regulations of health actions. It has to set limits and ensure some services like maternal healthcare are offered free to all women regardless of their income. The national insurance companies have to exercise uniformity of services and promote continuous coverage to individuals. The companies need integration with specific healthcare institutions that offer expert services and liaise on how they pay. The need for integration allows different citizens to access coverage anywhere as per their own choice.

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Government agencies need to implement specific strategies that do not expose citizens to financial hardship. They have to come up with a method to minimize pocket healthcare. There is a need for partnership with other countries and benchmarking with them to gauge their level of service delivery. These activities provide room for understanding what needs to be updated and improved. It also helps identify the strengths and weaknesses of their insurance system and its purpose to better them.

Health system leaders need to educate the user on the importance of continuous coverage. It helps serve as a stepping stone for decisions once health has been affected. Some examples of countries with good insurance to be emulated include Sweden and Switzerland. They have a well-stipulated health coverage plan that serves all the population. The manager should entice people to use the legalized insurance platforms set by the country.

Nursing organizations need to come up with specific criteria to cater to all. They should organize insurance plans and request overall government intervention to ensure that out-of-pocket is eliminated. The user fees should not exceed the maximum, and it has to follow the set formalities. The nursing association has to structure a well-defined and legalized insurance plan to suppress the individual payment format. It has petitioned for the changes and adoption of a new strategy that aligns with the modern way of life. The nursing stakeholders and sponsors should jointly work together to reduce the financial burden associated with healthcare (Chhugani, 2017). Healthcare is expensive, and it is a requirement that all the engaged stakeholders have a chance to exercise their duty and support healthcare where necessary. The out-of-pocket format needs revising and even abolishment if it exploits the citizens.

References

Chhugani, M. (2017). Breastfeeding- Let’s do it together! COJ Nursing & Healthcare, 1(1). Web.

Dagnan, S. (2018). Health system reforms to accelerate universal health coverage in Côte d’Ivoire. Health Systems & Reform, 4(2), 69-71. Web.

Devictor, X., & Do, Q. (2017). How many years have refugees been in exile? Population and Development Review, 43(2), 355-369. Web.

Jones, R., Haardörfer, R., Ramakrishnan, U., Yount, K., Miedema, S., & Girard, A. (2019). Women’s empowerment and child nutrition: The role of intrinsic agency. SSM – Population Health, 9, 100475. Web.

Nexon, D. (2020). Employer-sponsored insurance under the ACA. Health Affairs, 39(5), 908-908. Web.

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