scholarly journals Health Reform: What's Insurance Got to Do with It? Recognizing Health Insurance as a Separate Species of Insurance

2010 ◽  
Vol 36 (2-3) ◽  
pp. 436-451 ◽  
Author(s):  
Wendy K. Mariner
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Access To Health Care ◽  
The United States ◽  
Separate Species ◽  
Insurance Law ◽  
Insurance Reform ◽  
Patient Protection ◽  
Health Insurance Reform ◽  
Actuarial Fairness

Health reform debates in the United States are typically conducted using the language of insurance. President Barack Obama described his hopes for expanding access to care as “health insurance reform.” Both proponents and opponents of reform debated the merits of reform proposals leading to the Patient Protection and Affordable Care Act of 2010 in insurance terms. Yet, disagreements over the structure of reform reveal deep differences in what proponents and opponents of reform mean by insurance and the role it should play in mediating access to health care. Scholars of insurance law are likely to describe insurance somewhat narrowly as a risk spreading device. Industry representatives, among others, often view conventional indemnity insurance as the norm. From this perspective, reforms that move too far beyond underwriting risks can be seen as undermining actuarial fairness, threatening the very idea of insurance and possibly the industry itself.

scholarly journals Gender-Affirming Health Insurance Reform in the United States

2020 ◽  
Vol 8 (9S) ◽  
pp. 45-45
Author(s):  
Ledibabari M. Ngaage ◽  
Shan Xue ◽  
Mimi R. Borrelli ◽  
Bauback Safa ◽  
Jens U. Berli ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
The United States ◽  
Insurance Reform ◽  
Health Insurance Reform

scholarly journals Oil and Water: Mixing Individual Mandates, Fragmented Markets, and Health Reform

2010 ◽  
Vol 36 (1) ◽  
pp. 7-78 ◽  
Author(s):  
Allison K. Hoffman
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Health Reform ◽  
Care Delivery ◽  
Market Competition ◽  
Insurance Market ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Individual Mandate ◽  
Policy Objectives

AbstractThe 2010 federal health insurance reform act includes an individual mandate that will require Americans to carry health insurance. This article argues that even if the mandate were to catalyze universal health insurance coverage, it will fall short on some of the policy objectives many hope to achieve through a mandate if implemented in a fragmented insurance market. To uncover this problem, this article sets forth a novel framework that disentangles three different policy objectives the individual mandate can serve. Namely, supporters of the mandate might hope for it to: (1) facilitate greater health and financial security for the uninsured (“paternalism”); (2) eliminate inefficiencies in health care delivery and financing (“efficiency”); and/or (3) require the healthy to buy insurance to help fund medical care for the sick (“health redistribution”). Health redistribution — the primary focus of this article — is a shifting of wealth from the healthy to the sick through the mechanism of risk pooling. Many see health redistribution as a means to enable all Americans to more equitably access medical care on the basis of need, rather than on the basis of ability or willingness to pay.Drawing on evidence from the implementation of an individual mandate in Massachusetts's health reform in 2006, this article reveals that the fragmented American health insurance market will thwart the mandate's ability to achieve these objectives— in particular the goal of health redistribution. Fragmentation is an atomization of the insurance market into numerous risk pools that has been driven by market competition and regulation. It prevents Americans from sharing broadly in the risk of poor health and, in doing so, entrenches a system where access to medical care remains tied to ability to pay and individualized characteristics. The final section of this article examines how various policies, including some in the new law (e.g., insurance regulation and exchanges) and others not (e.g., expanded public insurance), can reduce fragmentation so that the mandate can successfully serve all desired objectives and in the process gain greater legitimacy over time.

Gender-Affirming Health Insurance Reform in the United States

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ledibabari Mildred Ngaage ◽  
Shan Xue ◽  
Mimi R. Borrelli ◽  
Bauback Safa ◽  
Jens U. Berli ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
The United States ◽  
Insurance Reform ◽  
Health Insurance Reform

Protect the Sick: Health Insurance Reform in One Easy Lesson

2008 ◽  
Vol 36 (4) ◽  
pp. 652-659 ◽  
Author(s):  
Deborah Stone
Keyword(s):  
Health Insurance ◽  
Medical Care ◽  
Low Income ◽  
The Elderly ◽  
The United States ◽  
Government Programs ◽  
Insurance Reform ◽  
Sick People ◽  
Health Insurance Reform ◽  
Inducing Factors

In most other nations, insurance for medical care is called sickness insurance, and it covers sick people. In the United States, we have “health insurance,” and its major carriers — commercial insurers, large employers, and increasingly government programs — strive to avoid sick people and cover only the healthy. This perverse logic at the heart of the American health insurance system is the key to reform debates.Focusing on sick people versus healthy people might seem a strange way to view the coverage issue. Most discussions of insurance categorize people into other groupings: the insured versus the uninsured; Caucasian whites versus other racial and ethnic groups; men versus women; poor and low-income people versus everybody else; children, adults, and the elderly; or citizens versus immigrants and undocumented aliens. More recently, health researchers have begun talking about “vulnerable populations,” using most of the same demographic groupings and adding other illness-inducing factors such as social isolation, stress, and impoverished neighborhoods. But as I will show, insurance plans now use premiums, cost-sharing, and other design features in ways that indirectly divide each of these groups into the sick and the healthy, to the detriment of the sick. By shifting the costs of illness onto people who use medical care — that is, sick people — market-oriented reforms of the last few decades have eroded insurance in the name of strengthening it.

scholarly journals Benefit of China’s Social Health Insurance Schemes: Trend Analysis and Associated Factors Since Health Reform

2021 ◽  
Vol 18 (11) ◽  
pp. 5672
Author(s):  
Wanyue Dong ◽  
Anthony B. Zwi ◽  
Ruhai Bai ◽  
Chi Shen ◽  
Jianmin Gao
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Inpatient Service ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Basic Medical Insurance ◽  
Basic Medical

With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal–Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.

Health Care and the Labor Market

ILR Review ◽  
1994 ◽  
Vol 48 (1) ◽  
pp. 65-67
Author(s):  
Maria Hanratty ◽  
Olivia S. Mitchell
Keyword(s):  
Health Care ◽  
Labor Market ◽  
Health Insurance ◽  
Planning Process ◽  
The United States ◽  
Health Care Insurance ◽  
Current Interest ◽  
Insurance Reform ◽  
Health Insurance Reform ◽  
Provide Health Care

Health insurance and the labor market are inextricably entwined in the United States. Yet, few studies to date have examined the uniquely American links between employees' demand for and employers' ability to provide health care insurance. This topic is of substantial current interest because employer-provided health insurance plays a central role in the national health insurance reform planning process.

scholarly journals Health Reform and the Constitutionality of the Individual Mandate

2011 ◽  
Vol 12 (4) ◽  
pp. 236-244 ◽  
Author(s):  
Jeffrey J. Lee ◽  
Deena Kelly ◽  
Matthew D. McHugh
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Critical Issue ◽  
Economic Effects ◽  
Patient Protection ◽  
Individual Mandate ◽  
The Individual

The Patient Protection and Affordable Care Act (ACA) of 2010 is landmark legislation designed to expand access to health care for virtually all legal U.S. residents. A vital but controversial provision of the ACA requires individuals to maintain health insurance coverage or face a tax penalty—the individual mandate. We examine the constitutionality of the individual mandate by analyzing relevant court decisions. A critical issue has been defining the “activities” Congress is authorized to regulate. Some judges determined that the mandate was constitutional because the decision to go without health insurance, that is, to self-insure, is an activity with substantial economic effects within the overall scheme of the ACA. Opponents suggest that Congress overstepped its authority by regulating “inactivity,” that is, compelling people to purchase insurance when they otherwise would not. The U.S. Supreme Court is set to review the issues and the final ruling will shape the effectiveness of health reform.

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