Income inequality in the United States may be a hot topic right now, but healthcare inequality is even more pervasive. Recent studies, including the 2010 National Healthcare Disparities Report conducted by the Department of Health and Human Services, have shown that the disparities in health coverage are increasing across the country. On one hand, there are people who have good health coverage and ready access to care. On the other, there is a large and growing segment of the population that has no or little health care coverage and very limited access to care. These differences often break down across age, gender, socioeconomic, racial and ethnic lines.
photo credit: Robert Couse-Baker
By far the biggest segments of the population which lack coverage or access to healthcare, are the poor and the working class. The poor receive worse care than the middle class or high-income earners on 80 percent of the most measured indicators. Most lower-income workers hold down jobs where health insurance is either unavailable or unaffordable, and Medicaid for adults is limited to the disabled and pregnant women. Even when a low-income person has health insurance, he or she may not have access to care because most low-income communities are critically under-served by healthcare providers. This is true of both urban and rural communities. A young mother living in the inner city of an east coast metropolis and a rural Midwest farmhand are equally likely to lack adequate health care.
Race and Ethnicity
Race and ethnicity also play a major role in healthcare inequality, with about 30 percent of Hispanic patients and 20 percent of African-American patients lacking access to routine health care, as compared to 16 percent of white patients. African-Americans also have much higher incidences of preventable diseases such as heart disease and diabetes, and much higher rates of death from cancer. Minority children are also much more likely to die of SIDS or preventable diseases or conditions than their white peers.
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Children are by far the best covered age group in the population. Every state now has a children’s health insurance program for the children of poor and working class families. Young adults are another matter, however, though the number of young adults without coverage is starting to decline now that many parents can keep their grown children on their own policy through the age of 27. Seniors, despite being eligible for Medicare, also tend to have limited access to care. Medicare’s restrictions on benefits and co-payments force many to delay or forgo care.
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Women are more likely to have adequate coverage than men. Nationwide, only about three-fourths of adult men have coverage. That figure is nearly 90 percent for women. Minority women lag behind white women and are also more likely to die of breast cancer and similar diseases.
Overall, the disparities in health coverage in the United States seem to be increasing, mostly as a result of the economic downturn. Many of those who are currently unemployed and uninsured are expected to be covered again as soon as they find a job. There are signs of hope even for the chronically under-served and uncovered, as communities are stepping up efforts to provide health care in low-income areas and to educate the public about preventable diseases and the management of conditions such as diabetes and heart disease.
Healthy People 2010: National Health Promotion and Disease Prevention Objectives, Department of Health and Human Services
Goldberg, J., Hayes, W., and Huntley, J. “Understanding Health Disparities,” Health Policy Institute of Ohio
Merzel, C, Gender differences in health care access indicators in an urban, low-income community, American Journal of Public Health
Nelson, A, Unequal treatment: confronting racial and ethnic disparities in health care, Journal of the National Medical Association
With companies laying off employees or cutting wages and benefit packages, workers are finding themselves with minimal health care coverage or without any insurance at all.
Many people who are self-employed, work for small companies that do not offer benefits or want to supplement the bare-minimum coverage they have are buying private health insurance.
There are several factors to consider before actually purchasing health insurance. Doing your homework first will save you from purchasing a policy that does not meet your health needs.
Shop Around For Insurance
Doing comparative shopping for private health insurance is no different than shopping around for big ticket items for your home. Start your search by checking with different insurance companies in your area—from larger, more well-known insurers, like Blue Cross Blue Shield, to smaller, local insurers. Because the costs for a health policy varies depending on the company, review both long-term and short-term plans each insurer has to offer.
Compare the benefits available as well as how much consumers are expected to pay for prescriptions, visits to the doctor’s office and the emergency room, screenings, x-rays, and tests. If you have young children, be sure to consider the cost for covering dependents. The Children’s Defense Fund said in its 2011 State of America’s Children report that 8 million children, or one out of 10 children, are uninsured.
When researching plans, also check to see how each insurer handles pre-existing conditions, such as cancer, diabetes, hypertension or heart disease. If you have an ongoing health issue, you can expect to pay a higher premium than those who do not have pre-existing conditions. In some cases, insurance companies deny coverage because of these conditions. Starting in 2014, the Affordable Care Act will require insurance companies to offer coverage to people regardless of whether they have a pre-existing condition. If you smoke or are overweight, the company may require you to have a medical examination before approving you for a policy.
Determine What You Can Afford
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Once you have narrowed down the policies that you prefer, check your household budget to see which one is the most affordable. Consider raising your deductible to help lower your premium costs. You may want to factor in coverage for dental and vision. Usually, these are additional costs, but worth considering nonetheless.
If you have access to a computer, you can get a live health insurance quote in a matter of minutes by inputting your personal information.
Call Before You Buy
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If you have questions after reading the plans, call the insurance company and talk to a customer service representative. If at all possible, set up an appointment so that you can meet in person to ask your questions. It’s best to have all of the facts about coverage and annual premium costs before buying private health insurance.
New health care legislation will begin taking effect between 2013 and 2014. The most important change takes place in 2014; starting that year, all American citizens are required to carry health insurance. This means that if you don’t purchase some type of health insurance by 2014, you’ll have to pay tax penalties. The penalty will be the greater of $695 per uninsured person in your family or 2.5 percent of your income. If your religion is opposed to purchasing health insurance, you’re a Native American tribe member, you’re not in this country legally or you’re in prison, this rule doesn’t apply to you.
If you have insurance through your employer, you don’t have to worry; your work-sponsored insurance meets all the requirements for mandatory health insurance coverage. The U.S. government may subsidize your health insurance if you make less than a certain amount of money. If you make less than 400 percent of the federal poverty guidelines in 2014, you’ll be able to shop for subsidized health care. The less money you make, the more of your health care coverage will be subsidized. Families who make the least amount of money will be eligible for fully subsidized health care. Subsidized health care will be sold through health exchanges at each state — customers will be able to choose between several low-cost health insurance options.
Money For Health Care Exchange
The federal government plans to provide money to each state to start up a health care exchange system, or a cooperative so that health care will be cheaper for eligible customers to buy. And if this health care is subsidized, it has to be subsidized by the government. Both of these facts add up to one thing: tax dollars are going to be used to pay for health care for some members of the population. Thus, taxes may go up to help support this program. In addition, people who are already receiving health care from their employer should be aware that they aren’t eligible for the subsidized program, so they may have less choices when it comes to their health insurance than self-employed and unemployed people.
The good news, however, is that once mandatory insurance laws kick in in 2014, insurance companies will no longer be able to deny customers insurance because they have pre-existing conditions, so everybody will have equal access to health insurance, regardless of their medical history.
The majority of seniors are using the wrong drug plan, partly due to the face that Medicare has a mindboggling assortment of plans and changes constantly from one year to the next. That is the conclusion drawn by a recent study of 22,000 beneficiaries of Medicare that supplied their medication and plan information during Medicare annual enrollment last year.
Among those participating in the survey, many were Florida seniors, of which ninety-four percent could have saved a great deal of money if they switched their Medicare plans.
Medicare beneficiaries in Florida have had a somewhat difficult time selecting a plan that is best for them, especially in comparison to their peers throughout the country. Across the nation, ninety percent of beneficiaries with Medicare would have been better off has they switched to a different plan.
This year, seniors will not have the same amount of time to choose the plan that best fits their needs. The enrollment period has been pushed up to October 15 by the federal government, and it will only last through December 7. In previous years, seniors were given until the end of the year to make up their mind about the Medicare plan that they chose.
Ross Blair is the president and CEO of PlanPrescriber, which is an organization that focuses on matching senior citizens with the medical and drug plans that are best for them. He said, “There is a belief among some seniors that ‘Hey, this is all Medicare. It doesn’t make much difference which plan I sign up for.’ ”
However, research by PlanPrescriber discovered that the average beneficiary of Medicare could save close to $550 simply by selecting a plan that has the lowest out-of-pocket costs for his or her medication requirements.
Beginning This month, Medicare will begin using predictive software that will allow the flagging of claims that appear to be suspicious prior to payment. This action is an effort to prevent fraud, rather than trying to track it down later.
Although it seems like a no-brainer, this anti-fraud strategy by Medicare previously consisted of a pay-and-chase technique, which is just as useless as it sounds.
According to a 2009 report by Lewin Group, the new approach is described as a preliminary level of modest screens, then an analytical model “that identifies improper payments, fraud and abuse by ’scoring ‘ the claim, based on its characteristics.”
Douglas Grimm, a healthcare attorney with Pillsbury Winthrop Shaw of Washington, D.C., says the Health Blog payers are able to customize the filters in the software so various types of service, geographic areas, equipment and facilities can be flagged. For instance, in Florida, the software can be set up to target the widespread frauds related to durable medical equipment.
How Will It Find Suspicious Claims
The report by the Lewin Group notes some things such as performance of uncommon procedures within a specific specialty, as well as records indicating that a provider is making a high number of claims for the same treatment on the same day should raise a flag.
According to the UnitedHealth Group, it has saved close to $125 million in just two years since it began using predictive modeling.
Although Grimm says, “pay and then verify later is not working,” he intends to see if any false positives are brought up by the system, which will lead to the delay of legitimate claims that are filed. He says, “Providers need to be sure their systems are in place to bill Medicare correctly.”
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