HLTH 385 Lecture Notes - Lecture 7: Patient Protection And Affordable Care Act, Health Insurance Mandate
Uninsured in America
• The uninsured in America began to drop significantly around 2010 and around the
time when the Affordable Care Act was passed
• Unless covered by Medicare and Medicaid, you fall into one of three categories:
employer, individual, or coinsured
• People who are uninsured still use medical care- paid or our of pocket or its free
care
• Uninsured are at risk of out of pocket high healthcare spending
• Insurance provides risk protection ^^^^
• Uninsured is both a symptom and a cause of inefficient system
• Sick=uninsurable
o Sick to the point where you can't work, eventually employer will drop you
from insurance plan
• Health insurance is unique from other kinds of insurance because you can really
estimate how much you're going to spend
o The accident, "getting sick", you can buy health insurance as soon as you get
sick - before ACA individual insurance plans had preexisting health clause
(they wouldn't pick you up or you'd have to pay more if you were critically ill)
• Why don't health insurance contracts last for 10 years?
• ACA Goals: improve function of market and cover the uninsured
• ACA Employer mandate: firms with 50+ employees have to provide insurance to
employees or they have to pay a tax
• Pre existing condition requirement
o w/ risk rating rules- insurers have to set your premium without regard to how
sick you are
• Can't rate on gender, how sick you are, they can rate based on age (to a
certain extent)
• Can't increase premiums for people who are really sick or reduce
premiums for people who are really healthy
• For individual market
o Individual mandate- individuals are required to have healthcare coverage, if
not, you have to pay a higher tax
o Giving people Subsidies (based on income level)- government help
o Pre existing condition requirement w/ risk rating rules
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