What health plan (HMO, PPO, EPO, POS, or High Deductible Health Plan) do you think is the best? Why?
When choosing a health insurance plan, there are many types of plans to choose from. Some of these plans include “Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Points of Service (POS), and Exclusive Provider Organization (EPO) (Barghelame, 2019). It is vital to understand the difference between these insurance plans as it can help one choose the right plan. With an HMO, an individual or a company has the freedom to choose a primary care physician (PCP) of their choice (Barghelame, 2019). The PCP coordinates care through in-network doctors and health care facilities. With PPO, individuals and companies can receive care from any provider without a referral. EPO combines flexibility and cost savings. In this case, individuals or companies ought to choose in-network providers. A POS plan combines elements of an HMO and a PPO.
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I think the POS plan is the best. The plan combines elements of an HMO and a PPO. The POS plan lets one have a PCP and also receive medical care from both in-network and out-of-network providers. The other benefit of the POS plan is that the doctor's staff coordinates visits and handles medical records. Therefore, there is less work on the clients' end.
Should public insurance plans have more ability to negotiate discounts? Should Medicaid be expanded?
Generally, public insurance plans cover a broad range of services. The plans usually pay an individual or a company's health care provider for a portion of the individual's or company's medical bills. Public insurance plans ought to have more ability to negotiate discounts. Generally, this would give individuals or companies to pay a monthly fee to get discounts on specific services or products from health care providers.
Traditional Medicaid eligibility varies by state but is typically limited to seniors, disabled people, and children from low-income families. The Affordable Care Act (ACA), also known as Obamacare, allows states in the United States to expand the eligibility of Medicaid to include people with mental illness without access to affordable health insurance and to uninsured children whose incomes are at or below 138 percent of the federal poverty level (FPL) (Milne, Chang, & Mollica, 2004). States should be encouraged to expand Medicaid programs in order to benefit low-income adults, hospital, and local economies. Medicaid expansion will provide greater access to health coverage, save states money, reduce uncompensated care, promote economic growth and job creation, and allows for state flexibility (Milne, Chang, & Mollica, 2004).
What do you think of the Affordable Care Act (Obamacare)? What are its strengths and weaknesses?
The ACA aimed to provide affordable health insurance coverage for all people in the United States (Komiski, Nonzee, & Sorensen, 2018). Insurance companies tend to use many tactics to drive up patients' costs or restrict care. Thus, the ACA was also designed to protect consumers from this. Despite the positive outcomes, Obamacare has been highly controversial. The ACA provided more health coverage to Americans. Millions of Americans have obtained health insurance coverage within the first five years of the ACA (Komiski, Nonzee, & Sorensen, 2018). The ACA also provides affordable health insurance as it requires insurance companies to spend at least 80% of insurance premiums on medical care and improvements (Komiski, Nonzee, & Sorensen, 2018). Under the ACA, individuals with pre-existing health conditions such as cancer can no longer be denied coverage. However, the ACA also has its own weaknesses. First, the ACA has caused premiums to rise for those who already had health insurance. Secondly, under the ACA, taxes are going up. New taxes were passed to help pay for the ACA.
What changes, if any, do you think should be made to the U.S. health care financing system? Consider the options below and feel free to add your own suggestions.
Many of you have argued that health care is too expensive. There are several ways to lower the costs of health care used by other countries:
Require health insurance companies to transition to not-for-profits. This lowers costs by limiting profits for health care companies.
Allow public programs like Medicare and Medicaid to negotiate cost savings with providers.
Move to a single-payer system with the government as a single-payer and allow the government to negotiate lower prices or set prices for health care.
When compared to other developed countries across the globe, the U.S. currently ranks highest in healthcare spending, yet life expectancy is shorter, and it does fare better. For this reason, there is a need to reform the health care system of the United States. In order to lower the costs of health care, the U.S should move to a single-payer system with the government as the single-payer and allow the government to negotiate lower process or set prices for health care. This system will address several problems with the U.S. system. First, it will provide universal health coverage to Americans. This would be a major step towards equality. This is because, under this system, both uninsured and underinsured Americans will have access to health care services. Under the single-payer system, overall expenses and wasteful spending could be better controlled. This system also has more incentive to direct health care spending toward public health measures. However, transitioning to the single-payer system has its own trade-offs.
References
Barghelame, K. (2019). What’s the difference between a PPO, HMO, EPO, and POS? [Online]. Retrieved from: https://gusto.com/blog/health-insurance/ppo-hmo-epo-pos . Accessed October 6, 2019.
Kominski, G., Nonzee, N., & Sorensen, A. (2018). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health. Vol. 38 : 489-505.
Milne, D., Chang, D., & Mollica, R. (2004). State perspectives on Medicaid long-term care: Report from a July 2003 state forum. Portland, ME. National Academy for State Health Policy.
