Healthcare Technology Featured Article

May 17, 2011

Universal Healthcare - Healthcare for All

Healthcare is a government-sponsored system that ensures healthcare coverage for all citizens of a nation, regardless of income level and employment status.

Some form of healthcare for all has been discussed and debated in the U.S. for nearly a century. The country came close several times, but it wasn't until March 21, 2010, when the U.S. House of Representatives passed legislation for healthcare reform, 219 to 212 (not one Republican voted "aye") did universal healthcare finally become a reality.

The recently enacted legislation, the Patient Protection and Affordable Care Act (PPACA, Pub. L. No. 111-148, (as amended by the Healthcare and  Education Reconciliation Act of 2010) provides for federally mandated health insurance to be implemented in the United States during the  2010-2019 decade with the Federal government subsidizing legal resident  households with income up to 400% of the Federal poverty level. This threshold varies according to State and household size, but for an average family of four, subsidies would be available for families whose income was about $88,000 or lower. In June 2010 adults with pre-existing conditions became eligible to join a temporary high-risk pool. In 2014 applicants of the same age will obtain health insurance at the same published rate regardless of health status — the first time in U.S. history that insurers will lose the right to load the premium or deny coverage prior to contract, or cancel a policy after contract due to an adverse health condition, or test result indicating that one may be imminent. The law will require almost everyone to have insurance by 2014, and prevents insurers from capping their liability for a person's healthcare needs, a move which is expected to rectify medically induced bankruptcy. The bill was one of Obama's key achievements.

Beginning in 2014, more far-reaching measures will begin to take effect.  States would be required to set up new "exchanges," or insurance marketplaces, that would offer a variety of healthcare plans for small businesses and individuals who do not get coverage from their employers.  Government subsidies would be available to those earning up to 400 percent of the Federal poverty level. Employers with 50 or more workers who do not offer coverage would be fined, and for the first time, most people would be required to obtain health coverage — either at work, or by purchasing it on their own — or pay a penalty.

All of this would be paid for in two ways: By reducing spending on Medicare by hundreds of billions, and by imposing a set of new taxes, including a 40 percent levy on certain high-priced insurance policies.

But while the bill is headed toward becoming law, the fighting over it isn't going away anytime soon. Republicans have already issued notice that they plan to campaign in this fall's midterm elections on a pledge to repeal it. There will be constitutional challenges. And in dozens of states, legislatures are considering measures that would attempt to exempt their citizens from some of its provisions, including the requirement that individuals purchase insurance.

Obama's legislation came from an idea, begun under the Eisenhower administration and developed under Nixon, of a market for healthcare based on private insurers and employers. Eisenhower locked in the tax break for employee health benefits; Nixon pushed prepaid, competing health plans, and urged a requirement that employers cover their employees. Obama applies Nixon's idea and takes it a step further by requiring all Americans to carry health insurance, and giving subsidies to those who need it.

Deborah DiSesa Hirsch is an award-winning health and technology writer who has worked for newspapers, magazines and IBM in her 20-year career. To read more of her articles, please visit her columnist page.

Edited by Stefania Viscusi
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