uninsured and underinsured

Emergency Medical Treatment and Active Labor Act (EMTALA)

Mandates hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay; ( don't have to treat BUT have to stabilize = "screen and stablilize" )

direct purchase insurance ( what about this limits people from getting good coverage)

More administrative barriers More limited coverage Higher costs than group insurance

COBRA 1985

provides employees with the right to continue coverage with the employer sponsored group plan for only up to 18 months after an event ( like losing a job) causes termination of coverage; costs 103% of the cost of their premium; doesn't apply if the company goes out of business

What impact will health care reform have on the number of underinsured?

Significant --> instead of people being uninsured there's going to be more people underinsured

CHIP is for and what is covered

for children that don't qualify for medicaid; covers: Routine check-ups Immunizations Dental and vision care Inpatient and outpatient hospital care Laboratory and X-ray services (based on income and family size)

underinsured

insured but without adequate financial protection

direct purchase insurance- how reform is getting more people covered

no pre-existing conditions, dependent coverage up to age 26, medical loss ratio, insurance exchanges, NO LIFETIME CAPS, ANNUAL LIMITS, AND VARIED PREMIUMS based on health status; required coverage of ESSENTIAL HEALTH BENEIFITS

implications of EMTALA and other reform measures

puts high enormous cost constraints on hospitals --> shift the cost to those who can pay Private insurers, government insurers_and you_; there is a high cost of undertreatment also --> worsened health status (impact ability to return to work); Medical bills is the #1 reason for filing bankruptcy in the US ; Lapses in insurance may reduce ones ability to get insurance

Reasons for lack of health insurance

unemployment (12.3 million in 2013= most of uninsured); too expensive, simply can't get insurance bc denied, indigent ( will likely never get health insurance); voluntarily uninsured

Medical Loss Ratio (MLR)

used in the Affordable Care Act to encourage health plans to provide value to enrollees; The Affordable Care Act sets minimum medical loss ratios for different markets (85% for large employers, 80% for small), as do some state laws. --> THE HIGHER THE MORE IS PAID FOR ACTUAL HEALTHCARE THAN ADMIN.