How Government Policy Contributes to Social Inequality: How the introduction of employer-sponsored health insurance contributes to inequality particularly in the workforce
Specific Purpose(s):
I. Introduction (must be brief and concise)
A. Introductory sentence
B. Thesis statement
II. Topic 1 – The government policy initiatives of the past 25 years affects the economic and racial/ethnic disparities in health and health care
A. Discuss how people acquire health insurance
§ Employer-sponsored
- employer-sponsored health insurance is voluntary, business are not legally required to provide health benefits for the employees
- some employees are ineligible, some do not sign up because of employees’ share of premium requirements
- high premiums vs. lowest wage employees
- half of the total working population of Americans are insured through employers and half are covered as a worker’s dependent
- private health insurance coverage is subsidized through the federal tax system
§ Public Programs
- Medicaid – for non-elderly, provides health coverage based on income and categories of eligibility, assists low-income Medicare beneficiaries; does not cover single adults and childless adults
- State Children’s Health Insurance (SCHIP) – covers low-income children not eligible for Medicaid
§ Private Non-group
- based on individual health risk, costs varies by age and health status
- can deny or limit coverage to persons in poor health or with chronic conditions
§ Uninsured
B. Discuss how the health care system in the country functions
§ The World health Organization (WHO) ranked the US health care system first in terms of responsiveness and expenditure but 37th in overall performance and 72nd by overall level of health in 2000
§ The CIA World Factbook ranked US 41st in the world for lowest infant mortality rate and 45th for highest total life expectancy
§ In 2006, Americans without health insurance coverage totaled to 16% of the total population or 47 million people
§ The public and private health insurance
- Public Health Insurance
Ø Medicare – 1) a federal program that covers individuals aged 65 and over and some disabled individuals, 2) a single-payer program, 3) financed by federal income taxes, payroll tax shared and individual enrollee premiums, 4) covers hospital services for Part A, physician services in Part B, offers a prescription drug benefit in Part D (Part C refers to Medicare Advantage)
Ø Medicaid – 1) a program designed for low-income and disabled, 2) administered by the District of Columbia, 3) financed jointly by states and federal government through taxes, 4) offers a comprehensive set of benefits including prescription drugs, 5) low reimbursement rate
Ø Other public systems – 1) SCHIP, designed in 1997, for children that belong to low-income families 2) Veteran’s Administration, a federally administered program for veterans of the military
- Private Health Insurance
Ø Employer-sponsored insurance – 1) provided by the employers as a part of benefits package for the employees, 2) administered by private companies both for-profit and not-for-profit, 3) financed by both employers and employees, 4) benefits vary greatly with the specified health insurance plan and the degree of cost-sharing
Ø Private non-group (individual market) – 1) covers part of the population that is self-employed or retired, 2) administered by private insurance companies, 3) individuals pay insurance premium out-of-pocket for coverage
§ Financing the US health care system
- Individuals and businesses
Ø Taxes
Ø Premiums
Ø Direct or out-of-pocket payments
- Government
Ø Money generated from taxes
Ø Public employees’ premiums
Ø Tax subsidy
- Private insurers
- Health Service Providers
C. Discuss the benefits and downsides of the health care system
§ Benefits
- General access to health care providers that offers best services with the inclusion of modern facilities, medical products as pharmaceuticals and medical devices and provision for medical researches
- Insurance payments in the form of cost-sharing and risk management
- Managed care that includes the preference of choice of provider organizations, health maintenance organizations
- Provisions for health care extensions to family members
§ Downsides
- Price rationing and the presence of third parties
- Cost control mechanisms
- Delays in care-seeking and preventive services
- Shared cost for the uninsured
- Administrative costs
- Coverage gaps
- Health disparities among minorities
D. Analyze how the health care system exacerbates health inequality
§ Costs
- annual health care spending in the US exceeds .6 trillion
- overemphasis placed on competition, competition exists among provider networks to assemble bargaining power
- healthcare is treated as a commodity; hence, competition does not provide quality or create health care value instead it adds massive administrative costs and complexity into the system
- reduces transparency of transactions and the comparability of performance and cost data; thus, it undermines accountability and the capacity of the health care markets to function efficiently
- continuous increase in insurance premium rates over the years that drives expensive new drugs, medical advances that requires state-of-the-art medical equipments
- shifting of health costs from employers to employees
- high-cost and low-cost patients balance
§ Coverage
- “risks categories”
- poorer members of the minority groups will be jeopardized
- disproportionate effect on other vulnerable groups
- additional financial burdens such as high premium rates, out-of-pocket costs that includes copays, coinsurance and deductibles
- job-based coverage
E. Explain the consequences of health inequality
§ Financial consequence
- ineligibility will leave the injured or sick with no choice but to stay at home instead of liquidating savings and income to pay for medical bills
- high cost of care that could possibly lead to individual bankruptcies
- health insurance coverage, amount ceiling of care paid for in catastrophic illness
§ Economic consequences
- additional costs for firms to add new workers; therefore, non-progress in job growth
- health care costs suppress wage increases due to total compensation costs
- more uncompensated medical care that subsequently results to higher costs and higher premiums
- lower productivity of the uninsured workers
F. Identify different government policies on health and health care provisions in context of history
§ Nonrefundable credit for nongroup insurance
§ Deduction for nongroup insurance expenditures
§ Refundable credit for nongroup insurance restricted to those not offered
§ Insurance
§ Refundable credit for any insurance expenditure
G. Review and analyze each policy and note specific sections that contribute to economic and social disparities
H. Discuss each section and explain the reasons why they could possibly contribute to social inequality
I. Discuss implications for policy-makers and for social workers
III. Topic 2 – How the economic benefits of health-related expenditures are distributed among individuals by income, race/ethnicity and family structure/composition, and how the distribution has change over time
A. Discuss the distribution of tax subsidies for health
B. Discuss the general economic benefits of health-related expenditures
C. Discuss conceptual and measurement issues
D. Discuss how health-related expenditures are distributed by income
E. Discuss how health-related expenditures are distributed by race/ethnicity
F. Discuss how health-related expenditures are distributed by family structure/composition
G. Analyze the general implications of the distribution and discuss specific implications of the distribution of health-related expenditures by income, race/ethnicity and family structure/composition
H. Discuss the trends/patterns in the distribution of tax subsidies for health-related spending
I. Analyze each identified trend/pattern and draw implications of social inequality from the analyses
IV. Topic 3 – How the current system of employer-sponsored health insurance contributes to inequality
A. Explain the current system of employer-sponsored health insurance
1. Coverage
1.1 Sponsorship
1.2 Eligibility
1.3 Participation
2. Employer’s Liability
The prevailing health care system is characterized by capitation and risk-sharing contracts. Effective facilitation of health care delivery and managed care control restructures legislations in light of the patients’ rights. It includes rules and standards that govern the delivery of care and the responsibilities of payers and providers. It included, for example, the right to sue health plans whenever the standard of care is violated. For employers, the liability is more stressed on adapting to uniform benefit plans. Violating this simple rule could result to standard malpractice cases and throwing of disputes over the terms of coverage especially for ESI. In existence of this new liability, employers are threatened to wither purchase insurance against the increased risk or expand the scope of covered services to better manage the risks.
3. Trends in Cost and Access
3.1 Factors that affect the trends
3.1.1 Premium Contributions – The general premise is that the higher the employee contribution is, the less likely employees are to enroll. There is a relationship between the influence of out-of-pocket contributions, total premiums and employer and workforce characteristics could affect the employees’ decision to enroll.
3.1.2 Wage Levels – The people insured through their employment are less sensitive to premium size compared to those in the individual market. The reason behind this is that they pay only a fraction of the full premium. Low-wage workers are more sensitive to the size of the contribution than are higher income workers.
3.1.3 Firm Size – Firms with large numbers of employees are more likely to offer their employees health insurance. The principal reasons of small employers typically points at the cost of insurance and the belief that employees have other sources of coverage. The firms that are least likely to offer coverage are those with low-wage workers, high turnovers, no unions and many part-time employees.
4. Legal and Advocacy
4.1 Right protection under employer-sponsored health insurance
4.1.1 ERISA
ERISA is a federal law that sets rules for private employer-sponsored benefit plans including health insurance plans. ERISA is administered by the Employee Benefits Security Administration (EBSA) of the US Department of Labor. The protections that ERISA provided are as follows:
4.1.1 Accountability – Someone called a fiduciary must be named to administer the health plan in a financially responsible manner and within the best interests of the enrollees.
4.1.2 Information – You must be given written information or what is called the summary plan description. It describes what the employer-sponsored plan covers and what rules must be followed under the plan.
4.1.3 Claims procedures and appeals – A separate written rules that outline how you can file a claim and how you can appeal a denial of covered services.
4.1.4 Other protections – Employer-sponsored health plans cannot discriminate against you in case of sickness by refusing to let you in by the plan or by charging you more by coverage. It must offer a special 30-day chance to enroll in case of change in family status.
4.1.5 COBRA – Group plans sponsored by employers with 20 or more workers must offer you the chance to temporarily continue coverage after you are laid off, quit, retire or lose dependent status under the plan.
B. Discuss the cost of health care benefits and discuss the payroll dollar breakdown
The cost of health care benefits is provided by the US Chamber of Commerce. They provide evidences of the structure and cost of the typical employee health benefit packaged provided in the US. For example, a report made by the department, based on the study that was conducted in 1999, the typical benefit package was worth an average of , 060 or 36.8% of total payroll expenses.
A breakdown of typical dollar shows that, on average, only 63.2 cents was devoted to wages and salaries. The dollar breakdown also included the: time not worked, legally required benefits, medical benefits, retirement and savings plans.
C. Discuss tax treatment of both employer and employee contribution
§ Federal tax treatment of employee contributions – tax-deductible for individuals. (if an employee contributes to Health savings Account) through salary reduction plans, the contributions are considered to be made by the employer).
§ State tax treatment of employee contributions vary from state-to-state
§ Federal tax treatment for employer contributions – employer contributions are generally excludable from employee’s gross income.
D. Analyze and discuss implications of this in workplace inequality
1. Income
2. Gender
3. Skills
4. Job security
5. Job satisfaction
6. Quality of Life
V. Topic 4 – How different approaches to health care reform and the expansion of health insurance coverage are likely to affect social inequality
A. Discuss the nature of health care reform and the expansion of health insurance coverage
Health care reforms included the following rubrics: 1) broader population covered by private and public health insurance, 2) improve the access to health care specialists, 3) expand the choice among and of health care providers, 4) improve quality of health care, 5) decrease health care cost and 6) decrease the cost of health insurance.
B. Discuss on-going debates regarding health care reforms
1. Coverage expansion
2. Income redistribution
3. Social health care programs
4. Achieving equity in health
C. Discuss why these health care system reforms will prove to be insufficient in the long run
§ The healthcare industry is the most heavily regulated industry in the US
§ Majority of the cost differential arises from medical malpractice and part of the cost sprung from regulatory requirements
§ Over intervention by several political entities
Credit:ivythesis.typepad.com
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