Good health is important to everyone; unfortunately, not everyone can afford adequate medical care when it’s needed. If you are uninsured or underinsured and need medical care now, yet cannot afford to pay for it, there may be a government program that can help you. Several health care options are currently available to qualifying, low-income individuals and families from either a federal or state agency to help you get healthy and stay healthy.

The Centers for Medicare & Medicaid Services (CMS)

The CMS is the federal agency responsible for administering the Medicare, Medicaid, State Children’s Health Insurance (SCHIP), Health Insurance Portability and Accountability Act (HIPAA), and other health-related programs. An overview of these programs is provided below, or you may visit their online site at http://www.cms.hhs.gov/ for additional information and how to apply for these benefits.

Medicare

Medicare is a social insurance program administered and funded by the federal government. It provides health insurance primarily for people age 65 or older, but also for people under age 65 who meet certain health criteria, who are either a US citizen or have been a permanent legal resident for five continuous years.

• In 2007, Medicare provided health care coverage for 43 million Americans

The Medicare program is administered by the Centers for Medicare and Medicaid Services (CMS), however eligibility and processing of premium payments is handled by the Social Security Administration. CMS has contracted with various private companies to assist with the administration.

The Medicare program is categorized into parts: Part A - Hospital Insurance, Part B - Medical Insurance, Part C - Medicare Advantage Plan, and Part D - Prescription Drug Plan. Medicare does not cover all of a person’s medical costs - beneficiaries have premiums, deductibles, and co-pay amounts. Some low-income people may also qualify for dual coverage with a program such as Medicaid to help pay for premiums and other out-of-pocket medical expenses.

Medicaid

Medicaid is a government entitlement program that provides health care to qualifying low-income individuals and families. It is jointly funded by the federal and state governments, although it is administered at the state level. Each state may have it’s own name for the program, as well as it’s own set of guidelines for eligibility and services. The CMS is responsible for monitoring the state-run programs and setting requirements for service, delivery, quality, funding, and eligibility standards.

• Medicaid is the largest source of funding for medical and health-related services for people with limited income

Being poor does not automatically qualify an individual or family for Medicaid benefits. To be eligible, one must fit into an eligibility group that is recognized by federal and state law, as well as meet certain requirements within each group. Among the groups covered are low-income parents, children, seniors, and people with disabilities. Some of the requirements involved are age, pregnancy, disability, blindness, income, assets, resources, citizenship or immigrant status.

When health care is provided by a participating health care professional or medical facility, Medicaid will pay all or a portion of the bill. The payment is sent directly to the health care provider, the money is not sent to you. In some cases, a patient may be asked to pay a small portion of the cost for some medical services.

The State Children’s Health Insurance (SCHIP)

The State Children’s Health Insurance (SCHIP) was created in 1997 to provide health insurance for uninsured children whose families were of limited income and could not afford private insurance, yet made too much money or had too many assets to qualify for Medicaid.

The SCHIP program is jointly funded by the federal and state governments and administered by the states. Although each state must follow general federal guidelines, each state is allowed to determine it’s own program structure, eligibility groups, benefit packages, payment levels for coverage, and administrative procedures. The program may also be called different names in different states.

• SCHIP provided health care coverage for 6.6 million children during 2006

The SCHIP program helps families have access to medical and dental care for children. With this program, many health care expenses are covered in full, although in some instances patients may be asked to pay a small co-pay amount.

Universal Health Care

It is time to reform the health care system in the United States - time to make it affordable, portable, and accessible to all Americans. We are fortunate to live in a nation where the health care resources are abundant - we have modern hospitals, sophisticated equipment, well-equipped rural facilities, skilled and dedicated physicians and nurses, and plentiful medications. The medical research conducted here is immense and we fund health care far more generously than any other nation. Yet, even with all the medical resources at our disposal, the present health care system is inefficient and inequitable.

The solution to our health care crisis is in developing a new system of health insurance - one that is more focused on providing equitable access rather than making a profit for big business. Health care should be decided by a doctor, not a case manager in an HMO office. Patients should be able to choose their own doctor, not be limited to those on an approved list. The money currently spent on health care should go towards more health care, not on wasteful overhead and executive bonuses.

The belief that all citizens should have access to affordable, high-quality medical care is the defining principle of universal health care. Universal health care is a very broad concept, it does not mandate complete government control. While government is important in passing laws and public policy, private doctors and medical practices would still be an important part of the health care system. Many are afraid that universal health care would lead to an institution of socialized medicine, but that is not the case.

A Better Solution - Streamline Costs

While there are many proposals for health care reform, the concept of a single-payer health insurance system would save money and be a better use of both taxpayer and health care dollars.

• The United State spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet, in comparison, our health care system performs poorly, 47 million people are without health insurance, and millions more and underinsured.

The current system of private, for-profit insurance spends 26 cents of every dollar on bureaucracy and paperwork. By streamlining payment through a single non-profit payer, it would save over $350 billion per year, a substantial amount of money which could be better spent on health care.

• Medicare operates with 3% overhead, non-profit insurance 16% overhead, and private (for-profit) insurance 26% overhead.

Funding of Universal Health Care

• Funding for universal health care is provided by the population, whether through compulsory health insurance, taxation, or a combination of both. Some health care costs may be paid by the patient and some health care costs may be covered by the universal health insurance program.

Although the structure of the health system would change under a universal health care program, the funding would be provided by the same people who pay for it now - taxpayers. Currently, public money (federal and state taxes, property taxes, and tax subsidies) already pays for about 60% of the US health care system. Instead of private spending for insurance by employers, employees, and other individuals, however, the amount would be collected as a tax. Overall, spending by employers and individuals is expected to go down. Although health care would continue to be a mix of public and private health care providers, the payment would be handled by one health insurance program. This would reduce waste and make the system more efficient.

A Better Solution - Make Insurance Portable

To make insurance portable is to separate insurance coverage from employment. The insurance plan should follow a person - from job to job, job to self-employment, job to retirement, job to raising a family, or whatever other employment change life may bring. A person should not have to switch insurance companies with a change in employment or lose coverage because they want to take a few years off to raise a family or retire early. This current process is disruptive, often requires a change of doctors, affects coverage, and increases paperwork. A person should be able to choose a health plan, pay an affordable premium to a single-payer insurance program, and have that same coverage and premium irregardless of employer or job status.

A Better Solution - Improve Access to Preventive Care

Increasing access to preventative health care and basic treatment will improve health outcomes and reduce treatment costs.

• less than 4 cents of every health care dollar is spent on prevention and public health

With our current health care system, no one can be turned away for medical care in the event of a medical emergency. As a result, the uninsured are more often treated in emergency rooms than those without insurance. Because the uninsured don’t have access to treatment when a health problem first occurs, they don’t seek medical care until it becomes a much more serious situation. Emergency room care is very expensive - it would cost less to either pay for preventive health care or treat the health problem before it become a more serious situation.

• 75% of all health care dollars are spent on patients with one or more chronic conditions, many of which can be prevented

More money should be spent on prevention and public health. With access to preventive care and early treatment, many cases of illness or chronic diseases could be controlled or prevented.

What Are The Issues

Most Americans are well aware of the many problems with the current health care system in the United States. Lack of access to affordable health insurance and rising health care costs is of great concern to many Americans. Many working families worry about getting sick or injured because they cannot afford health insurance or basic health care. Many individuals are turned away from insurance companies because of a pre-existing medical condition or illness. Others lose their health insurance when they are laid off from work or change jobs.

The dire health care situation can be seen in the numbers. More than 47 million people in the United States do not have health insurance and about 9 million of them are children. Over 40 million people a year do not get medical care when they need it, even if insured, because they can’t afford it. More than 8 out of 10 uninsured people are from working families. Thousands of deaths every year are attributed to lack of health insurance.

The issues to address in the reform of the health care system:

• Affordability
• Portability
• Accessibility

Affordability

The cost of health insurance and health care is rising at a pace faster than wages and inflation. According to a study completed by the Kaiser Family Foundation, from the year 2000 to 2006, the overall inflation rate increased 3.5%, wages increased 3.8%, and health care premiums increased 87%. Most of the uninsured are working Americans who cannot afford the cost of health insurance.

Many Americans are able to afford health insurance only because it is subsidized by their employer. In 2006, the average health insurance premium for a family, provided through an employer health benefit program, was $11,480. Of this amount, the employee paid an average of $2,973 towards the premium.

Not only does employer-sponsored health insurance make it possible for many people to afford coverage, but group plans are generally less expensive than individual plans. This makes health insurance coverage very expensive for people who have to purchase health care insurance individually, either because they work at jobs that don’t offer employment health benefits or are self-employed.

Of the 84% of Americans with health insurance, approximately 60% get their health insurance through their employer, while only 9% of the insured purchase their own policies (the remaining insured get health coverage through the government; Medicaid, Medicare, or Military).

Portability

In our current health care system, the majority of health insurance coverage is tied to employment. When health insurance is tied to employment status, it can be very disruptive and inefficient. It is estimated that about 24% of the uninsured are without insurance because they lost their job or had a change in employment. People should not have to worry about what will happen to their health insurance or health care needs if they lose their job, change employers, take time off to raise a family, retire, become injured or disabled, or any other reason that affects employment. Health insurance should follow a person, not a job.

Accessibility

While the primary reason individuals do not have health insurance is because of cost, there are also many people who cannot get insurance because of pre-existing medical conditions. For some, their health insurance is actually cancelled and bills left unpaid due to their illness or injury. Under the current private health care system, insurance companies are profit-driven. If an applicant is considered high risk, they can refuse to sell them a health insurance policy.

For the uninsured, the lack of health insurance limits access to medical care such as preventative healthcare, check-ups, immunizations, dental care, prescriptions, eye exams, eyeglasses, and mental health care. Many of the uninsured have to live without proper medical care, even when it is needed, unless it is an emergency. This often causes smaller health problems to become even more serious, treatable health conditions are left untreated, more situations are treated in emergency rooms, and some may even die from preventable conditions.

The lack of accessibility to health care also affects children. Studies show that uninsured children are more likely to be sick, miss more school days, and perform more poorly in school than children with insurance. Many children suffer from asthma and cannot afford the treatment that will benefit their health and education. Many children cannot afford the recommended immunizations. Many children get ear infections that are not treated, leading to hearing loss.

While many low-income children qualify for Medicaid or the State Children’s Health Insurance Program (SCHIP), many families are unaware of these benefits and are not enrolled in the program. For these children, it is important to get the word out, increase enrollment, and help the families access the health care coverage available.

Obesity is steadily increasing in the United States population and the rate of severe obesity is increasing the fastest. It is estimated that one in three Americans, more than 93 million people, are obese and that more than eight million Americans are morbidly obese.

Obesity has reached epidemic numbers, leading to increased health risks and rising health care costs, yet many insurance companies do not cover weight-loss treatments such as medically managed weight loss programs or bariatric surgery. Although your insurance company should have an interest in keeping you healthy and preventing costly medical expenses, most insurance companies will only pay for costs of obesity-related problems after they develop.

Advocates for obese patients are pressing for change in the health care system to make sure that obesity is treated as a disease and that individuals struggling with obesity have increased access to safe and effective medical treatment. Although many policies have yet to improve, there are many steps you can take now to get your insurance company to cover the necessary medical treatment for obesity.

What is Obesity

Obesity is considered a complex, chronic disease that negatively affects a person’s physical health as well as emotional and mental health. Obesity is determined by measuring a person’s Body Mass Index (BMI), which takes into account height and weight. Adults with a BMI greater than 30 are considered obese; those with a BMI greater than 40, or more than 100 pounds overweight, are considered morbidly obese.

Obesity increases the risk of developing many serious health conditions, including heart disease, type 2 diabetes, hypertension, severe sleep apnea, arthritis, and cancer. Obesity is the second leading preventable cause of death after tobacco use and is associated with four of the ten leading causes of death in the United States; coronary heart disease, type 2 diabetes, stroke, and several types of cancer.

Treatments for Obesity

The rising incidence of obesity has increased the role of doctors and health professionals in the treatment of obesity. While some people are successful at losing weight on their own, participating in a medically supervised weight loss program can provide weight loss and health benefits. In some cases, medical supervision is necessary, such as for patients on a very low calorie diet, for severely obese patients (BMI greater than 35), and for patients with other health problems. While medically supervised programs are expensive, costing approximately $2000 for the first three months, they still cost less than the ongoing costs associated with obesity.

The last resort treatment for morbid obesity is bariatric surgery, any of several procedures which promote weight loss by restricting eating, altering digestion, or both. Depending on the type of procedure performed, the most popular are lap band surgery or gastric bypass surgery, the average cost can range from $15,000 to $30,000. Although this treatment may be recommended by your doctor, many insurance companies are reluctant to cover bariatric surgery.

Gaining Coverage for Obesity Treatment

You can help with the approval process for bariatric surgery by familiarizing yourself with the insurance requirements and providing the insurance company with the proper documentation. Most insurance companies require records of medical history, current health condition including height, weight, and list of obesity-related health problems, and documentation of previous weight loss attempts. Most insurance companies also require a Letter of Medical Necessity from your doctor, which explains your health status, diagnosis of obesity, and recommendation of bariatric surgery for treatment. Most bariatric surgeons are experienced at working with insurance companies and your doctor should be more than willing to help you work through the approval process.

During the approval process, it is important to keep copies of all medical documents and correspondence from your insurance company. If your first request for pre-authorization is denied, you have the option to appeal, but it is necessary to have all your paperwork in order. If you get a denial from your insurer, make sure you get a denial notice in writing listing the exact reason(s) for denial. Many times a denial is based on missing paperwork or unmet requirements. As timing is an issue, not only is it necessary to provide the necessary documentation, but make sure you file the appeal in a timely manner.

If your insurance policy has an exclusion for “obesity surgery” or “treatment for obesity” you may still be able to appeal and gain approval for bariatric surgery. Bariatric surgery is now recognized as an effective treatment for other life-threatening disorders, including type 2 diabetes, hypertension, or heart disease. As these are usually covered health conditions, your appeal would be based on your doctor’s Letter of Medical Necessity that states the need for weight loss surgery to treat one of these covered diseases.

Throughout the approval process for obesity treatment, you will need to be your own best advocate. The insurance company may not make the process easy, but it is important that you don’t give up. When dealing with the insurance company, it is important to be pleasant and polite, yet persistent and determined. In making their decision, the insurance company needs to be convinced that you qualify for surgery and that it is the most effective type of treatment for your personal health situation. Many patients have followed the insurance process through to the end and have successfully gained approval for bariatric surgery.

If you need additional information or help in getting approval from the insurance company, you may want to contact the Obesity Law and Advocacy Center (www.obesitylaw.com) for legal advice. Another helpful website that you may be interested in visiting regarding Obesity Advocacy is the Obesity Action Coalition (www.obesityaction.org). We have no affiliation with either of these resources but they appear to be effective advocates for individuals affected by obesity.

Q. What is the purpose of health insurance?

A. The purpose of health insurance is to help you pay for the high cost of health care and protect you financially from unexpected medical expenses in the event of a serious illness or injury. Also, with health insurance, you are more likely to get routine and preventative care, have a regular doctor, and have access to health care when you need it.

Q. Is it legal for insurance companies to refuse to sell someone health insurance?

A. In many cases, yes. Health insurance is provided by private companies, and like most private companies in the United States, the bottom line is to make a profit. The idea behind insurance is the transfer of risk - the insurer accepts the larger financial risk in exchange for a smaller periodic premium. Insurers are allowed to consider their financial risk when accepting or denying insurance coverage to an applicant, which is based on a person’s medical history. While insurers’s are often allowed to discriminate based on medical history and pre-existing conditions, they cannot discriminate on certain factors such as race, gender, and national origin.

In some states, laws have been passed which mandate that insurers offer coverage to people with pre-existing conditions within a certain period of time. Just because they have to offer coverage, however, does not guarantee that the coverage will be affordable.

If you have been denied coverage and think you are being discriminated against, you should contact your state’s insurance commission and find out whether or not what the company is doing is legal.

Q. Are employers legally required to provide group health insurance for employees?

A. There is currently no federal law requiring employers to provide their employees with group health insurance. This is one aspect of health care reform that has been considered by Congress, however, as one of the possible solutions of making health care insurance more affordable and accessible to working individuals.

Q. What options do I have if I have a pre-existing condition and cannot get health insurance?

A. Over 30 states have established a program, known as a high-risk pool, that offers health insurance to people who don’t have access to coverage through group insurance or cannot purchase private health insurance due to a pre-existing medical condition. Most states that offer the program fund the risk pool through premiums as well as tax revenues or assessments on health insurance companies doing business in that state. To find out if your state operates a high-risk pool, contact your State Insurance Commissioner, Contact information should be listed in the government section of your local telephone book.

Q. What options do I have if I cannot afford health insurance?

A. If you cannot afford health insurance, you may qualify for one of the government-sponsored programs for low-income individuals and families, such as Medicaid and the State Children’s Health Insurance Program (SCHIP). You should contact the social services office in your area to discuss eligibility and available services. In the event of a medical emergency, you will not be turned away for treatment at a hospital due to lack of health insurance.

Q. What is Medicaid?

A. Medicaid is a joint federal-state program operated at the state level that provides health care coverage for qualifying people with limited income. Medicaid helps many individuals and families who cannot afford to pay for health care by covering some or all of their medical expenses.

• In 2006, 12.6% of health care coverage was provided by Medicaid.

To receive coverage from Medicaid, you must first qualify. Medicaid is only available to people with limited income, but not all people with a limited income will qualify. Some of the other eligibility requirements considered are age, pregnancy, disability, blindness, other assets and resources (such as bank accounts and real property), and citizenship status.

If you need assistance with health care expenses, you should contact the social services office in your area to see if you qualify. Telephone numbers and locations are usually listed in the government pages of the telephone book. You will want to talk to a qualified caseworker in your state, as each state has it’s own rules for eligibility and covered services. For more information on the Medicaid program, visit the government website at www.cms.hhs.gov/MedicaidGenInfo.

Q. What is SCHIP?

A. State Children’s Health Insurance Program (SCHIP) is a joint federal-state program similar to Medicaid, which was created by Congress in 1997. The purpose of SCHIP is to provide health insurance to low-income children whose parents earn too much money to be eligible for Medicaid but not enough to purchase private health insurance.

SCHIP eligibility varies from state to state, but in most states uninsured children 18 years of age or younger with a family income up to $34,100 a year for a family of four will be eligible. The insurance provides coverage for doctor visits, immunizations, hospitalizations, and emergency room visits, either at little or no cost.

To learn more about SCHIP, you may either contact the social services office in your area or visit the website at www.insurekidsnow.gov.

Q. What is Medicare?

A. Medicare is a federally funded health insurance program for American citizens and permanent residents who are 65 years or older. Generally, you are eligible if you or your spouse worked at least 10 years in a Medicare-covered employment. If you are under 65, you may also qualify if you have certain disabilities (many people with morbid obesity are categorized as disabled under the Social Security Act) or end-stage renal disease (permanent kidney failure that requires dialysis or a kidney transplant).

• Medicare is the nation’s largest health insurance program, covering nearly 40 million people. In 2006, 13.6% of health care coverage was provided by Medicare.

Medicare, which is administered by The Centers for Medicare & Medicaid Services (CMS), pays for many health care services and supplies. Sometimes it will pay the entire bill, at other times a co-payment will be required. Medicare has two parts: Part A is for hospital insurance, Part B is for medical insurance. Most people do not have to pay for Part A, while many pay a monthly premium for Part B. Some individuals may qualify for dual Medicare/Medicaid coverage. To learn more about the Medicare program, visit the Medicare site at www.medicare.gov.

Q. What is COBRA?

A. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law passed by Congress in 1986 that allows for a continuation of group health insurance in some situations where it otherwise might be terminated. When coverage is lost due to certain specific events, COBRA provides the right to temporary continuation of health coverage at group rates to qualifying former employees, retirees, spouses, former spouses, and dependent children. Usually, COBRA participants pay the entire premium without any employer co-pay, but the cost is usually less expensive than paying for individual health coverage.

COBRA eligibility is determined by meeting specific requirements of three factors: qualified health plans, qualified beneficiaries, and qualifying events. For more information on eligibility and coverage, visit the US Department of Labor website at www.dol.gov, then go to search/A to Z index and go to COBRA.

What Can You Do

If you support health care reform, you can become an advocate simply by speaking out and letting others know what issues concern you and what steps you support to bring change. This can be something as simple as talking to friends and family members about the impact of a health care law, as formal as sitting down and talking to your government representatives about your views, or as involved as actively participating in efforts to bring about change in laws or policies.

Health care advocacy can take place at the local, state, or federal level. Cities make decisions that affect local social and health programs; state legislatures propose and vote on health care issues, the Governor signs or vetoes the bill; and the representatives in Congress make laws at the federal level, which are then approved or vetoed by the President.

Write or talk to your government representatives about the health care issues that concern you. Follow the ongoing proceedings of the government agencies in issues related to health care and stay informed on the pending legislation.

Those who are passionate about reforming health care may also want to learn more about being an effective advocate and knowing how to best exert their influence. The following tips will explain how you can be a better advocate for health care issues in your community.

Advocacy Tips for Expanding Your Influence

• Get others involved - your influence is multiplied when you can get others to join you in with your efforts; talk to people, explain the issues, share with them what they can do to make a difference
• Share your experience with others - health care problems lets you share your health care problems with others to help identify how and where the US health care system fails it’s citizens
• Contact a non-profit or foundation organization involved with health care reform - ask how you can best support their efforts, from volunteering your time to donating money, especially during elections or concerning pending legislation
• Contact your representatives in government - share your views, show support or disapproval for pending legislation
• Write a letter to the editor - writing a letter to the editor of your local newspaper is one creative way of sharing your views and letting others know what they can do to help

Advocacy Tips for Influencing Congress

• Call your representative - a telephone call is a good way of letting your legislator know your views on an issue, and every call makes a difference; to find the telephone number, look in the government pages of the phone book, call information, or call the Washington DC switchboard at (202) 224-3121 and ask for your Representative’s or Senator’s office
• Write a letter - letters can make a difference, as they help a legislator know what their constituents back home are thinking
• Send an Email - sending a letter via Email to your representative is another way to express your views on an issue and pending legislation; to find an Email address go to www.senate.gov or www.house.gov
• Visit your representative - legislators usually visit their home district from time to time; either attend a home town meeting or ask if you can schedule a time to meet individually
• Stay informed - in order to know the issues and contact your representative you can find information on pending legislation, copies of bills, and congressional schedules at the congressional website known as “Thomas” (as in Thomas Jefferson) at http://thomas.loc.gov

Advocacy Tips for Influencing the President

If you want to share your views on health care issues and pending laws with the President you will want to write or call the White House. The Administration uses telephone calls and letters to measure public opinion. Contacting the President can be just as important as contacting your representatives in Congress.

• When writing a letter or Email, start with “Dear Mr. President”
• The Email address is President@WhiteHouse.gov
• You can call the White House comment line at (202) 456-1111 to register your opinion on a particular issue and leave a response using your touch-tone phone or with an operator
• The White House fax number is (202) 456-2461

Make A Difference

Every person can make a difference - share your views with others in your community, join a grassroots advocacy group, and contact your representatives in government. Those who are passionate about health care issues and get involved will be the ones to bring about change.

Health insurance is a program that helps pay for medical expenses. It may be purchased privately (non-government) or provided by the government.

• Private health insurance is when health care coverage is purchased from a private health insurance company, whether provided on a group basis through an employer or union, or purchased by an individual directly from the insurance company.
• Government health insurance is when health care coverage is funded by a federal, state, or local government agency.

Although specific health plans vary greatly in coverage, policies typically cover medical expenses for some or all of the following; injury, illness, dental, vision, preventative health care, and prescription drugs. Under a wider definition of health coverage is long-term nursing care, long-term custodial care, and disability insurance.

How it Works

The purpose of health insurance is to protect oneself from high or unexpected health care expenses. The amount you pay for this protection is set by the insurance company and paid as a monthly premium or annual tax. The insurance company determines how much to charge by estimating the overall risk of health care expenses and then determining how much money needs to be kept in reserves so that the funds will be available to pay for the benefits as specified in the insurance agreement.

Where Americans Get Health Insurance

Of the approximately 84% of Americans that have some form of health insurance coverage, the US Census Bureau reports that it is provided by the following (percentages are approximate and coverage may overlap):

• 60% through an employer
• 9% purchased directly
• 27% from a government agency

Private Health Insurance

Private health insurance may be purchased on a group basis (employers, unions, trade or industry groups) or purchased by individuals. The cost of health insurance varies by group or individual based on a fee schedule set by the insurance company. Rates are often influenced by age and geographical region. The range of available plans are similar between those provided through an employer and those purchased individually, although individual plans, on average, tend to have higher deductibles, co-payments, and premiums.

The largest private health insurers in the United States are UnitedHealth, WellPoint, Aetna, Cigna, and Humana.

Government Health Insurance

Among the people in the United States covered by some type of health insurance, approximately 27% received their insurance coverage through a government agency. The largest government health insurance programs are:

Medicare
Federal health care insurance program for people 65 years of age or older and certain people with long-term disabilities under 65 years of age.

Medicaid
Joint federal and state health care welfare program for qualifying low-income individuals and families.

SCHIP (State Children’s Health Insurance Program)
Joint federal and state health care insurance program for low-income children whose parents do not qualify for Medicaid coverage yet cannot afford to buy private insurance.

TRICARE or CHAMPUS (Civilian Health and Medical Program of the Uniformed Services)
Military health care program for active duty and retired members of the military, their families, and survivors.

CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs)
Military health care program for eligible veterans, veteran’s dependents, and survivors of veterans.

VA (Department of Veterans Affairs)
Military health care program which provides medical assistance to eligible veterans of the Armed Forces.

State Plans
State sponsored health insurance plans for low-income individuals without other insurance, may by called different names in different states.

IHS (Indian Health Service)
Health care program administered by the Department of Health and Human Services for eligible American Indians.

The Health Insurance Debate

The issue of health care is considered a priority by a majority of Americans and most believe the current health care system needs to be changed. While there is agreement that something needs to be done, the debate is focused on how this is to be accomplished. Some believe that health care should be a right or privilege that is extended to all citizens regardless of the ability to pay and others believe that health care is not a right and therefore the government should not be responsible for providing coverage. Even among those that support providing universal health care, not all agree that it should be mandatory. The issues surrounding health care reform and universal health care is not limited to the uninsured, but affects all Americans.

HealthPAC online is managed by a group of dedicated volunteers who are interested in helping explain the current health care system, its flaws, and exploring ways to improve the health care in the United States.

While every attempt has been made to ensure the accuracy of the information contained on this website, HealthPAC online makes no warranties, either express or implied, regarding the content of this information.

HealthPAC online does not accept advertising, sponsorship or donations to help ensure a non-biased approach to the presentation of content contained on the website.

What is It

Universal health care is the belief that all citizens should have access to affordable, high-quality medical care.

Structure and Funding of Universal Health Care

Universal health care is a broad concept that can be structured and funded in various ways. The common factor for all universal health care programs is that they require some form of government involvement, whether it is through legislation, mandates, or regulation. The laws determine what type of care must be provided, to whom the care must be provided, and the basis for determining coverage.

In some universal health care programs the government may also manage the health care system, but in many instances the health care system uses both public and private health care providers.

Funding for universal health care is provided by the population, whether through compulsory health insurance, taxation, or a combination of both. Some health care costs may be paid by the patient and some health care costs may be covered by the universal health insurance program.

Single Payer Health Insurance Systems

Many people who support universal health care prefer a system known as “single payer health insurance.” Single payer health insurance is one in which the government finances health care but is not involved in delivering the care, much like Medicare and Medicaid. This idea fits the broader definition of socialized medicine, but it is a distinctly different system from the more literal meaning of socialized medicine in which the government also employs the health care professionals and is involved in health care delivery.

Universal Health Care vs Socialized Medicine

Although some people refer to universal health care as socialized medicine, the concepts are not completely synonymous. The term “socialized medicine” is primarily used only in the United States by those who do not support the idea of universal health care. Outside the US, the terms most used are universal health care or public health care. The actual definition of socialized medicine is somewhat varied and inconsistent in usage, though it generally describes any system of health care that is publicly financed, government administered, or both.

• For some, socialized medicine is specific to systems in which the government both operates the health care facilities AND employs the health care professionals. In the United States, examples of this type of care are the United States Veterans Health Administration, and the medical departments of the US Army, Navy, and Air Force.
• Others consider socialized medicine in broader terms as any system that is partially or totally funded by government although health care is provided by private business. Examples of this type of health care system in the United States is Medicare, Medicaid, and the US Military’s TRICARE.

Socialized Systems in a Capitalist Society

Many Americans believe in a free market society, and thus their beliefs may extend to health care as well. While a capitalist structure, supply and demand, and a free market system help regulate business models, should health care be run as a profit-driven industry? This is a basic issue at the core of the universal health care debate. Currently, many socialized programs provide a wide variety of beneficial services to Americans, including police departments, fire departments, public libraries, public schools, Medicare, Medicaid, and the US Military and Veterans health programs. Socialized programs can play an important role in capitalist societies - the challenge is in finding the right balance and determining how the United States can best provide health care for all it’s citizens.

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