U.S. Health Care Reform: Definition & Policies

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  • 0:04 Healthcare Reform Basics
  • 0:34 Consumer Options
  • 3:13 What Reforms Are in the Works?
  • 4:14 Checks and Balances in Reform
  • 5:43 Lesson Summary
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Lesson Transcript
Instructor: Maya Shapland

Maya has worked in the clinical, education, and management sections of healthcare for over 25 years and holds bachelor's degree in Speech and associate degree in Nursing.

In this lesson, you will learn important definitions and policies that are currently driving healthcare reform. This is a hot topic that spans many spheres of government and the private sector, and is especially important for those looking for healthcare coverage. Let the journey begin!

Healthcare Reform Basics

In the complex world of healthcare reform, healthcare reform basics include the policy and procedures to improve the healthcare delivery system involving government, insurance companies, employers, and the public, for those needing care. Healthcare reform is expected to:

  • Find solutions that insure more people who need coverage
  • Provide more choices of providers
  • Allow more access to specialty providers
  • Deliver more quality patient care
  • Lower costs of healthcare

Consumer Options

The Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010 to begin a process of changes to the U.S. healthcare system and choices for the public. The online marketplace at Healthcare.gov walks a person through options to become insured. The basic purpose is to encourage all citizens to become insured. Let's join Mr. and Mrs. Jones as they look at the options and walk through the process of choosing the best plan for themselves and their four children.

Here are the choices confronting the healthcare consumer today:

  1. Stay uninsured. This means the family would have no coverage. The data from the beginning of 2016 listed by the Centers for Disease Control and Prevention (CDC) showed 27.3 million Americans were uninsured, 8.6% of the population. The Jones family finds this option to be the least expensive until one of the four children needs a surgical procedure.
  2. Purchase healthcare privately .This option is very expensive. Mrs. Jones has a job that pays just enough to get the family through the month. Purchasing insurance on her own would cost more than $1,500.00 per month.
  3. Purchase employer coverage. The employee has insurance coverage only during employment. The employer may cover some of the cost and may provide a network of physicians and other service providers to reduce cost. The cost of this option is increasing for the employee. Mr. Jones is employed by a company providing health coverage, which will bring the cost for his family down to $800.00 per month.
  4. Purchase exchange-based coverage. The Affordable Care Act Marketplace or state plans may provide an exchange program for coverage. Information can be found at Healthcare.gov. This option for the Jones family would cost around $1,300.00 per month.
  5. Use a flexible spending account. The client can put away pre-tax dollars for healthcare expenses. Mr. Jones opts to have an extra $50.00 taken out of his paycheck each month to help with deductibles.
  6. Use a healthcare savings account. This is an option with high deductible plans for a pre-tax savings account to cover medical expenses.

There are advantages to private insurance subscriber networks based on the group's particular needs. For example, BMW has employee insurance and medical care, including lab, x-ray, dental, vision, and pharmacy, at the workplace.

Based on their research of the options, the Jones family decides to go with their employer coverage.

What Reforms Are in the Works?

It's time to get to the core of some of the many reforms now in place. Providers' payments are being linked to performance. This is called value-based purchasing and is an effort to compensate providers and hospitals for quality care. One of the chief goals of the Affordable Care Act is to increase quality of care and decrease the cost of insurance premiums.

This goal has effects on many areas according to the Centers for Medicare and Medicaid Services (CMS):

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