Wednesday, June 15, 2022

How Does Health Insurance Make Healthcare More Accessible

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Easily the most significant recent step to lessen health disparities came when Congress passed the ACA in 2010. The law requires people above a certain income to have health insurance, and it expands the Medicaid program to cover those who cant afford it. A 2012 Supreme Court ruling created a significant pothole on the road to universal coverage, however, allowing states to opt out of the Medicaid expansion. That left 4 million poor Americans in 20 states ineligible and on their own.

Under the ACA, we created a new structure where just about every American citizen and legal resident has access to some kind of affordable health insurance coverage, except for poor adults in states that have not accepted Medicaid expansion under the ACA, McDonough said.

Despite that large pool of uncovered people, McDonough said, the ACA has clearly reduced health inequalities in much of the nation, particularly for minority and ethnic groups.

The ACA has succeeded in taking a major step forward in reducing inequalities as pertains to access in health insurance coverage, McDonough said. It has not solved it, but its a major step forward.

The act also has reduced disparities in medical care and in health status, according to McDonough and McGuire. By requiring insurance companies to cover people regardless of pre-existing conditions, it has worked to level the financial gap between the sick and the well.

Substandard care leads to 260 premature African-American deaths daily.

Us Vs Canadian Healthcare: What Are The Differences

Here in the US, we often get a bit caught up in the healthcare debate. The media often suggests that our neighbors, the Canadians, have better healthcare than we do. However, a side-by-side comparison will show that each system has its pros and cons.

As soon-to-be or current allied health professionals, youre probably very interested in this ongoing debate. Instead of jumping to conclusions about which system may be better, lets uncover the real differences between US and Canadian healthcare.

Who Your Health Insurance Policy Covers

Your health insurance policy covers you if the policy is in your name.

Your spouse or partner and children under 19 years old may also be eligible for coverage under your insurance policy. Children over 19 may be eligible for coverage under your policy if they are still in school or if they are disabled.

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How Does The Health Insurance System Work In The Us

In the US, healthcare plans are usually provided through private companies. There are some instances where the government steps in with some safety nets for those who have disabilities, are unemployed, or live at or close to poverty level. Otherwise, Americans take care of their own healthcare without assistance from the government.

Private Health Insurance To Fill In The Gaps


Another somewhat contentious issue is private health insurance. Just like in the United States, private health insurance may be offered by employers. Canadians are also free to purchase private coverage to help defray from the cost of care which is not covered by the universal services . Just like in the US, most of these private insurance companies are for-profit.

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Insurance For Expatriates Living In Canada

  • The flexibility to tailor a plan to suit your individual needs
  • Access to Cigna Globals trusted network of hospitals and doctors
  • The convenience and confidence of 24/7/365 customer service
  • Premium Benefits, Coverage and Service
  • Define your deductible and prescription benefits
  • For Foreigners in the US or US citizens abroad
  • Physical therapy
  • Psychologist visits

Outside of Quebec, Canadians are not permitted to purchase private insurance for care that is covered by the public Canadian healthcare system. The reasoning for this is a desire not to undermine the principle of universal access to healthcare.

Maintaining Your Dental Health

In Canada, our public health insurance doesnt cover the cost of most dental services. To know whats covered, check with

  • your public health authority
  • your private health care provider

Your oral health is an important part of your general well-being. Dentists can help you maintain healthy teeth and gums, treat gum disease and other problems, and understand how to improve your oral care at home.

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Health Care In Canada: Access Our Universal Health Care System

Canada has a universal health care system funded through taxes. This means that any Canadian citizen or permanent resident can apply for public health insurance.

Each province and territory has a different health plan that covers different services and products. There are some important differences between each plan so make sure you know what your plan covers.

Once your province or territory adds you to their health system, youll get a health card. Show this card at hospitals or medical clinics to get non-emergency services.

In general, with public health insurance you wont have to pay for

  • most health care services
  • emergency medical services, even if you dont have a health card

If you have an emergency, go to the nearest hospital. A walk-in clinic might charge fees if you dont live in that province or territory.

Whether you get coverage from public or private health insurance, all doctors in Canada provide health services in a confidential manner. This means that your doctor cant discuss your health information with someone else without your permission.

The Aca Improved Access To Prescription Drugs

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    Prior to the ACA, 9 percent of individual market plans did not cover prescription drugs. The ACA expanded drug coverage by requiring marketplace plans to cover at least one drug in each drug class and to count out-of-pocket drug expenses toward a beneficiarys deductible. By expanding Medicaid eligibility as well as broadening the Medicaid Drug Rebate Program, the ACA gave more low-income Americans access to brand-name and generic drugs and lowered the costs for taxpayers. The ACA also expanded the 340B drug discount to include more providers, including critical access hospitals and rural referral centers.

    The ACA also laid out a process for faster Food and Drug Administration approval of biosimilars, biologic drugs that are essentially analogous to generic versions of branded drugs. By encouraging competitors for high-cost biologic drugs, the ACA rules on biosimilars can potentially help bring down the price of these types of prescription drug costs and help make new therapies available to patients who need them. These are all important steps toward drug affordability, but there is much more work to be done.

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    Premium Tax Credits Provide More Targeted Assistance Than Reinsurance

    A commonly discussed alternative approach to making coverage more affordable for middle-income people is a reinsurance program, which would reimburse insurers for some of the costs associated with high-cost enrollees.

    Like eliminating the income cap on premium tax credits, establishing a federal reinsurance program, or providing federal funding for state reinsurance programs, would reduce premiums for consumers by investing additional federal dollars. Also like extending premium tax credits, reinsurance would provide help almost exclusively to people who arent currently eligible for subsidies.

    But as a way of directing help to these consumers, reinsurance has two significant disadvantages compared to extending tax credits.

    First, the assistance it provides is significantly less targeted. Where extending premium tax credits would guarantee all consumers at least one coverage option that costs less than 10 percent of their incomes, a similar-cost, permanent federal reinsurance program would reduce premiums by about 25 percent across the board. That means:

    Following The Medical Surveillance Process

    If you have a significant medical condition , well send you a Medical Surveillance Notice form. This form tells you that your local health authority will contact you about your condition. Theyll make sure youre registered in the health system and that your health and condition are monitored. This process protects you, your family and the public by making sure

    • youre registered with your local health care system
    • your health is monitored by the right health care professionals
    • that youre getting the care you need for your condition

    The medical surveillance form we send you will have instructions to follow.

    If you dont follow the medical surveillance process, it may impact future applications, like for visas or citizenship.

    Your local health authority will tell us when youve successfully followed the process so we can update your medical surveillance status. Well tell you when we update your status.

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    Barriers And Resources To Address Them

    For each of the nine strategies, barriers to implementation include limited federal funding, restrictive federal regulations, and a lack of collaboration and buy-in from community stakeholders . Even with federal policy changes, vulnerable communities and the hospitals that serve them may not have the resources needed to successfully adapt emerging strategies on their own. Some resources for overcoming barriers include applying for grants and establishing learning networks to share information and ideas. However, the most important resource may be hospitalcommunity partnerships.

    The building of hospitalcommunity partnerships can bring together a variety of individuals and organizations to address implementation barriers and make a bigger impact than either the hospital or a community organization could do on its own. This collaborative approach is effective because different stakeholders are addressing similar issues and serving the same populations thus working together creates an opportunity to align efforts, reduce duplication, optimize financial resources, and, ultimately, improve the overall health and well-being of the community.

    If You Need Medication For A Minor Illness Or Injury

    LETTER: Make health insurance more accessible

    If you need medication for minor illnesses or injuries that arent urgent or life threatening, you can go to a pharmacy to speak with a pharmacist. A pharmacist can help you with

    • colds
    • headaches
    • minor cuts or burns

    While pharmacists cant give you prescription medication without a note from a doctor, they can recommend over-the-counter medication to help you.

    You must pay for over-the-counter medication yourself.

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    Young Adults And Children Have Greater Access To Coverage

    One of the first ACA provisions to go into effect was the rule guaranteeing young adults the right to stay on a parents insurance until age 26. About 2.3 million young adultsa group that is less likely to have an offer of employer-sponsored insurance than their older counterpartsgained coverage under the ACAs dependent coverage provision. Later on, additional young adults gained coverage though marketplace financial assistance and Medicaid expansion. As a result, the uninsured rate among people ages 18 to 24 fell by half, dropping to 15 percent in 2017.

      About one-quarter to one-third of new enrollees under Medicaid expansion are children.

      The ACA raised standards to ensure that children in low- and middle-income families can access health coverage. It extended the minimum Medicaid eligibility level for children to 138 percent of the federal poverty level and mandated that states use a uniform definition of income to set standards for childrens coverage. About one-quarter to one-third of new enrollees under Medicaid expansion are children. The ACA also defined pediatric dental and vision care as part of essential health benefits, ensuring that kids covered through both the marketplace and Medicaid have coverage for those services. Further, expanding coverage to adultsthrough the ACA marketplaces and Medicaid expansionhelps parents stay healthy and provides financial security to the entire family.

      Making Health Care More Affordable

      For decades, rising health care costs have hurt American competitiveness, and forced too many families into bankruptcy to get their families the care they need. Thats why, after years of inaction in Washington, President Obama took on the insurance companies to pass comprehensive health insurance reform, giving Americans the security of knowing that insurance companies will be required to cover preventive care, wont be able to deny them coverage for a pre-existing condition, cant drop them if they get sick, and wont be able to bill them into bankruptcy because of an illness or injury.

      The Affordable Care Act, passed by Congress and signed into law by President Obama in March 2010, gives middle class families better health security by putting in place comprehensive health insurance reforms that will hold insurance companies accountable, lower health care costs, guarantee more choice, and enhance the quality of care for all Americans.

      Here are some of the most important ways health care reform will benefit middle class Americans, several of which are already in place:

      Ending insurance industry abuses: The Patients Bill of Rights puts consumers, not insurance companies, in control of their health care. Insurance companies can no longer deny coverage to children with existing conditions, cancel coverage when people get sick, and place lifetime dollar limits on the amount of care you can get.

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      The Share Of Uninsured People Delaying Or Going Without Care Declined In 2020

      From 2016-2018, the share of uninsured adults delaying or going without medical care increased by almost three percentage points, whereas the share of insured individuals delaying or going without medical care held mostly steady over the same three years.

      Starting with the 2019 NHIS survey, the U.S. Centers for Disease Control and Prevention redesigned the questionnaire, and updated the sampling weights methodology. As a result, changes in estimates from 2018 to 2019 cannot be attributed to actual change over time alone. We have indicated the break in the survey when presenting measures over time. The trend from 2018 to 2019 in the percent of adults delaying or foregoing care is likely at least partly due to changes to NHIS questionnaire and sampling weights, rather than actual changes in access to care alone.

      Uninsured adults continue to face access barriers due to cost of care. In 2020, 30% of uninsured adults reported delaying or not getting care due to cost reasons compared to 6% of insured adults. While the share reporting delaying or not getting care due to cost reasons decreased from 2019 to 2020, much of this is because COVID-19 presented another reason care was delayed or foregone. COVID-related stay-at-home measures, potential risk of infection at doctors offices and hospitals, and concerns over hospital capacity led to sharp declines in utilization.

      Extensiveness Of Insurance Benefits

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      The type of health insurance and the continuity of coverage have also been found to affect receipt of appropriate preventive and screening services. Faulkner and Schauffler examined receipt of physical examinations, blood pressure screening, lipid screening for detection of cardiovascular disease, Pap test, CBE, and mammography and identified a positive and statistically significant âdoseâ responseâ relationship between the extent of coverage for preventive services . Insurance coverage for preventive care increased men’s receipt of preventive services more than it did that of women. Men with no coverage for preventive services were much less likely than men with complete coverage for such services to receive them . Women with no preventive services coverage also received fewer of these services than did women with full coverage for them .

      Ayanian and colleagues used the 1998 BRFSS data set to analyze the effect of length of time without coverage on receipt of preventive and screening services for adults between ages 18 and 65. Those without coverage for a year or longer were more likely than those uninsured for less than one year to go without appropriate preventive and screening services. For every generally recommended service , the longer-term uninsured were significantly less likely than persons with any form of health insurance to receive these services .

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      What Is The Affordable Care Act

      The Affordable Care Act provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:

      • You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans.

      • Insurers can’t refuse coverage based on gender or a pre-existing condition.

      • There are no lifetime or annual limits on coverage.

      • Young adults can stay on their familys insurance plan until age 26.

      • Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.

      Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.

      Yet Still 1 In 11 Adults Reported That They Delayed Or Did Not Get Care Because Of Cost Reasons

      Most Americans do not report cost-related access barriers to health care. Still, a substantial portion of the population about 1 in every 11 adults said that they either delayed or did not receive medical care due to cost reasons in 2020. Though the share of people reporting not delaying or getting care due to cost reasons slightly decreased from 2019 to 2020, this is because care was delayed or did not happen due to the COVID-19 pandemic in 2020.

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      How To Get Cobra

      Group health plans must give covered employees and their families a notice explaining their COBRA rights. Plans must have rules for how COBRA coverage is offered, how beneficiaries may choose to get it and when they can stop coverage. For more COBRA information, see COBRA Premium Subsidy. The page links to information about COBRA including:

      Without Insurance Healthcare In Canada Is Expensive

      How Does Health Insurance Make Money

      How is healthcare in Canada for those without insurance? With no public or private insurance, patients are expected to pay for their medical care. Though Canadian healthcare costs are overseen by the government, uninsured patients can be charged higher rates. For example, one Ontario hospital charges non-residents hundreds of dollars more for healthcare :

      • MRI: Non-resident of Canada $2,030
      • Lab tests: Non-resident of Canada $360
      • X-Ray: Non-resident of Canada cost starts at $49

      Signing up with a general practitioner will ensure you have a provider to oversee your medical care. However, finding an office that is accepting new patients may be difficult, particularly in rural areas. If you need help finding a primary care physician, the health insurance offices in all provinces and territories have resources to assist you. There may also be immigrant-serving organizations or expat communities that can offer guidance. For those with private insurance, your insurer should be able to tell you about providers.

      Even without a primary care physician, you can easily access medical care in Canada. For non-emergency situations, visit a walk-in clinic or community health center. Services like Medimap are available to help you find a clinic, as well as specialized care providers.

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