The Financing of Health Care in the United States

The Financing of Health Care in the United States
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The Financing of Health Care in the United States
Introduction
The economic turmoil caused by the Covid-19 pandemic has renewed the focus on medical insurance coverage as millions of Americans lost their sources of livelihood and, consequently, their medical coverage. Obamacare was tailored to address gaps within the healthcare system that left millions of individuals and households without medical insurance by reforming the Medicaid insurance to include low-income households and offering Marketplace coverage grants for poor individuals. After the enactment of the Affordable Care Act (ACA), the number of nonelderly Americans without insurance coverage reduced by 20 million, declining to the utmost low in the year 2016. However, the number of nonelderly Americans without health insurance increased for three consecutive years starting in 2017, rising by 2.2 million from 2016’s 26.7 million to 2019’s 28.9 million. The rate of the uninsured rose from 10 percent in 2016 to 10.9 percent in 2019. This paper examines the United States population’s health care insurance coverage status, discussing the key insurance findings regarding Maryland, the key primary payers and their coverage percentages, the percentage of the uninsured and underinsured in Maryland, and what the trend graph shows in regards to public or private payers and the uninsured.
Summarize the key insurance findings regarding your state of choice.
Based on the medical insurance coverage of the total population map, the state of Maryland falls under the tier two category with a total of 3,213,800 insured individuals (Kaiser Family Foundation, 2022). Tier two is a category that includes states that have between 2,264,600 and 4,968100 insured individuals (Kaiser Family Foundation, 2022). The insured population is quite significant, considering that it represents more than half of the state’s population during the year. The state defers to the Affordable Care Act (ACA), which provides federal requirements for coverage. ACA requires that all citizens have health insurance that meets a prescribed coverage standard. Maryland’s approach infers that it does not have state-specific health insurance laws outside the requirements of ACA. Citizens have multiple options available that provide coverage for health care costs. The choice of any option is dependent on an individual’s coverage needs, ability to pay, and employment status. By subscribing to ACA, Maryland, like many other states, has managed to address the dual challenges of lack of insurance coverage and high care costs. Residents can obtain health insurance from private providers during open enrollment in securing coverage. If an individual misses this period or is otherwise unqualified, they can access coverage through unique short-term plans. Based on Maryland’s Medicaid fact sheet provided by Kaiser Family Foundation (2022), the state had one of the best-uninsured rates of 7% in 2019.
Who are the primary payers, and to what percentage of the coverages?
In Maryland, the primary payers include employers, Medicaid, and Medicare, whose percentages of coverage are 54.7%, 18.7%, and 13.3%, respectively. The employer category included coverage by a current or past employer or a union, in which case the person being insured is either a dependent or a policyholder. Payments by Medicaid include a wide range of coverages, amongst them Medicaid, Children’s Health Insurance Plan (CHIP), and any other form of medical assistance facilitated through government plans for individuals with disabilities or low incomes. Payments by Medicare include a host of non-Medicaid coverages except for dual-eligibles. Employers stand out as the biggest payers considering that they cater for coverage as benefits to the employees. Coverage ranges from health insurance for full-time employees to coverage for part-time employees and staff health insurance premiums payments. Although employers pay the most, expanding employer coverage has been slow compared to Medicaid expansion and growing Medicaid-managed private insurers (Sommers et al., 2017). Compared to other states, the trend is similar where the three payers (employers, Medicaid and Medicare) finance coverage more. This trend can be explained partly by the existence of an individual mandate penalty for individuals who did not obtain insurance (Frean et al., 2017) which positions the three payers as the readily available options to ensure compliance. Although the penalty remains canceled presently (Gostin, 2019), there lacks data to develop a comparative analysis to determine if the trend applies nowadays. The percentage of those covered by employer-sponsored insurance either via their own employment or as a dependent of the same family reduced from 62.2 % in 2008 to 54.7% in 2019 in Maryland (Kaiser Family Foundation, 2022). However, employer-sponsored health insurance remains more prevalent compared to non-group, Med...