Healthcare reimbursement in United States is a hybrid of public and private, and for profit and non-profit insurers. With so many players involved, the healthcare system is uncoordinated and fragmented. The cost of healthcare has also continued to rise with the quality far from ideal. The past two decades have seen policies implemented through the Children’s Health Insurance program and the Patient Protection and Affordable Care Act (ACA). These policies have improved access to affordable health coverage to people who were previously uninsured and those not eligible to Medicare. The implementation of these policies have seen the population of uninsured Americans reach a low of 8.5%(Crowley et al., 2020). The most vulnerable and young adults have been major beneficiaries of these policies. The government is committed to ensuring that all people have affordable health coverage.

Adults over the age of 65 years and some people with disabilities are eligible to benefit from the national Medicare program. The federal government also provides various programs for veterans and people with low incomes. The states manage and pay for local coverage. Employers also provide private insurance. When the Affordable Care Act became law in 2010, more than 16% of the population was not insured(Crowley et al., 2020). However, the rate has dropped to 8.5% of the population. Health insurers, both public and private set their own benefit packages and cost-sharing polices which are guided by federal and state regulation.

There is no universal health coverage in the United States. In 1920s, employer-sponsored health insurance was introduced. It gained popularity over the years with 55% of the population under this coverage in 2018. In 1965, Medicare and Medicaid were enacted through the Social Security Act with other public insurance programs. The Medicare program provides health care coverage to persons aged 65 and above. Medicaid program was first used to give states the option to receive federal matching funding in order to ensure heath care services for low income households and people with disabilities. The program was eventually made mandatory to expectant women and children up to the age of 18 years. The program offers coverage to almost 18% of the population(Crowley et al., 2020).

The Affordable Care Act represents an expansion of government role in financing health care. The law requires Americans to obtain health care insurance. It also extended coverage for young adults by allowing them to continue with parent’s private health plans until the age of 26. States were also allowed to expand the expand Medicaid eligibility. This program resulted in more than 20 million people gaining coverage thereby reducing the number of uninsured adults to 12% by 2018.

The Affordable Care Act established a cost-sharingresponsibility by the government, employers and individuals to ensure that Americans can have access to affordable health insurance. States also co-fund various health coverage programs as required by federal regulations. They set the eligibility criteria and cost sharing requirements of the health package. States also fiancé health insurance for state employees and regulateprivateinsurance. Public health insurance accounted for 45% of the total health care spending in 2017. Medicare and Medicaid service centers are the largest source of government health funding(Crowley et al., 2020).

In 2018, private health insurance accounted for 34% of total health expenditures. Almost two thirds of the American population rely on private insurance for health coverage. Majority of this is from employer sponsored insurance, with only a small share purchasing from for-profit and nonprofit programs. The country is spending twice as much per person on health care as compared to other countries(Warren, 2018). This is caused by the high prices of private health insurance. Private insurance pays higher prices than what public programs such as Medicare pays for the same services. The high prices lead to high premiums and out-of-pocket costs for people with private insurance. Employers who contribute to the cost of coverage also face higher premiums. In 2018, 173 million Americans had private insurance. Out of this, 154 million were from an employer plan. Thus, employers face rising health expenses to cover their employees.

The disparity in costs of private insurance and public health insurance has called for measures to standardize health insurance coverage. The Medicare Payment Advisory Commission reports that Medicare beneficiaries are satisfied with their care and have no trouble accessing health care. Despite the lower payments, Medicare beneficiaries are satisfied with the quality of care(Warren, 2018). This has brought calls to lower private insurance reimbursement to Medicare rates. However, it is not clear whether this will affect access and quality of care.

Federal and state lawmakers have proposed using Medicare rates to gain control of health care prices. Maryland state has created a Health Services Cost Review Commission to set hospital rates regardless of insurance. Legislation at the federal and state level have the ability to limit health care prices. However, proposal to limit private insurance reimbursement will be met with fierce opposition from providers as it will decrease revenue. In recent times, Medicare for all proposal have met opposition. Adoption of Medicare rates for all would see hospitals loose revenue which might affect the quality of care due to cost cutting measures.

References

Crowley, R., Daniel, H., Cooney, T., & Engel, L. (2020). Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Annals Of Internal Medicine, 172(2_Supplement), S7. https://doi.org/10.7326/m19-2415.

Warren, S. (2018). Medicare Proposes Overhaul to Home Health Payment. The ASHA Leader, 23(9), 24-25. https://doi.org/10.1044/leader.pa1.23092018.24.