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Linda J. Blumberg, John Holahan, Jack Hadley, and Katharine Nordahl, Setting A Standard Of Affordability For Health Insurance Coverage, Health Affairs Web Exclusive, June 4, 2007 [Abstract] [PDF] [Technical Appendix] [Reprints & Permissions]

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Health Insurance Coverage: A Response

Mustafa Younis, William B. Cissel, Ph.D., MSPH, CHES, David Bernstein, J.D., Esq., Hassan Younies   ( 25 July 2007 )

Definition Of 'Affordable Health Care'

Marjorie A. Rosenberg, Paul H. Johnson Jr., Ian Duncan   ( 7 August 2007 )

Affordability Not The Entire Story

Jeffrey T. Kullgren, Catherine G. McLaughlin   ( 16 August 2007 )

Health Insurance Coverage: A Response 25 July 2007
Mustafa Younis, Associate Professor Florida International University, William B. Cissel, Ph.D., MSPH, CHES, David Bernstein, J.D., Esq., Hassan Younies Send comment to journal: Re: Health Insurance Coverage: A Response younis99{at}gmail.com Mustafa Younis, et al.	Affordable health care for all Americans has been an issue since the Truman administration. However, within the global market, health care has become a burden on multinational corporations headquartered in the United States. Furthermore, it has become more burdensome for American families. The main reason for bankruptcy in the United States is the inability to pay for medical expenses. In 2006 more women filed for bankruptcy than enrolled in colleges and universities. Most of these bankruptcies were the result of an inability to pay for health care. The United States is one of very few industrialized countries that have health insurance linked to employment. Since individuals, in collaboration with their health care providers, know more about their health than the insurance firms, the most obvious reason for this system is for the insurer to be able to insure mainly the healthy members of the population. The premise is that the healthiest members of the population are the ones who are able to work. The debate regarding health care as a right or privilege has not been substantially settled. Should public health care be treated as a right? Or is it a privilege? Should the businesses that comprise the health care industry be treated as a regulated monopoly? Many leaders in the health care industry keep telling us that Americans do not need a health care system run or controlled by the government. Whether it is run by the government or private enterprise, people want and clearly need affordable health care. One part of the solution for reducing the escalating cost of health care is to create a single health insurance payer or a quasi-governmental health insurance agency. The proposed corporation would negotiate drug prices and payments for hospitals and physicians and would provide malpractice insurance to health care providers. As a natural monopoly, such an insurance agency would have lower costs due to economies of scale. With a single insurer, reimbursement and billing would be standardized, which in turn would reduce the cost of services provided by hospitals, physicians, and other health care providers. This would result in an economically efficient health system, providing access to care through equitable financing, efficient supply of services, and financial sustainability. Another key facet of the solution is to stop linking health insurance to employment. If the healthiest members of the population were permitted to obtain health insurance outside the system insuring the vast majority of the population, the costs for care of the rest of the population would be inordinately expensive. The final facet of the proposed solution is including health promotion and disease prevention services within the health insurance program. It behooves the program to have clients improve their fitness and mental/emotional well-being to avoid expensive health care services. In long run, market forces would moderate demand for health care.
Definition Of 'Affordable Health Care' 7 August 2007
Marjorie A. Rosenberg, Associate Professor University of Wisconsin-Madison, Paul H. Johnson Jr., Ian Duncan Send comment to journal: Re: Definition Of 'Affordable Health Care' mrosenberg{at}bus.wisc.edu Marjorie A. Rosenberg, et al.	The article by Linda Blumberg et al. defined a benchmark standard of affordability for an individual or family as a “share of income now devoted to health spending by privately insured people” in the context of the Massachusetts legislation designed to expand health insurance coverage. Health care affordability is a vague term that is usually used without being defined. The legislation helps define affordability synonymously with the presence of health insurance coverage. Affordable health insurance is not equivalent to affordable health care. The determination of affordability depends on the perspective taken. What is affordable for a person who is currently insured could make it unaffordable for the employer, for the government, or for the insurer. Health care affordability of one stakeholder, such as a consumer, should not be defined in a vacuum without consideration of the interrelated impact of events on other stakeholders. The impact of the health insurance legislation in Massachusetts will have interaction effects. The level of what is deemed to be affordable will impact the number of those who can obtain subsidized health insurance, as well as the level of government expenditures. Any shortfall in the program would be shifted to other stakeholders. The definition of "affordable health care" for the U.S. health care system must be defined from each of the individual stakeholder perspectives and examined for impact of changes one each stakeholder to determine the affordability for the health care system.
Affordability Not The Entire Story 16 August 2007
Jeffrey T. Kullgren, Resident in Internal Medicine Brigham and Women's Hospital, Catherine G. McLaughlin Send comment to journal: Re: Affordability Not The Entire Story jkullgren{at}partners.org Jeffrey T. Kullgren, et al.	Blumberg and colleagues discuss how to determine affordability standards for health insurance premiums, with direct application to the current Massachusetts health reform. Affordability of health insurance and health care is understandably the primary focus of many state initiatives aimed at improving access for the uninsured, as financial barriers to health care in this population are well-documented. Health services researchers have also long recognized, however, that access to care is a multidimensional concept consisting of both financial and nonfinancial dimensions. While there is currently little information on the degree to which nonfinancial barriers contribute to the access problems of the uninsured, surveys of more than 1,000 participants in the Robert Wood Johnson Foundation's Communities in Charge program found that while affordability problems most often limited access, nonfinancial barriers were common and often coexisted with financial barriers. Half of the respondents who reported at least one affordability barrier also reported a non- affordability barrier. Language problems, difficulty getting to the provider during office hours, and simply not knowing where to go were often cited as reasons for not receiving the medical services that they needed. The Massachusetts health reform and similar coverage expansion proposals being considered at all levels of government generally do not include formal plans to address these nonfinancial barriers. Little attention, for example, has been paid to concurrently expanding primary care capacity or ensuring that culturally appropriate safety net services are readily available. To the extent that coverage expansions truly seek to eliminate disparities in access based on insurance status, focusing solely on making medical care more affordable will likely not yield the desired effect. Targeting only financial problems without concomitant efforts to identify and remedy coexisting nonfinancial barriers will still leave unsolved problems of unmet need and the resulting deleterious health effects.