Being an American if you’re not worried about the state of health here there are some statistics that can get your head reeling for sure! Despite being right up there economically America faces innumerable health risks and not for nothing. According to a study, United States is the only nation that’s gone through industrialization without paying much heed to its health insurance system. A UN Health Development report takes one further into the details. According to that, the uninsured have a real tough time dealing with health disorders simply because they’re uninsured. Hospitals and medical centers do not take it into their stride if they find uninsured persons seeking care and the latter end up with less than their fair share. Additionally, their chances of receiving quality outpatient care also go down a few notches.

Other studies reveal how Americans are more prone to diseases. Even a child born to this nation does not have as many chances of survival as a baby born in El Salvador has! Canada who is one of the closest neighbors records better health amongst commoners. At least that is what a report claims when it says Canadians, on an average, have a longevity of about three years more than Americans. And believe it or not Cuba also wins when it comes down to average longevity!

The final one should come as a surprise- more than 90% of Americans feel the health insurance system will either have to undergo dramatic change or it will have to be discarded completely for a set- up that’ll serve the people better!

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The Great Depression of the 1930s devastated the health insurance industry. Millions of people lost their jobs and had little money to pay for “extras” like insurance, so few bought new policies and many stopped paying the premiums on their existing policies

Many people falsely claimed sickness disability benefits, since these benefits were sometimes the only possible source of income for someone who could not find a job. As a result, the claims that companies paid rose in relation to the premiums they received.

As damaging as the Depression was, there were many positive developments during this period. Companies became more financially cautious, which helped bring about a more stable industry with fewer company failures

A new spirit of cooperation emerged-companies became more willing to share with each other information about the claims that they paid, and actuaries and underwriters were able to use this information to set premiums at competitive but adequate levels

Medical expense insurance, which had been pioneered in the 1920s, developed and spread, and employment-based group health insurance, on which the modern health insurance environment is centered, emerged.

The Development of Medical Expense Insurance

Medical expense insurance differs from the earlier sickness insurance in that benefits take the form of reimbursement for the actual cost of hospital, surgical, and medical services, not a lump-sum payment for days of illness

The first form of medical expense insurance was individual hospital expense insurance, which was written in the 1920s. This insurance covered only hospital services (not surgeons’ or physicians’ services) and was first offered by hospitals themselves

The first group hospital expense insurance policy was written in 1929. Baylor University Hospital in Dallas, Texas insured 1,500 school teachers who were members of a mutual benefit society. The benefits provided were up to 21 days a year of semiprivate room and board and necessary hospital services and supplies.

Health Insurance in the Early 20th Century

During the Depression, hospitals were faced with declining revenues as people without jobs could not afford to pay for hospital care. As a solution, many hospitals adopted the group hospital expense insurance plan pioneered at Baylor

Many people who could not pay large hospital bills could pay small premiums, and these premiums provided the hospitals with income

Around the country several hospitals in the same state or part of a state banded together to offer this kind of insurance. This was the origin of the Blue Cross plans.

Group hospital expense insurance was also provided by employers and commercial insurers. This first occurred in 1934, when the General Tire & Rubber Company asked its insurer to add hospital expense benefits to the group insurance program it provided for its employees.

Hospital expense insurance covered only services provided by hospitals, not surgeons’ fees nor physicians’ charges for hospital, home, and office visits. This gap was filled when commercial insurers introduced group surgical expense benefits beginning in 1938, followed by group medical expense benefits to cover physicians’ visits in 1943

Physician-sponsored surgical-medical coverage was first offered in 1939, when the state medical society in California established the California Physicians’ Service, a statewide plan. This was the first of the Blue Shield surgical-medical Health Insurance in the Early 20th Century

Labor unions have been active in the United States since the mid-19th century, but before the Depression only a small minority of workers were union-members.

In the 1930s and 1940s unions grew dramatically and gained increased leverage in negotiating with employers. One of the things that unions began to demand was employer-sponsored group health insurance, and in 1948 the National Labor Relations Board ruled that unions had a right to make this demand as part of collective bargaining.

The Supreme Court confirmed this ruling in 1949. As a result, employment-based group health insurance became the norm for unionized labor. Most unionized companies offered group health insurance to their nonunion managerial employees as well.

The growth in employment-based group health insurance was also encouraged by federal tax policy. Employers were allowed to deduct as a business expense their expenditures for employee health coverage. And individuals did not have to pay income tax on employment-based health coverage-even though it was given to the employee by the employer it was not considered taxable income. This made health insurance attractive to both businesses and employees.

The Spread of Employer-Sponsored Group Health Insurance

Employer-sponsored group health insurance plans (which centered on medical expense coverage) experienced tremendous growth in the 1940s. This growth was spurred by war-time wage controls, labor union demands, and tax policy.

During World War II, in an effort to control inflation, the federal government prohibited industrial employers from raising wages or prices. This meant that although labor was scarce because so many people were in the military, employers could not raise salaries to attract and retain workers. But providing fringe benefits, including health insurance, was not forbidden, and this is what many employers did.

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Unlike Medicare, Medicaid provides extensive benefits for long-term care. But the Medicaid program was created to pay for care needed by the poor, and only those who meet the program’s definition of poverty can receive these benefits.

Some people who are not poor when they first need long-term care are eventually able to rely on Medicaid to cover the costs of their care. They spend their assets and income on care until they have very little left, at which point they meet Medicaid’s definition of poverty and qualify for benefits. This practice is called spending down. It is a viable means of meeting long-term care needs, but it has significant drawbacks, some obvious and others not so obvious.

Spending down of course results in the loss of financial independence, as a Medicaid recipient is left with extremely limited assets and income. An elderly person who has worked hard and been self-supporting her whole life becomes indigent and must depend on the government for her needs. Spending down also means that hard-earned assets cannot be used for such purposes as helping grandchildren go to college, and they cannot be left to heirs.

The types of long-term care available to a Medicaid recipient are often limited. Benefits for home and community-based services are not offered by all state Medicaid programs, eligibility for them may be restricted, and funding is generally limited. And only a few state programs pay benefits for care in assisted living residences. Consequently, some Medicaid recipients who could be cared for at home are forced to enter a nursing home.

Finally, a Medicaid recipient may have a limited choice of long-term care facilities, and the facilities generally considered the most desirable may not be available to her. This is because in most states facilities receive less for caring for Medicaid recipients than they do from private patients. For this reason, some nursing homes that have a superior reputation and can easily fill their beds do not accept Medicaid recipients. Most nursing homes that do admit Medicaid patients allocate only a limited number of beds to them, and the most popular of these facilities often have long waiting lists for Medicaid recipients. As a result, Medicaid recipients often end up in facilities that, while certified by Medicaid and perfectly adequate, are found by others to be less desirable for various reasons. Another consideration is that, if fewer facilities are open to a Medicaid recipient, she may have to go wherever a bed is available, which might be distant from her family and friends.

In summary, those who rely on Medicaid to meet their long-term care needs lose their assets and their financial independence and have limited choices of types of care and facilities.

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The state and the Hawai’i Medical Service Association have reached an agreement to provide an estimated 3,500 uninsured children in “gap group” families with health coverage.

The three-year Keiki Care Plan pilot project is aimed at families who do not qualify for state or federal healthcare programs but can’t afford healthcare premiums.

The majority of these families have household incomes equal to or more than 300 percent of the federal poverty level, according to HMSA.

These programs would help those families who are unable to get health coverage.

Because these children have no access to preventive care, many are often taken to emergency rooms. This care often is not compensated, placing a burden on hospitals and physicians.

“This is more than just a family problem,” Cliff Cisco, HMSA senior vice president, said in a statement. “It’s a community problem and it requires a community-based solution where public and private sectors work together to cover our children.”

Lillian Koller, director of the state Department of Human Services, said this plan will ensure that all Hawai’i children will have access to healthcare.

“By launching Keiki Care, Hawai’i has moved a step closer toward our goal of all residents having access to quality health insurance,” Koller said.

HMSA, Hawai’i’s largest insurer, and the state each will contribute $1 million to cover the cost of the premiums.

Laura Lott, HMSA spokeswoman, said HMSA will use money from its $500 million reserve fund to pay for the program, which she said will not be subsidized by HMSA membership dues.

To be eligible, children must be between 31 days and 19 years old, live in Hawai’i, be uninsured continuously for at least six months and be ineligible for any other federal or state health plan, such as Quest. The Quest program is available to low-income families.

Enrollment begins Saturday and coverage will take effect April 1.

“The Quest kids are taken care of, and then there’s a group whose families make too much money to qualify for Quest, but then maybe the work provides for mom and dad, but it doesn’t offer a children’s benefit,” Lott said. “So those are the groups that we really are targeting.”

The Keiki Care Plan will provide basic healthcare benefits, including doctor visits, immunizations, diagnostic tests, certain preventive services, emergency care, mental-health care, dental services and some prescription drugs.

Although families won’t pay a premium, they will be responsible for copayments for certain services. Office visits would require a $7 copayment, for example, while hospital stays will cost $100 per day.

Anyone with questions about the program should call HMSA at 948-5555. Information about the program should be on HMSA’s Web site, www.hmsa.com, by Saturday, Lott said.

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