Health Insurance and the Affordable Care Act – Health System Example

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"Health Insurance and the Affordable Care Act" is a perfect example of a paper on the health system.   Purchasing health insurance for an organization taking into consideration employee lifestyle choices and health economics would factor A health plan for groups is a welfare benefit plan for employees instituted and maintained by a union that is an employee organization, or an employer or both, that gives medical care for contributors or their dependents through insurance or directly, reimbursement, or otherwise. An EPO plan would be most suitable for a fifty people organization with different lifestyles and would also be cost beneficial.

The acronym EPO stands for the Exclusive Provider Organization plan. A member of an EPO may utilize the hospitals and doctors within the network, but can't go outside it for care. There are no benefits outside the network. (Barr, 2011). EPO plans generally provide the best level of in-network use hence maximizing the favorable effects of the agreed network discounts or rates. Personal care physicians within the network help facilitate appropriate and convenient access to specialists for persons who are covered. EPO plans generally have self-funded plan costs or the lowest premiums since doesn’ t charge for some preventive care, as well as routine screenings and annual exams.

Also has affordable co-insurance or co-payments for each visit once one has met his/ her deductibles if any. It allows for no claim forms or referrals. There is freedom for one to select his/ her own care providers within the national network alongside global coverage for emergency care.   All in all, an EPO plan may bargain for a lower rate with this plan with an HMO or PPO plan (Barr, 2011). Implications of the Affordable Care Act on ones decision to purchase insurance The Affordable Care Act was brought into law on 23rd March 2010 by President Barack Obama in order to bring reforms to the health care sector.

on June 28, 2012, it was upheld by the supreme court. The act makes health insurance affordable, quality, and available to both private and public through regulations, taxes, protection of consumers, insurance exchanges, subsidies, and other reforms. For one to purchase insurance, its plans have met the basic requirements of the ACA.

The cost of insurance also has to be taken into consideration. For those who cannot afford they can get subsidized health insurance based on their income or become eligible and exempt for cost assistance. The price of insurance will be footed on tobacco use, age, and a number of people in the family rating area. Advantages and disadvantages of purchasing health insurance as opposed to having your employees receive governmental insurance The employer-based health insurance market offers almost two- thirds insurance coverage to the under 65 population. It has various advantages as compared to state insurance as discussed below. For one it offers economies of scale.

Groups of employers get some sort of leverage in buying health coverage, depending on group size. Therefore groups pay considerably less per capita for health coverage of the same benefits than individuals. as the bargaining unit, individuals only have themselves and their dependents which is a weak alternative. This type of approach gives cost-effective and high-quality health coverage for many Americans. Another advantage is it enhances wellness. The involvement of the employer in the provision and choice of health care benefits makes an environment that looks into employee productivity and health not forgetting wellness and prevention.

(Cooper & Schone, 1997) On the demerits, one, it maintains a mystery on who in fact pays for the medical care used by employees. Both employees and employers appear to believe that the firm caters to the cost of the contributions to the insurance premiums for their workers, about 80 percent of the premium.   Employers suppose that the costs could either be recovered through the prices of services or the goods or they sell whereas employees seem to believe that health insurance paid by the employer is God-send, a gift on top of their pay.

Consequently see a little individual gain in trying to control their health care costs (Cooper & Schone, 1997). The second chief failing is the lack of permanency in employment-based health insurance. It is usually attached to a particular post in a particular company and is lost on the loss of employment. This translates to a lack of health insurance in unemployment (Cooper & Schone, 1997).


Barr, Donald A. (2011). Introduction to U.S. Health Policy: The Organization, Financing, and

Blumberg L. J. et. al. (2001). Worker decisions to purchase health insurance. Int J Health Care Finance Econ; 1:305-25.

Cooper P. F. , Schone B. S. (1997). More offers, fewer takers for employment-based health insurance: 1987 and 1996.; 16(6):142-9.

Delivery of Health Care in America . JHU Press.

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