If you’re anything like me, you’ve probably heard the word “healthcare” being thrown around so often and still don’t know what it entails. I recently attended a presentation given by two of my friends who work at Centers for Medicare & Medicaid Services (CMS), and I would love to share with you what I learned in hopes that you also benefit from a basic understanding of healthcare in the U.S.
CMS administers the Medicare program, Medicaid, and oversees CHIP (Children’s Health Insurance Program)… but wait, what does all of that even mean?
Think of it this way:
Medicare is care for the elderly.
Medicaid is aid for low-income individuals.
CHIP is a program for the uninsured children and pregnant women in families with low income that is too high to qualify for Medicaid.
Let’s break it down even further:
MEDICARE
Medicare is a federal health insurance program that covers three groups of people:
1. People who are 65 and older
2. People under the age of 65 with certain disabilities
3. People of any age who have End-Stage Renal Disease (ESRD)
There are four parts to medicare:
Part A helps pay for inpatient hospital stays, and skilled nursing care.
Part B helps cover outpatient care and doctor visits.
Part C combines Parts A and B and is managed by private insurance companies approved by Medicare.
Part D helps pay for outpatient prescription drugs.
MEDICAID
Medicaid is jointly funded by the Federal and state government and is the nation’s primary public payer of acute health, mental health, and long-term care services. Medicaid eligibility is based on income and resources, and is determined by each state.
CHILDREN’S HEALTH INSURANCE PROGRAM
CHIP provides health coverage to nearly 8 million children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
So, how does ObamaCare play into all of this?
PATIENT PROTECTION AND AFFORDABLE CARE ACT (OBAMACARE)
The Affordable Care Act is a new health reform law that Obama signed in 2010. It requires most U.S. citizens and legal residents to have health insurance by January 1, 2014. Those without coverage will pay a tax penalty (unless they qualify for a hardship exception). However, not all states are required to participate in the Medicaid expansion. The incentive is that states will get federal matching of 100% for every new Medicaid enrollees over the first three years, and 90% afterwards. Check out this statistic:
This is what changed under ObamaCare:
THE UNINSURED
These are usually low income working families that don’t have access to employer-sponsored insurance, or folks that have a pre-existing condition that makes insurance unaffordable or inaccessible.
Cool, so what’s the problem with healthcare?
The issue is that currently, 18.5% of the non-elderly population is uninsured because health insurance policies are too expensive. The question becomes: how do we reconcile assisting those in need of medical health care with the fact that healthcare spending is exceeding our budget?
THE HEALTH INSURANCE MARKETPLACE
Starting this fall, there is a new way to buy health insurance: the marketplace. Through this program, you can find a health insurance that fits you budget (so long as you’re not currently incarcerated).
WHY THIS MATTERS TO YOU!
It matters because affordable health care is vital for the wellbeing of every individual and should be a fundamental right. It matters because personal responsibility is a foundation for change. It matters because you have a voice in helping the health of your community! If you’re young, healthy, and uninsured, it’s a good time to get covered. There are many health insurance options available! Most importantly, it’s a good time to get educated about issues that affect us and the world around us.
Quality Time with Christine 