Universal Health Care And My Hmo

By Author: Jerry Wetzstien
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If you are currently covered by an HMO plan, you may be wondering how universal health care will affect your plan. Many covered by HMOs are wondering the same thing and are apprehensive about any changes that may increase costs or decrease their quality of care. Here is a simple breakdown of how your plan may be affected if national coverage is implemented.

The idea of universal health care is not a new one. The premise that all Americans should have access to basic healthcare coverage has been around for decades. However, the idea became re-energized during the Clinton administration when the then president proposed his own version of a comprehensive health care plan. That proposal failed miserably but the heated debate it generated has never fully died down. Since then, several bills have been considered.

In 2005, the House of Representatives introduced HR676, entitled the U.S. National Health Insurance Act which would have established a comprehensive plan under which all U.S. citizens would have been eligible for free health care covering all medically necessary care including primary care and prevention, prescription ...
... drugs, emergency care and mental health services. This bill, just like Clinton's version, eventually went nowhere.

Some mistakenly refer to universal health care as a single-payer plan which would supplant most insurance. Whereas some proposed plans involved coverage through a single government-backed payer, others offered a combination of public and private coverage. In some of these cases, employers and employees would contribute a percentage and a government-backed entity would also provide contribution. HR676 fell under this type of combination.

Right now, the U.S. is the only industrialized country without universal health care. Both sides of the divide have their arguments why this is or is not a good situation. Some argue that no civilized country should have citizens who are denied basic healthcare and that U.S. mortality rates compare miserably with that of other Western countries, even some third-world countries. Others claim that such coverage would result in higher taxes for everyone and a diminishment in the overall quality of medical care. The basis for this argument is the simple axiom that you get what you pay for. Hypothetically, if everyone is guaranteed basic health care, monies would be stretched thin and hospitals would no longer be able to pay competitive salaries to physicians nor invest money in the latest technology or research and development.

The criticism again some insurers is that there is discrimination against those with pre-existing conditions and extensive limits based on age and gender. Health Maintenance Organizations, familiarly known as HMOs, in particular have taken hits because of the strict guidelines under which physicians can participate and practice as well as the procedures allowed for their patients. These measures were implemented to control medical overspending and reimbursement abuses. On average, HMOs cost patients less in premiums than traditional insurance plans and many of those covered under HMOs are satisfied with their premiums and their care.

The current plan proposed by Obama is termed the "public option plan" and stipulates that those presently covered by insurance, including HMOs, would not be affected detrimentally. Among the stipulated benefits, the proposed plan asserts it would:

End discrimination against people with pre-existing conditions;

Limit premium discrimination based on gender and age;

Prevent insurance companies from dropping coverage when people need it most;

Cap out-of-pocket expenses so people don't go broke when they get sick;

Eliminate extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money;

Protect Medicare for seniors; and

Eliminate the "donut-hole" gap in coverage for prescription drugs. The donut-hole refers to a coverage gap in Medicare Part D that is the difference between the initial coverage limit and the catastrophic coverage threshold once a beneficiary surpasses the prescription drug coverage threshold.

The plan supposedly would be funded by an increased tax on the wealthy; middle-income families should not see a rise in their taxes.

The plan also would require that large employers cover their employees and individuals who can afford to buy insurance do so. How this would translate into premiums and quality of coverage is still being debated. Would employers have to raise premiums on their employees? Will individual HMO plans also see an increase in premiums and more restrictions on coverage? These questions still need to be adequately answered.
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