September 4,2009
HEALTHCARE GLOSSARY
Republicans and Democrats have been trying to pass health care
Legislation for many years, as a result, politicians and media
often assume citizens are familiar with the ongoing legislative
buzzwords associated with it. Below is a glossary that will help
you become fluent in the language of health care:
The Exchange A "marketplace" created by the legislation in which
individuals could comparison-shop for insurance plans overseen by the
government . Plans offered within this exchange must meet certain
basic standards, to be determined by an "expert panel" (see below) It's
still unclear on which level these exchanges would be offered e.g.
national, regional, statewide, etc.
Single-payer System Sometimes called "Medicare for all" a system
in which one entity (typically the government) arranges payment for
everybody's medical care. This is in contrast to the multiple health
insurance companies that now assume this task. Advocates of a
single-payer system say it would simplify paperwork, eliminate
administrative costs and more easily achieve universal coverage;
opponents call it "socialized medicine.
Public Option Also called a "government-run plan," this
government-sponsored insurance policy would be offered alongside
private plans within the "exchange" (see above). The goal would be to
insure a greater number of Americans by offering more choices and by
setting reimbursement rates for doctors and hospitals – which could
also prompt insurance companies to compete more fairly and cut
premium costs, proponents say.
Co-ops Senate Budget Committee Chairman Kent Conrad (D-ND) has
proposed "health cooperatives" as a compromise/alternative to the
public option. Like the public option, these co-ops would be nonprofits
and would compete with private plans within the exchange. But the key
distinction is that they'd be "owned" by members, not the government
(although the government would likely provide initial start-up help).
Universal Health Care A situation in which everyone has medical
insurance. This is difficult to achieve without a single-payer system in
which every citizen is automatically covered, even if Americans were
required to purchase insurance. In August, Obama estimated that the
various health care legislation would likely cover only about 38 million
of the estimated 46 million Americans without insurance.
Gang of Six Three Democrats and three Republicans on the Senate
Finance Committee. The "centrist" Gang of Six is reportedly working
toward a bipartisan Senate bill by Sept. 15.
Underinsured Those who have an insurance plan that provides poor
coverage against illness. Some researchers define it as spending more
than 10 percent of income on out-of-pocket medical costs (excluding
premiums). By some estimates, more than 60 percent of
bankruptcies are linked to medical expenses; and in about 75% of these
cases, the individuals filing for bankruptcy had health insurance.
Expert Panel Both House and Senate bills establish an "expert panel"
from various health and medical disciplines to determine which benefits
meet minimum requirements for inclusion in the health insurance
exchange.
Medicare A taxpayer-supported government insurance program for
persons who meet specific medical criteria and/or are age 65 and older.
It was first signed into law in 1965 and now comprises four-parts: A, B,
C and D.
Medicare Part A covers hospital services, Part B covers
physician services, and Part C, also called Medicare Advantage, allows
people to enroll in a private plan, which the government helps
reimburse.
Medicare Part D, the most recent add-on, took effect in 2006 and offers
a voluntary prescription drug benefit.
Medicaid Enacted in 1965, a taxpayer-supported government health
insurance program for the poor, funded by a combination of federal and
state money. Medicaid is administered by the states. The current health
care bills seek to expand Medicaid eligibility to cover more Americans.
CHIP (Children's Health Insurance Program) A taxpayer-supported
government health insurance program for children whose parents
aren't poor enough to qualify for Medicaid. In February 2009, President
Obama signed into law a reauthorization of CHIP ("CHIPRA") that
extended coverage eligibility to about 4 million children who would've
otherwise been uninsured. Currently the program is set to expire in
2013, after which it's unclear what would happen to CHIP-eligible children.
Donut Hole Also called "the gap" or the "coverage gap" in Medicare
Part D. Part D enrollees' drug costs are partly covered up to a certain
amount each year ($2,700 in 2009), after which enrollees must spend a
certain amount of their own money (about $4,350 in 2009) before
"catastrophic" drug coverage kicks in.
Mandate A requirement that an individual or business purchase
health insurance or risk paying fines or payroll taxes.. In the House bill,
individuals who neglect to purchase insurance for themselves or
families would pay a 2.5 percent tax on their adjusted gross income.
Cadillac Plans Also called "gold-plated" health insurance plans. The term typically refers to those whose overall premiums total between $19,000 and
$25,000 per year There has been some discussion of taxing these
high-end plans. But some argue that the premiums might be high
because of preexisting conditions. .
Copyright © 2009, Tribune
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