"In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and…
Health Insurance Coverage In Germany
"Since 2009, health insurance has been mandatory for all citizens and permanent residents, either through SHI [Statutory Health Insurance] or private health insurance (PHI). SHI covers 85% of the population – either mandatorily or voluntarily. Cover through PHI is mandatory for certain professional groups (e.g. civil servants), while for others it can be an alternative to SHI under certain conditions (e.g. the self-employed and employees above a certain income threshold). In 2012, the percentage of the population having cover through such PHI was 11%. PHI can also provide complementary cover for people with SHI, such as for dental care. Additionally,…
Major Provisions of the Affordable Care Act
• Established “health exchanges” or “marketplaces” on a statewide basis that sold community-rated individual and family insurance policies that were required to cover ten sets of “essential health benefits.” Policies could be sold in four “metal tiers”, Bronze, Silver, Gold, and Platinum, which cover 60%, 70%, 80%, and 90%, respectively, of typical health expenses. The tiers with the more comprehensive coverage generally have higher premiums.•Provided income-based subsidies to purchase insurance policies on the exchanges. Families earning up to four times the FPL were eligible for at least some financial assistance to pay for insurance. Various restrictions applied; for example, people…
Health Insurance Coverage In the US Before the ACA
"Until the major provisions of the ACA went into effect in January 2014, health insurance coverage was always voluntary. About 30% of the population was covered through the two major public programs enacted in 1965: Medicare for seniors (later extended to the disabled) and Medicaid for poorer Americans [2]. Most others received coverage through their employment, either as employees or dependents, but such coverage was always voluntary: employers did not have to provide it, and individuals were not required to buy it. Less than 10% purchased coverage on their own."As far back as the 1950s those with pre-existing illnesses generally found…
Impact on Coverage of Administrative Changes and Repeal of the ACA’s Individual Mandate
"One would expect to see an uptick in the number of uninsured for two reasons: (1) the financial penalty for being uninsured will be removed beginning in 2019, and (2) premiums will rise due to adverse selection, by an estimated 10%, although most people are protected through rising financial subsidies. Estimates by the Congressional Budget Office project that by 2027, five million Americans would lose individual coverage; another five million, Medicaid coverage; and three million more, employer coverage [11]. Moreover, the Trump Administration has made various administrative decisions that will lead to fewer people choosing to purchase coverage, including: (1) occasionally…
ACA Policy Changes 2017-2018
"As noted, despite calls to repeal the ACA 'on day one,' the President Trump, even with the support of a Republican Congress, was not able to repeal the legislation – although the vote in the U.S. Senate was very close. (Whether the House of Representatives would have passed the Senate bill is conjectural.) Due to arcane rules in the U.S. Senate, repeal before the U.S. National 2018 congressional elections will be extremely difficult because it would require 60 votes out of 100 – and Democrats and Democrat-leaning independents hold 48 seats."The Republicans were able to make a major legislative dent,…
Impact of Other Proposed Changes to ACA
"In addition, the administration is proposing other changes that could to lead to the sale of cheaper and less comprehensive policies at a cost of reducing consumer protections. States would gain more flexibility in defining what constitutes essential health benefits. Individuals would be allowed to purchase health insurance across state lines, which would give people in a state with tougher regulations the ability to purchase from another state where regulations are lower and insurance is cheaper. Regulations governing small employers that group together to create their own plans (called “association health plans”) would be modified to permit less comprehensive policies. And the…
