We need to address the following topics to implement effective healthcare reform in the US. 

• Access to primary care
• Misunderstanding health insurance
• Role of the government
• Public Plan
• Private Health Insurance Plans
• Education of the Public

 Access to Primary Care is the Answer to Healthcare Reform

The healthcare problems in the US are caused by the lack of access many Americans have to primary care physicians, physician assistants and nurse practitioners.    This creates problems on many levels.  The US falls below other countries in the treatment of chronic illness.  People use the emergency room as their only form of healthcare.  This raises the cost of healthcare for everyone.  The costs are distributed over the people that do pay by higher costs of services and health insurance rates. 

Lack of access to primary care causes:

• Use of emergency rooms for non emergency healthcare such as urinary tract infections, minor injuries and upper respiratory infections
• Chronic conditions such as hypertension, high cholesterol, diabetes, heart disease, arthritis related conditions and asthma do not get treated
• Lack of treatment leads to health situations with much higher costs
• Many persons needing treatment, when treated, cannot pay and the costs are then passed on to persons, insurance companies and the government as increased costs
• Hospitals bear the burden of treating people which do not need to be in the hospital or might not have needed to be there if they had received ongoing primary care
• Chronic health conditions do not receive sufficient care or sporadic care
• People do not go to the doctor when they should for fear of the costs
• The healthcare system becomes clogged

I believe that healthcare costs can be brought under control by making primary care accessible to everyone and encourage people to use it.  We need to educate people so they feel comfortable seeing their primary care physician.  We need to make emergency rooms for real emergencies.  We need to have more primary care physicians, physician assistants and nurse practitioners.  This also means teaching people new 21^st century ways to relate to our new healthcare system

All discussions seem to be about people being uninsured.  This leads to all proposed solutions focus on finding ways to get people insured.  Yes, this is important, however if we focus on people not having access to primary healthcare then proposed solutions will be about ways to get people access to primary healthcare.   We need to also focus on ways to encourage people to use primary care providers as much of the US culture uses healthcare for acute care or waits until the really need emergency care.  We need to encourage prevention and wellness supported by access to primary care.  Even if people have access to primary care, they need to use it.

Florida Health Insurance and Medicare Website
www.floridahealthinsurance.com
International Health Insurance Website
www.insurance-network.com

 This could happen for a variety of reasons.  Maybe you lost your job.    Maybe you quit your job to take another job.  The new job either does not offer health insurance or you have to wait before it starts.    You might lose your employer group health insurance because the company you work for decides to discontinue or reduce their employee benefits.  Maybe your hours were reduced and so you no longer qualify for the group health insurance.   Maybe you are getting divorced and you were covered as the spouse on his or her insurance.   Any number things can happen with result being, you have lost your employer group health insurance.  

So, what now?   The easiest situation is the person that is changing jobs and the new job has health insurance and employee benefits.  You just have to wait until the new benefits start.  Often there is a 90 day waiting period before benefits start.  In this situation, where you know you will be getting new benefits at a certain time, there are couple things to consider.   The first is your current health.  If your health is good or if you or a family has health issues helps determine what is the best way to handle the gap in insurance between when the prior employer’s insurance ends and the new employer’s insurance begins.   If there are no problem health issues, then a temporary health insurance plan is a good choice.  You can find those at www.temporary-health-insurance.net  if you or a family member has some health issues, where a break in coverage or having those conditions would be a problem, and then you need to seriously consider taking COBRA benefits during the gap between plans.

COBRA, the Consolidated Omnibus Budget Reduction Act was passed in 1985.   COBRA is the federal legislation that governs health insurance continuation for employer’s having 20 or more employees.  It applies to most businesses. There are few exceptions to this.    If your employer is governed by COBRA, and you have lost your employer group health insurance and the employer still has their group health insurance plan in force, then COBRA legislation governs what is available to you and for how long. 

The most basic benefit period is 18 months.  This means that you and anyone in your family that was on the group health insurance plan could continue with their health insurance for up to 18 months from the time they lost health insurance.   Other longer benefit periods would apply if the person was disabled or lost their insurance due to divorce.   COBRA is the responsibility of the employer and there are strict guidelines for notification.   The insured has time periods to make a decision and to pay.   It is important to know what these are if COBRA is the only health insurance option.   The COBRA legislation can be found at www.floridahealthinsurance.com/cobra.htm

If you qualify for individual health insurance, then that might be the best option.  The reason is the individual health insurance plans generally cost less than employer group plans.   This comes as a surprise to many people.   Group health insurance plans have to include all eligible employees and family members.   They qualify irrespective of their health.   This is good for people that have health problems that would not qualify for a medically underwritten group health insurance plan.   It does mean that the cost of the group plan has to be higher to cover the costs of guaranteeing insurance to everyone.    Employer group health insurance plans also include many mandated or required benefits.   Every mandated benefit increases the cost of the insurance.

Finally, we have the situation where you have lost your employer health insurance due to the employer going out of business or discontinuing their group health insurance.   In this case COBRA is not an option as there is no longer a group health insurance plan.   If you are insurable, then individual or temporary health insurance is a good choice. If you are uninsurable then you would need to consider a HIPAA guaranteed issue plan or if your state has a state high risk pool then see if you qualify for that.   The same applies to people that have left a job from an employer that is not governed by COBRA.

COBRA is for businesses with 20 or more employees.  States have their own legislation to govern insurance continuation for businesses with less than 20 employees.  You should check in your state.

In summary, your choices are temporary health insurance, COBRA continuation, individual health insurance, HIPAA or your state’s high risk pool.   You can find detailed information on all of these options at www.floridahealthinsurance.com