Access to Health Insurance

In 2000 the U.S. Census Bureau reported that about 38.7 million people in the United States (about 14.3 percent of the population) lacked health insurance coverage. Those without insurance are usually self-employed, work part-time, or work in low-wage jobs, so they lack access to low-cost, employer-sponsored group plans. Many of these workers cannot afford to purchase individual health care insurance, but they do not qualify for coverage under government programs for low-income Americans. For example, almost half (47.5 percent) of full-time workers in low-wage jobs were uninsured in 2000. Nevertheless, even without insurance, these individuals may be able to receive care without charge or at reduced rates in government-run hospitals.

Although millions of Americans lack health insurance because they cannot afford it, many others cannot buy health insurance because insurers consider them at especially high risk of needing expensive health care. Insurers assess the risks posed by applicants for insurance and then group applicants into similar classes of risk. Americans who are considered average or better-than-average risks can usually purchase insurance policies at a relatively affordable price. When an applicant presents too much risk, however, private companies consider it difficult or even impossible to offer insurance coverage to that person.

For example, some private companies will not offer coverage to an individual with a known predisposition to develop cancer because he or she presents a high risk of needing expensive treatment. Also, the few companies willing to insure such high-risk individuals will charge higher premiums to assume the risks. Increased premiums often make the insurance policy unaffordable to high-risk individuals. Even worse, occasionally no insurance company will offer a policy to a person who presents an exceptionally high risk of needing expensive medical care, such as a person infected with the virus that causes acquired immunodeficiency syndrome (AIDS).

Some insurance companies have introduced clauses to their policies that are designed to keep costs down by denying access to private insurance for anyone who already suffers from significant medical conditions. Introduction of preexisting condition clauses in insurance policies became especially widespread in the 1980s and early 1990s. Many workers found it virtually impossible to change jobs if any member of their families had a serious health problem because preexisting condition clauses in their new employer-sponsored plan would deny them access to insurance coverage. The Congress of the United States addressed this problem by introducing the Health Insurance Portability Act of 1996, which requires most employer-sponsored plans to accept transfers from other plans without imposing a preexisting condition clause.

2.Insurance Costs and Quality of Health

REASONS FOR HEALTH INSURANCE
TYPES OF PLANS IN THE UNITED STATES
1.Indemnity Plans
2.Managed Care Plans
-Health Maintenance Organizations
-Preferred Provider Organizations
-Point-of-Service Plans
3.Government-Funded Plans
-Medicare
-Medicaid
DISABILITY INSURANCE
OBTAINING COVERAGE

-Group and Employer Plans

-Individual Plans

FEATURES OF HEALTH INSURANCE POLICIES

-Deductible