TruthAboutHealthCareReform.org

• State of being actually or legally out of funds to pay creditors
• The stain of personal bankruptcy can remain on a debtor's credit report for years and lead to financial headaches (e.g. very high interest rates) that can make it very hard for the individual to regain a high standard of living

• Many of these plans were organized as not-for-profit organizations under special state laws by state hospital (Blue Cross) and state medical (Blue Shield) associations
• These laws differed significantly across states, sometimes imposing special obligations or regulatory requirements on Blue Cross and Blue Shield plans (e.g., to insure all applicants) and sometimes providing financial advantages such as favorable tax status
• Blue Cross and Blue Shield plans operate and are regulated in a similar manner to commercial insurers, although in a few states Blue Cross and Blue Shield plans continue to have special requirements to accept applicants for health insurance on a more lenient basis than is applied to other types of insurers

• Commercial health insurers (sometimes called indemnity insurers) are generally organized as stock companies (owned by stockholders) or as mutual insurance companies (owned by their policyholders)
• A prominent example is Aetna, a stock company

• This is a requirement that insurers accept applicants for coverage, without regard to their health status or previous claims experience
• For example, health insuring organizations generally are required by state and federal law to issue coverage to small employers that apply
• Separate provisions of law generally address the extent to which health insuring organizations can vary premiums based on health status, claims experience, or other factors (Rate Bands)

• This is a provision of an insurance policy or law which guarantees a policyholder the right to renew their policy when the term of coverage expires
• The health insuring organization generally is permitted to change the premium rates at renewal

• Is a basic measure of a country's economic performance
• It is the value of all goods made and services provided within the borders of a nation, in a given year
• It is a fundamental measurement of production, and is very often positively correlated with the standard of living
• US GDP = $14.11 Trillion (2007)

• HMOs usually are licensed under special state laws that recognize that they tightly integrate health insurance with the provision of health care
• HMOs operate as insurers (meaning they spread health care costs across the people enrolled in the HMO) and as health care providers (meaning they directly provide or arrange for the necessary health care for their enrollees)
• Examples of state-licensed HMOs include Kaiser Permanente and Harvard Pilgrim

• Is a mechanism for people to:
  • Protect themselves from the potentially extreme financial costs of medical care if they become severely ill
  • Ensure that they have access to health care when they need it. Health care can be quite costly, and only the richest among us can afford to pay the costs of treating a serious illness should it arise.
• Private health coverage products pool the risk of high health care costs across a large number of people (policy holders), permitting them (or employers on their behalf) to pay a premium based on the average cost of medical care for the group of people. This risk-spreading function helps make the cost of health care reasonably affordable for most people.

• Employers and individuals join health "cooperatives" that negotiate with private insurers who offer a minimum set of benefits
• Individuals choose among plans offered by their purchasing cooperative, with employers paying most of the premium
• The premiums are priced the same for everyone in the plan, regardless of health status
• Cooperatives serve not only to negotiate prices, but also to gather relevant information for consumers about each available option.
• EXAMPLE: The Health Insurance Exchange being proposed in the health care reforms

• Medicaid covers many low-income and disabled individuals
• The federal government and states share responsibility for funding Medicaid, but each state administers its own Medicaid program
• State Medicaid programs are mandated to cover certain categories of people, such as low-income pregnant women and children
• Each state has the option of expanding eligibility if desired

• Medicare is a federally run program that covers the vast majority of individuals aged 65 and over, as well as some disabled individuals
• Medicare is financed by federal income taxes and a payroll tax that is shared by employers and employees
• Medicare enrollees also pay a monthly premium for certain services
• Medicare is an example of a single-payer health care system

• In a multi-payer system, citizens usually have access to health care coverage through a single-payer system, and use private insurance companies for additional medical coverage for expenses not covered (example: dental, eye care, elective surgeries)
• In the US, however, there is no guaranteed access to a single-payer system -- As a result, individuals are responsible for getting their own insurance from a private insurance company, resulting in a much larger multi-payer system

• The Organization for Economic Co-operation and Development (since 1961)
• A setting in which governments can compare policy experiences, seek answers to common problems, identify good practices, and co-ordinate domestic and international policies
• The mandate of the OECD is broad, covering economic, environmental, and social issues
• Members:

  AUSTRALIA	KOREA
  AUSTRIA	LUXEMBOURG
  BELGIUM	MEXICO
  CANADA	NETHERLANDS
  CZECH REPUBLIC	NEW ZEALAND
  DENMARK	NORWAY
  FINLAND	POLAND
  FRANCE	PORTUGAL
  GERMANY	SLOVAK REPUBLIC
  GREECE	SPAIN
  HUNGARY	SWEDEN
  ICELAND	SWITZERLAND
  IRELAND	TURKEY
  ITALY	UNITED KINGDOM
  JAPAN	UNITED STATES

• Is a term adapted from Latin "pro capite" phrase meaning "per head"
• In everyday English, it means "per person"
• It is usually and most commonly used in national and international statistics

• This is the contract between the health insuring organization and the policyholder
• The policyholder may be an individual or an organization, like an employer

• PPOs are networks composed of physicians and other health care providers that agree to provide services at discounted rates to people enrolled in health insurance offered by a health provider
• Typically enrollees in such an arrangement are given financial incentives - such as lower copayments -- to use network providers
• It is common for people to believe that they are covered by a preferred provider organization (PPO), but these entities generally do not actually provide health coverage

• Refers to insurance provided by the government (federal or state)
• Public insurance can be funded by income taxes (e.g. Canada), as well as a combination of income and payroll tax (e.g. Medicaid in the US)

• These are laws that restrict the difference between the lowest and highest premium that a health insuring organization may charge for the same coverage
• For example: a rate band may specify that the highest rate a health insuring organization may charge for a policy may be not more than 150 percent of the lowest rate charged for the same policy
• The rate bands may limit all factors by which rates vary (e.g., age, gender), or may apply only to specified factors, such as health status or claims experience

• S-CHIP covers children whose families make too much money to qualify for Medicaid, but too little to be able to afford an acceptable level of health care
• Like Medicaid, the federal government and states share responsibility for funding S-CHIP

• Under a single-payer health care system, one entity (usually the federal government but could also be a private insurance company) is responsible for financing basic medical costs for the entire population
• In the case of a federal government being the single-payer, revenue is generated through taxation
• The central role of the government in this system is to collect and distribute money. It does not necessarily control any of the other aspects of health care.
• EXAMPLE of a Single Payer System: The US Medicare System

• Is a term used primarily in the United States to refer to various kinds of publicly-funded health care; the term is frequently used negatively and incorrectly in U.S. political debate concerning health care
• The correct definition is confined to systems in which a government operates health care facilities and employs health care professional
• Example: UK health care system and the Veterans Administration in the United States

• Health insurance organizations that are organized and regulated under state law, although federal law adds additional standards and, in some cases, supersedes state authority
• There are three primary types of state-licensed health insuring organizations:
  • Commercial health insurers
  • Blue Cross and Blue Shield Plans
  • Health Maintenance Organizations (HMOs)

• Individuals who have health coverage but are not adequately protected from high medical expenses
• This is often a result of not being able to afford the appropriate coverage, or not understanding the limited coverage insurance companies are providing

• An individual or group without insurance (private or public)
• Individuals in the United States must pay for doctors visits and medical procedures out-of-pocket; if they are uninsured, they cannot get reimbursed for medical expenses

• Refers to health care coverage for all citizens of a nation, regardless of income level or employment status, and often covers medical, dental and mental health care
• In such a system, health care services are primarily paid for by government-funded programs, but is often in combination with private insurance companies for services not provided for by the government (e.g. certain dental care, prescription eye-wear, etc)
• Universal health care is implemented in nearly all developed nations, with the exception of the USA, as well as in many developing countries

• The Veterans Administration delivers health care to veterans in government-owned VA facilities
• The VA is funded by federal taxpayer dollars
• The VA system is a socialized health care system