Health Care Reform Glossary
Republicans and Democrats have been trying to pass health care legislation for many years. Perhaps as a result, politicians and media often assume citizens are familiar with the ongoing legislative saga and the jargon and policy buzzwords associated with it. Below is a glossary of key terms 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. They are Sen. Kent Conrad (D-ND), Sen. Jeff Bingaman (D-New Mex.), Sen. Max Baucus (D-Mont.), Sen. Charles Grassley (R- Iowa), Sen. Olympia Snowe (R- Maine) and Sen. Mike Enzi (R-Wyo.).
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 U.S. 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. In general, 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.
