According to some experts, such as Uwe Reinhardt,[120] Sherry Glied, Megan Laugensen,[121] Michael Porter, and Elizabeth Teisberg,[122] this pricing system is highly inefficient and is a major cause of rising health care costs. Health care costs in the United States vary enormously between plans and geographical regions, even when input costs are fairly similar, and rise very quickly. Health care costs have risen faster than economic growth at least since the 1970s. Public health insurance programs typically have more bargaining power as a result of their greater size and typically pay less for medical services than private plans, leading to slower cost growth, but the overall trend in health care prices have led public programs' costs to grow at a rapid pace as well.
Since 1974, New Zealand has had a system of universal no-fault health insurance for personal injuries through the Accident Compensation Corporation (ACC). The ACC scheme covers most of the costs of related to treatment of injuries acquired in New Zealand (including overseas visitors) regardless of how the injury occurred, and also covers lost income (at 80 percent of the employee's pre-injury income) and costs related to long-term rehabilitation, such as home and vehicle modifications for those seriously injured. Funding from the scheme comes from a combination of levies on employers' payroll (for work injuries), levies on an employee's taxable income (for non-work injuries to salary earners), levies on vehicle licensing fees and petrol (for motor vehicle accidents), and funds from the general taxation pool (for non-work injuries to children, senior citizens, unemployed people, overseas visitors, etc.)
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In January 2013, Representative Jan Schakowsky and 44 other U.S. House of Representatives Democrats introduced H.R. 261, the "Public Option Deficit Reduction Act", which would amend the 2010 Affordable Care Act to create a public option. The bill would set up a government-run health insurance plan with premiums 5% to 7% percent lower than private insurance, with the Congressional Budget Office estimating a reduction in the United States public debt by $104 billion over 10 years.[12]
Prior to the Patient Protection and Affordable Care Act, effective from 2014, about 34 states offered guaranteed-issuance risk pools, which enabled individuals who are medically uninsurable through private health insurance to purchase a state-sponsored health insurance plan, usually at higher cost, with high deductibles and possibly lifetime maximums.[30] Plans varied greatly from state to state, both in their costs and benefits to consumers and in their methods of funding and operations. The first such plan was implemented In 1976.[30]
The university recognizes the following days as holidays: New Year's Day, Martin Luther King, Jr. Day, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. When a recognized holiday is on Saturday, it is observed on the preceding Friday. When a recognized holiday is on Sunday, it is observed on the following Monday.
The US health insurance market is highly concentrated, as leading insurers have carried out over 400 mergers from the mid-1990s to the mid-2000s (decade). In 2000, the two largest health insurers (Aetna and UnitedHealth Group) had total membership of 32 million. By 2006 the top two insurers, WellPoint (now Anthem) and UnitedHealth, had total membership of 67 million. The two companies together had more than 36% of the national market for commercial health insurance. The AMA has said that it "has long been concerned about the impact of consolidated markets on patient care." A 2007 AMA study found that in 299 of the 313 markets surveyed, one health plan accounted for at least 30% of the combined health maintenance organization (HMO)/preferred provider organization (PPO) market. In 90% of markets, the largest insurer controls at least 30% of the market, and the largest insurer controls more than 50% of the market in 54% of metropolitan areas.[116] The US Department of Justice has recognized this percentage of market control as conferring substantial monopsony power in the relations between insurer and physicians.[117]
Fringe benefits are generally included in an employee’s gross income (there are some exceptions). The benefits are subject to income tax withholding and employment taxes. Fringe benefits include cars and flights on aircraft that the employer provides, free or discounted commercial flights, vacations, discounts on property or services, memberships in country clubs or other social clubs, and tickets to entertainment or sporting events.
Michael F. Cannon, a senior fellow of the libertarian CATO Institute, has argued that the federal government can hide inefficiencies in its administration and draw away consumers from private insurance even if the government offers an inferior product. A study by the Congressional Budget Office found that profits accounted for only about 4 or 5 percent of private health insurance premiums, and Cannon argued that the lack of a profit motive reduces incentives to eliminate wasteful administrative costs.[38]
The employer typically makes a substantial contribution towards the cost of coverage. Typically, employers pay about 85% of the insurance premium for their employees, and about 75% of the premium for their employees' dependents. The employee pays the remaining fraction of the premium, usually with pre-tax/tax-exempt earnings. These percentages have been stable since 1999.[58] Health benefits provided by employers are also tax-favored: Employee contributions can be made on a pre-tax basis if the employer offers the benefits through a section 125 cafeteria plan.
All regular full-time employees are required to enroll in a retirement plan. Regular part time employee’s enrollment is optional. Employees who are non-US citizens on F-1 or J-1 visas are not eligible for retirement membership. Non-exempt employees are automatically enrolled in the Tennessee Consolidated Retirement System Hybrid (TCRS). TCRS is a defined benefit and contributory plan which requires 5 years of service to vest. Exempt employees have the option to elect the TCRS Hybrid or Optional Retirement Program Hybrid (ORP). The ORP is a defined benefit and contributory plan with no vesting requirements. Both retirement options require a monthly employee contribution of 5%.

An alternative proposal is to subsidize private, non-profit health insurance cooperatives to get them to become large and established enough to possibly provide cost savings[27][28] Democratic politicians such as Howard Dean were critical of abandoning a public option in favor of co-ops, raising questions about the ability of the cooperatives to compete with existing private insurers.[6] Paul Krugman also questioned the ability of cooperatives to compete.[29]
Carrin, Guy; James, Chris (January 2005). "Social health insurance: Key factors affecting the transition towards universal coverage" (PDF). International Social Security Review. 58 (1): 45–64. doi:10.1111/j.1468-246x.2005.00209.x. Retrieved 10 March 2013. Initially the health insurance law of 1883 covered blue-collar workers in selected industries, craftspeople and other selected professionals.6 It is estimated that this law brought health insurance coverage up from 5 to 10 per cent of the total population.
Form 1095-C is a tax form under the Affordable Care Act ("ACA") which contains information about your health care insurance coverage. Form 1095-C is distributed to all full-time employees working an average of 30 hours or more per week, for all or part of the calendar year. For information about Form 1095-B, please contact your health care provider directly.

In March 2017, the U.S. House of Representatives passed The Small Business Health Fairness Act (H.R. 1101), which established "requirements for creating a federally-certified AHP, including for certification itself, sponsors and boards of trustees, participation and coverage, nondiscrimination, contribution rates, and voluntary termination."[79][84]


According to a 2007 study, about 59% of employers at small firms (3–199 workers) in the US provide employee health insurance. The percentage of small firms offering coverage has been dropping steadily since 1999. The study notes that cost remains the main reason cited by small firms who do not offer health benefits.[66] Small firms that are new are less likely to offer coverage than ones that have been in existence for a number of years. For example, using 2005 data for firms with fewer than 10 employees, 43% of those that had been in existence at least 20 years offered coverage, but only 24% of those that had been in existence less than 5 years did. The volatility of offer rates from year to year also appears to be higher for newer small businesses.[67]
Fringe benefits are generally included in an employee’s gross income (there are some exceptions). The benefits are subject to income tax withholding and employment taxes. Fringe benefits include cars and flights on aircraft that the employer provides, free or discounted commercial flights, vacations, discounts on property or services, memberships in country clubs or other social clubs, and tickets to entertainment or sporting events.
In 2006, a new system of health insurance came into force in the Netherlands. This new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance by using a combination of regulation and an insurance equalization pool. Moral hazard is avoided by mandating that insurance companies provide at least one policy which meets a government set minimum standard level of coverage, and all adult residents are obliged by law to purchase this coverage from an insurance company of their choice. All insurance companies receive funds from the equalization pool to help cover the cost of this government-mandated coverage. This pool is run by a regulator which collects salary-based contributions from employers, which make up about 50% of all health care funding, and funding from the government to cover people who cannot afford health care, which makes up an additional 5%.[31]
Nearly one in three patients receiving NHS hospital treatment is privately insured and could have the cost paid for by their insurer. Some private schemes provide cash payments to patients who opt for NHS treatment, to deter use of private facilities. A report, by private health analysts Laing and Buisson, in November 2012, estimated that more than 250,000 operations were performed on patients with private medical insurance each year at a cost of £359 million. In addition, £609 million was spent on emergency medical or surgical treatment. Private medical insurance does not normally cover emergency treatment but subsequent recovery could be paid for if the patient were moved into a private patient unit.[44]
All regular full-time employees are required to enroll in a retirement plan. Regular part time employee’s enrollment is optional. Employees who are non-US citizens on F-1 or J-1 visas are not eligible for retirement membership. Non-exempt employees are automatically enrolled in the Tennessee Consolidated Retirement System Hybrid (TCRS). TCRS is a defined benefit and contributory plan which requires 5 years of service to vest. Exempt employees have the option to elect the TCRS Hybrid or Optional Retirement Program Hybrid (ORP). The ORP is a defined benefit and contributory plan with no vesting requirements. Both retirement options require a monthly employee contribution of 5%.
Private health insurance may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by individual consumers. Most Americans with private health insurance receive it through an employer-sponsored program. According to the United States Census Bureau, some 60% of Americans are covered through an employer, while about 9% purchase health insurance directly.[53] Private insurance was billed for 12.2 million inpatient hospital stays in 2011, incurring approximately 29% ($112.5 billion) of the total aggregate inpatient hospital costs in the United States.[12]
However, with the Patient Protection and Affordable Care Act, effective since 2014, federal laws have created some uniformity in partnership with the existing state-based system. Insurers are prohibited from discriminating against or charging higher rates for individuals based on pre-existing medical conditions and must offer a standard set of coverage.[31][32]
The purpose behind the public option was to make more affordable health insurance for uninsured citizens who are either unable to afford the rates of or are rejected by private health insurers. Supporters argued that a government insurance company could successfully lower its rates by using greater leverage than private industry when negotiating with hospitals and doctors,[18] as well as paying the employees of the public option insurance company salaries as opposed to paying based on individual medical procedures.[19]
Coupled with high-deductible plans are various tax-advantaged savings plans—funds (such as salary) can be placed in a savings plan, and then go to pay the out-of-pocket expenses. This approach to addressing increasing premiums is dubbed "consumer driven health care", and received a boost in 2003, when President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act. The law created tax-deductible Health Savings Accounts (HSAs), untaxed private bank accounts for medical expenses, which can be established by those who already have health insurance. Withdrawals from HSAs are only penalized if the money is spent on non-medical items or services. Funds can be used to pay for qualified expenses, including doctor's fees, Medicare Parts A and B, and drugs, without being taxed.[106]

Funding from the equalization pool is distributed to insurance companies for each person they insure under the required policy. However, high-risk individuals get more from the pool, and low-income persons and children under 18 have their insurance paid for entirely. Because of this, insurance companies no longer find insuring high risk individuals an unappealing proposition, avoiding the potential problem of adverse selection.

Most provider markets (especially hospitals) are also highly concentrated—roughly 80%, according to criteria established by the FTC and Department of Justice[118]—so insurers usually have little choice about which providers to include in their networks, and consequently little leverage to control the prices they pay. Large insurers frequently negotiate most-favored nation clauses with providers, agreeing to raise rates significantly while guaranteeing that providers will charge other insurers higher rates.[119]
All regular full-time employees are required to enroll in a retirement plan. Regular part time employee’s enrollment is optional. Employees who are non-US citizens on F-1 or J-1 visas are not eligible for retirement membership. Non-exempt employees are automatically enrolled in the Tennessee Consolidated Retirement System Hybrid (TCRS). TCRS is a defined benefit and contributory plan which requires 5 years of service to vest. Exempt employees have the option to elect the TCRS Hybrid or Optional Retirement Program Hybrid (ORP). The ORP is a defined benefit and contributory plan with no vesting requirements. Both retirement options require a monthly employee contribution of 5%.

Prior to the ACA as of 2007, about 9% of Americans were covered under health insurance purchased directly,[53] with average out-of-pocket spending is higher in the individual market, with higher deductibles, co-payments and other cost-sharing provisions.[72][89][90] While self-employed individuals receive a tax deduction for their health insurance and can buy health insurance with additional tax benefits, most consumers in the individual market do not receive any tax benefit.[91]


An individual with Cerebral Palsy will likely require specialized medical services throughout his or her lifetime. The expense for a chronic disability can greatly exceed the expense for standard care an individual without the condition incurs. Cerebral Palsy results in a chronic, physical impairment, which typically involves routine doctor visits, extended hospital stays, a range of therapies, planned surgeries, drug therapy, and adaptive equipment. Depending on the level of impairment, Cerebral Palsy usually requires a comprehensive, multidisciplinary health care team that may include any combination of the following: pediatrician, neurologist, radiologist, orthopedic surgeon, physical therapist, occupational therapist, and vocational therapist. Some individuals also require the assistance of a registered dietician, a speech pathologist, ophthalmologist, urologist, and a cosmetic dentist, amongst others.

Coupled with high-deductible plans are various tax-advantaged savings plans—funds (such as salary) can be placed in a savings plan, and then go to pay the out-of-pocket expenses. This approach to addressing increasing premiums is dubbed "consumer driven health care", and received a boost in 2003, when President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act. The law created tax-deductible Health Savings Accounts (HSAs), untaxed private bank accounts for medical expenses, which can be established by those who already have health insurance. Withdrawals from HSAs are only penalized if the money is spent on non-medical items or services. Funds can be used to pay for qualified expenses, including doctor's fees, Medicare Parts A and B, and drugs, without being taxed.[106]


The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate.[12] An amended version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.[13]
An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan can do so by submitting an Opt-Out Request Form to EmblemHealth. An employee, or eligible dependent, must meet certain criteria and the request must be approved by EmblemHealth before the exemption is granted. The Opt-Out Request Form is available on the EmblemHealth website. 
Coverage from a health insurance policy or a public health program can greatly relieve the financial burden of health care expenses due to Cerebral Palsy. Those who are uninsured or underinsured can experience financial strain and require assistance from alternative funding sources such as community groups, charity organizations, or local business establishments. When no health insurance exists, providers often request payment in advance of services, or a payment plan agreement.
Long-term care (LTC) insurance reimburses the policyholder for the cost of long-term or custodial care services designed to minimize or compensate for the loss of functioning due to age, disability or chronic illness.[126] LTC has many surface similarities to long-term disability insurance. There are at least two fundamental differences, however. LTC policies cover the cost of certain types of chronic care, while long-term-disability policies replace income lost while the policyholder is unable to work. For LTC, the event triggering benefits is the need for chronic care, while the triggering event for disability insurance is the inability to work.[123]
Premiums, or the cost of the medical coverage, are based on some factors including country of origin, age, medical history, etc. It is advised to have more comprehensive insurance for US medical coverage because it can cost a lot, but the costs of not having it can be much higher. For example, the tests and scans doctors often run are costly and typically not covered by budget medical insurance plans.
Shortly after his inauguration, President Clinton offered a new proposal for a universal health insurance system. Like Nixon's plan, Clinton's relied on mandates, both for individuals and for insurers, along with subsidies for people who could not afford insurance. The bill would have also created "health-purchasing alliances" to pool risk among multiple businesses and large groups of individuals. The plan was staunchly opposed by the insurance industry and employers' groups and received only mild support from liberal groups, particularly unions, which preferred a single payer system. Ultimately it failed after the Republican takeover of Congress in 1994.[34]
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