The first blog entry focused on what basic information we have about the experiences of people getting (or not getting) needed health care.  But let’s step back and think about why people get health care, and how people currently (or in the future) think about what health care they should get regardless of their ability to pay for it. Should only certain “vulnerable” people be guaranteed health care, or everyone? What services should always be included?  Which services are “optional” and should be allowed to differ by insurer?  How much people can be expected to pay out of pocket?   How much is too much to pay for private health insurance?

So here are some questions to think about when we’re discussing access to health care.

• If health care is not a right, why did Congress pass the Emergency Medical Treatment & Labor Act (EMTALA), which requires Medicare-participating hospitals (almost all of them) to provide emergency treatment? Why is emergency care guaranteed, but not other types of care? If a person does not chose to purchase health insurance (but could theoretically afford it), should they still be guaranteed emergency care?
• How much of insurance premiums should be returned to enrollees as benefits (the loss ratio)? For example, the Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases.
• What benefits, if any, should health insurers have to cover in order to qualify as health insurance (and not just catastrophic insurance)? What about dental care, mental health care, or substance use disorder care?  Should  they be separate policies (as dental care is usually now, but mental health and substance use disorder care are not)?  What about long-term care?
• How much should healthy people subsidize health care costs for ill or disabled people? In reality everyone might become ill or disabled at some point (or a family member might).
• Why do males complain about paying for pregnancy-related insurance coverage?  Did they have no responsibility for the pregnancy, or infant care? Is the responsibility entirely by the mother? Should women not have to pay for viagra in their policies?
• If the thought is that Medicaid should cover “the most vulnerable” people, how is that defined? Right now Medicaid covers more than 1/3 of (all) children, many disabled people, poor and low-income nursing home residents (often after they have spent down their assets), pregnant women (Medicaid covers more than 1/2 of all births), and in some states, the very poorest people.  If Medicaid funds are reduced, which of these populations should be considered “nonvulnerable”)?

These are just a few of the questions that must be considered when thinking about access to health services.  Please posts your thoughts, additional questions, and your experiences accessing the health care system.