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Amrican Health Care

Mr.Davis
Arvin Farzanegan
period 2

1. The American health care bill is going to talk about the health care and obama
care program and how great the program is but somehow there are problems and
issues going on with the program and it needs few little reforms to improve the
benefits of it for the citizens of United States.
2. Low-income immigrant children are less likely than their U.S.-born citizen
counterparts to see a doctor even when they are insured: The report, finds that lowincome immigrant children with private or public health care insurance were
significantly less likely to visit a doctors office during 2010 than their native-born
counterparts 44 percent versus 69 percent for children with private coverage, and
62 percent versus 71.5 percent for children with public coverage. Overall, whether
insured or uninsured, 47 percent of low-income immigrant children reported visiting
a doctors office during 2010 compared to 69 percent of U.S.-born children.
Regarding adult health care usage, the report finds that immigrant adults had lower
rates of doctors office and even emergency room visits. Analysis of Medical
Expenditure Panel Survey (MEPS) data showed that 8 percent of low-income
immigrant adults overall reported an emergency room visit during 2010, compared
to 13 percent of their native-born peers; for those who were uninsured, the rate was
6 percent for immigrants and 14 percent of the native born. And for adults with
public insurance coverage, the rate was 17 percent for immigrants and 25 percent
for their U.S.-born peers. While it is commonly believed that immigrants overwhelm
emergency rooms, perhaps in part because so many are uninsured and have
problems securing care in doctors offices, our analysis shows that immigrants
even those who have insurance use emergency rooms more sparingly than the
native born, said report co-author Leighton Ku, who is director of the Center for
Health Policy Research at George Washington University.
Using 2011 Census Bureau Current Population Survey data, the report finds that 44
percent of non-citizen immigrants in the United States are uninsured, compared to

13 percent of native-born citizens. Among low-income households, the lack of


insurance coverage is more than twice as high for non-citizen children with noncitizen parents compared to citizen children (38 percent versus 17 percent). And
almost twice as many low-income non-citizen adults are uninsured as their citizen
peers (62 percent compared to 35 percent). Their lower rates of coverage are due in
part to low coverage through their employers about 40 percent of noncitizen
workers are employed in the service and construction industries, which have low
rates of insurance offering.
1

Persons who report the emergency department as the place of their usual source

of care are defined as having no usual source of care.


2

Includes all other races not shown separately and unknown health insurance

status.
3

The race groups, white, black, American Indian or Alaska Native, Asian, Native

Hawaiian or Other Pacific Islander, and 2 or more races, include persons of Hispanic
and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with
1999 data, race-specific estimates are tabulated according to the 1997 Revisions to
the Standards for the Classification of Federal Data on Race and Ethnicity and are
not strictly comparable with estimates for earlier years. The five single-race
categories plus multiple-race categories shown in the table conform to the 1997
Standards. Starting with 1999 data, race-specific estimates are for persons who
reported only one racial group; the category 2 or more races includes persons who
reported more than one racial group. Prior to 1999, data were tabulated according
to the 1977 Standards with four racial groups and the Asian only category included
Native Hawaiian or Other Pacific Islander. Estimates for single-race categories prior
to 1999 included persons who reported one race or, if they reported more than one
race, identified one race as best representing their race. Starting with 2003 data,
race responses of other race and unspecified multiple race were treated as missing,
and then race was imputed if these were the only race responses. Almost all
persons with a race response of other race were of Hispanic origin.
4

Percent of poverty level is based on family income and family size and composition

using U.S. Census Bureau poverty thresholds. Missing family income data were

imputed for 16% of persons 18-64 years of age in 1993-1996, 24%-28% in 19971998, and 30%-32% in 1999-2007.
5

Health insurance categories are mutually exclusive. Persons who reported both

Medicaid and private coverage are classified as having private coverage. Medicaid
includes other public assistance through 1996. Starting with 1997 data, statesponsored health plan coverage is included as Medicaid coverage. Starting with
1999 data, coverage by the Children's Health Insurance Program (CHIP) is included
as Medicaid coverage. In addition to private and Medicaid, the insured category also
includes military, other government, and Medicare coverage. Persons not covered
by private insurance, Medicaid, CHIP, public assistance (through 1996), statesponsored or other government-sponsored health plans (starting in 1997), Medicare,
or military plans are considered to have no health insurance coverage. Persons with
only Indian Health Service coverage are considered to have no health insurance
coverage. In 1993-1996, health insurance status was unknown for 8%-9% of adults
in the sample. In 1997-2007, health insurance status was unknown for 1% of adults.
3. President Obamas health care reform plan, also known as ObamaCare or
the Affordable Care Act, is the law of the land now which means that all Americans
with an income above a certain threshold have to purchase or have health
insurance. The provision referred to as the individual mandate is what legally
required most US citizens and legal residents to obtain private, employer
sponsored or public health insurance (through state run exchanges). Based on the
most recent data available it is estimated that the majority of the US population
gets health insurance through their employers while 50 million people are
uninsured. The remaining consumers either buy their own private insurance or are
covered by federal/state government programs, such as Medicaid and Medicare.

Individuals: For the 2014 tax year (reported/filed in 2015), individuals who did not
have insurance would owed $95, or 1 percent of income, whichever is greater. For
the 2015 tax year it rose to the greater of $325 or 2 percent of income. But the
penalty for 2016 rises yet again, reaching $695, or 2.5 percent of income,
whichever is greater. From 2017, the minimum tax penalty per person will rise each
year with inflation. And for children 18 and under, the minimum per-person tax is
half of that for adults ($47.50). The tax penalty is pro-rated, so that a person who is
not covered for only a single month would pay 1/12th of the tax that would be due
for the full year.
While the focus is on the $95 (single adult) penalty, the actual penalty may be
much more for higher income people because the percentage component of the

penalty comes into play. For example, a single person whose MAGI is $35,000 and
elects not to have health insurance, may be liable for a penalty of $249 ($35,000
$10,150 = $24,850 x 1% = $249).
Families: For families the 2014 health insurance non-compliance penalty was
capped at $285 per family, or 1% of income, whichever is greater. In 2015 it rose to
the greater of $975 or 2 percent of income. For 2016, it will jump sharply to $2,085
per family, or 2.5% of income, whichever is greater. From 2017, the penalty/tax will
rise in line with inflation. The minimum amount per family is capped at triple the
per-person tax, no matter how many individuals are in the taxpayers household.
So, for example, a couple with one child over 18 (or two children age 18 or under),
and no coverage, would pay a minimum of $285 in 2014, $975 in 2015 and $2,085
in 2016. And that would be the minimum no matter how many uninsured
dependents a taxpayer has.
The maximum penalty (under the percentage of income criteria) is capped at the
national average price of a bronze plan sold through the health insurance
marketplace. For 2014 the maximum was $9,800 and is expected to rise to $12,500
in 2015 and then $13,000 in 2016.
Individuals or families who fall below income-tax filing thresholds would not owe
anything or get subsides to offset health insurance costs. People who are
unemployed or cannot find a policy that costs less than 8% of their modified
adjusted gross income would also be exempt from penalties under the
individual mandate. On the other hand, to offset the cost of providing insurance to
low income households, individuals making more than $200,000 a year and couples
earning above $250,000 will get additional health care taxes deducted as payroll
taxes. These people are also hit with a 3.8 percent tax on investment income.

4. Difficulties created by financial barriers are compounded by the issue of access to


end-of-life care, in this instance the Medicare hospice benefit itself. Access
encompasses a variety of issues, including awareness of the hospice benefit (e.g.
what types of patients do physicians refer to hospice?), acceptance of the hospice
benefit in light of cultural and language issues, acceptance of the Medicare hospice
benefit in lieu of the regular Medicare benefit, and the ability to supplement the
hospice benefit with other caregivers.
In low-income populations and minorities there are special issues of access.
Medicare beneficiaries who die in low-income areas have higher end-of-life costs,
are less likely to use hospices and are more likely to die in a hospital than the
general population3. African Americans represent only 8% of hospice users, yet
make up 13% of the total population11. Language and cultural barriers, possible
distrust of the system (e.g. fear of being mistreated or undertreated), and lack of

hospice referrals from the medical community may all contribute to this low
utilization rate.
Nursing-home residents are another group that tend not to receive hospice care.
Only 1% of the nursing-home population is enrolled in hospice, and 70% of nursing
homes have no patients enrolled in hospice 13. This is despite the growing number of
people who die in nursing homes (20% of the total population in 1993, up from
18.7% in 1986)13. This underutilization results from the emphasis on rehabilitation
and restoration that is embedded in both nursing-home philosophy and nursinghome payment systems. The Medicare skilled-nursing-home benefit is specifically
designed for short-term rehabilitation patients and not for those who are in the last
stages of life. In addition, in most States Medicaid pays hospices directly for any
hospice patients who are in nursing homes. The hospices must then pay the nursing
homes (for patients' room and board). This process delays payments to the nursing
homes, which may already be concerned about narrow margins, and becomes a
barrier to hospice services for nursing-home residents.
People with non-cancer diagnoses are also less likely to use hospice, usually
because physicians tend not to refer them. Possible explanations are that physicians
think hospice services are only for cancer patients, do not think of these patients as
dying or simply find the task of prognostication too difficult for non-cancer
diagnoses.
The HIV/AIDS population is surprisingly under-represented in hospice. One reason is
that many people with HIV/AIDSwho tend to be youngwant the option of
aggressive and experimental care in addition to hospice services. Medicare's
hospice guidelines prohibit this. In addition, the increasing life expectancy and
reliance on complex drug regimens often make HIV/AIDS patients ineligible for
hospiceeither because they do not meet the six-months-to-live criterion or
because the cost of the drugs is too high.

5.Conclusion:We should improve the health care and Obama care plan in a way that is
affordable for every citizen of U.S egardless of their financial situation and it should be
easy to access for everyone.

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