In the national debate about health insurance policy, one question that is not asked nearly enough is, “What do we mean by the term affordable health insurance?” This question is the key to bringing all parties to a mutual understanding of the nation’s health care needs and the best policies to guarantee such coverage.
What is affordable?
One factor involved in defining affordable health insurance is the amount of a person’s total income which that consumer can be expected to spend on health care. This amount cannot be figured solely on the basis of insurance premiums. The amount of money applied through co-pays, deductibles, expenses not covered under the consumer’s policy, and preventive measures must be taken into account.
If a consumer is able to pay an insurance premium, but has no discretionary income left to use for co-payments, the policy does not qualify as affordable health insurance. Similarly, if a patient who has no car can afford to pay premiums and co-payments, but there is no reasonably-priced public transportation which that consumer can use to travel to the location covered by the policy, it is not affordable health insurance. If a person is able to pay for all doctor’s visits and prescription medications, but does not have access to more expensive food needed to comply with a diet recommended by a doctor to treat a specific condition, such as high cholesterol, diabetes, or a food allergy, that patient’s health insurance is not affordable.
What is health?
Some professionals have described the current state of medical coverage in the United States as “illness care” rather than health care. The idea behind this distinction is that most medical insurers design “affordable health insurance” plans to treat unexpected diseases, rather than facilitating the management of a person’s overall wellness. Insurance companies have done this in various times and places by excluding “routine care” such as vaccination and cancer screenings, excluding mental health care or covering it at different rates, and covering prescription medications after a diagnosis rather than covering preventive therapies such as diet or exercise therapies.
Affordable health insurance must take into account both individual and societal definitions of affordability. If a person needs a particular type of care to become or remain a productive part of the community, the health of the society demands that the patient receive that care. Similarly, if a person’s continued existence is almost guaranteed to be a detriment to society without treatment, an affordable health insurance policy demands that the person be treated so that the “disease,” whether a contagious condition such as AIDS, substance abuse, or mental illness which may lead to violence or other crimes, does not cause greater harm to the rest of society.
What is Insurance?
To be affordable health insurance, a policy must be one in which a consumer has a reasonable idea of what will be covered and what the patient must pay out-of-pocket. This predictability is central to the concept of affordable health insurance, because it allows the patient to manage his or her own care. This means estimating the amount of money which must be on hand for co-payments. It means determining how much to place in cafeteria plans for deductibles, co-payments, and medications. Affordable health insurance means that a consumer should be able to expect that he or she is prepared for a medical emergency if he or she has a savings account containing at least the amount of a deductible.
In addition, affordable health insurance must ensure that the coverage will be available when it is needed, which is often at the time when the patient is least able to pay premiums or co-payments. Most people would agree that someone who works with the food of others should not go to work with a contagious disease, but missing work often means forfeiting the pay which would cover the doctor’s visit and medication needed to reduce the chances of passing the disease to others. An employee with an anxiety disorder may be very successful when working and on a low dose of medication; if a lay-off, resulting in the removal of both prescription medication coverage and income, leaves this patient facing the triple stresses of job search, financial insecurity, and medication withdrawal, the policy of the former employer cannot be considered affordable health insurance, as the consumer was unable to count on it when it was most needed.
