Health insurance premiums charged to individuals born with genetic defects
Week 4 Discussion(Economics of Healthcare)
BACKGROUND :
NY Times, May 3, 2017
Jimmy Kimmel’s tearful description of his newborn son’s heart defect has galvanized parents across the country. A few shared his experience as a frantic new father; many more gave silent thanks that they had been spared this ordeal. But the talk-show host’s monologue has also focused new attention on how infants with such birth defects were cared for before passage of the Affordable Care Act, and what may lie ahead for them should the legislation be repealed.
“No parent should ever have to decide if they can afford to save their child’s life,” Some medical experts, too, are deeply worried that these young patients may not receive the intense care they need. “The physical, emotional and financial tolls that families experience caring for children with complex chronic health problems are already extraordinary,” said Dr. Jay Berry, a pediatrician at Boston Children’s Hospital. Roughly 40,000 infants are born each year with a heart defect. The one that struck Mr. Kimmel’s son is called Tetralogy of Fallot with pulmonary atresia; it affects about seven of every 100,000 babies born alive and accounts for 2 percent of all congenital heart defects.
The condition is hard to miss: The child is often born blue because the passage from the heart to the lungs is completely blocked. Blood cannot get to the lungs, where it would be oxygenated. The infant is alive only because a passageway to the lungs during fetal development remains, letting blood get through. It will close, though, and the condition can be fatal without immediate surgery, which can cost $100,000. Roughly 90 percent of these children will survive to age 18, but the initial surgery is just a temporary fix. Doctors usually have to operate several times over the years. And people with the condition need regular care from experts.
Before the passage of the Affordable Care Act in 2010, federal law required employer-sponsored plans to cover newborns regardless of their health status as long as their parents enrolled them within 30 days, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
If parents switched jobs, their new insurers could not impose waiting periods or charge more for sick newborns. But things were different for parents who bought their insurance individually.
All 50 states had laws requiring newborns to be covered under a parent’s insurance policy and not to be charged more if they were sick, if they were enrolled within 30 days. But if a parent switched plans after a baby’s birth, the new insurer could refuse to cover the care for an ill infant for an initial period of time or charge more, Ms. Pollitz said. They could also do so if the parents were uninsured to begin with.
Lifetime limits on coverage were a problem, too. In both individual and employer-sponsored plans, some critically ill children met policy limits within the first few years of their lives. Ms. Pollitz pointed out, however, that about half of all newborns were and still are insured by Medicaid, “which basically says whatever the kid needs is covered.” Many infants with severe congenital defects require home care provided under the program, as well.
TASKS:
Discuss on each of the following statements, state your opinion, example of a situation, and why it matters.
a) “Health insurance premiums charged to individuals born with genetic defects (that result in above average use of medical care) should be higher than those charged to individuals without such defects.”
b) “Insurance companies should be required to cover all applicants regardless of health condition and not allowed to charge sicker individuals higher premiums.”
RUBRIC/CRITERIA:
Use as many economic principles (from the textbook and other sources) as you can in answering the questions. As a guideline, each of the 10 points will be derived from the following:
1. Post your answer (400-500 words) to the posted DQ responding to the matter asked, instead of repeating the question or not attending to the question. Substantive answers include making comments using concepts found in the assigned reading materials or offering examples from your experience. Hence merely providing a brief “yes, I agree” or “no, I do not agree” postings are not adequate posts
2. Write in correct grammar; any errors will translate to a deduction in points.
3. Check for the spelling; any errors will deduct points.
4. Your responses must be substantive that include your own thoughts, supported with research (at least two external sources other than textbook, and you must quote these sources).
5. You get one point when you respond to one of your classmates’ posts, also with substantive comments (100-200 words).
6. One more point when you respond to another classmate’s post (100-200 words).
7. One point for collaboration. It is intended that your involvement in discussions be of a collaborative nature. Collaboration spirit is quite different from confrontation. If disagree, learn to disagree respectfully.
8. Deadline for each DQ will be at 11.55pm on the due date as posted in the modules, but you are free to make your comments prior to that. One point will be deducted for each day of late submission.
9. Creativity: offer a creative solutions or ideas or impact on the obvious socio-economic impacts of each topic; or a future recommendation or alternative options for the future with regard to the topic in question.
10. Cite your resources; as a rule of thumb, about 20 percent may come from quotes, with 80 percent in your own words.(Cite two External Sources)
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