By: Emily Beaver
Maybe you've heard President Obama talking about reforming health care or seen TV news reports about people protesting recent town hall meetings. But if you think health care reform doesn't impact you, it's time to tune into the debate.
One goal of health care reform is making sure that everyone can get health insurance, including young people. About 30% of Americans ages 19-24 don't have insurance, and one in seven teens doesn't have insurance, says Claire Brindis, Director of the Philip R. Lee Institute for Health Policy Studies at University of California, San Francisco.
Many young people aren't covered by their parents' health plans, don't get insurance at work, can't afford to buy insurance or simply don't think they'll get sick. But if you get sick or injured when you're uninsured, you might not get the medical care you need or you may go into debt because of medical bills.
Cutting through the health care jargon isn't easy. Here are ten health reform terms you need to know:
1. Expanding coverage
Expanding health insurance to cover all Americans is a major part of health reform, Brindis says. Other important goals are making sure that people who do have insurance can keep it and lowering the costs of providing health care.
2. The public option
You may have heard debate about whether a "public option" should be included in health reform. The public option is health insurance run by the government, says Melissa Rodgers, Associate Director of the Berkeley Center on Health, Economic and Family Security.
A public health insurance plan would be one option for people who don't have insurance, or don't have insurance that covers their medical needs, Rodgers says. No one would be forced to participate in the public plan.
A public plan can do things the private insurance market can't, like make sure that everyone gets access to affordable healthcare, she says.
Medicare and Medicaid (which is called Medi-Cal in California) are public health insurance plans the government already runs. Medicare is a national program that provides health insurance for people age 65 and older, and some younger people with disabilities.
Medicaid is a health insurance program for low-income people run by individual states. Each state has different rules about how poor you must be to qualify for Medicaid, Brindis says.
4. Individual Mandate
An individual mandate means that every American would be required to have health insurance. If this mandate was approved, young people could no longer go without health insurance because they can't afford it or don't think they will get sick, says William H. Dow, Associate Professor of healthcare economics at U.C. Berkeley.
If everyone has to be insured, the government will have to help people who can't afford insurance pay for it, Dow says. That could put pressure on the government to find more money to help people pay for health care.
5. Employer-sponsored coverage
Many workplaces, from small businesses like your neighborhood coffee shop to large companies like Starbucks, provide health insurance coverage for employees. People who are self-employed or work part-time usually don't get employer-sponsored coverage.
6. Individual market
The individual health insurance market is currently the main option for people who can't get insurance coverage through a government program like Medicare or Medicaidan or an employer-based plan (or through a parent or spouse's employer-based plan). On the individual market, private insurance companies negotiate prices for health plans with individual people or families rather than large groups of people, such as all the employees at a company.
Employer-sponsored coverage has a different set of rules than the individual market. In the individual market, nothing prevents insurers from denying participants coverage or charging high prices, Rodgers says.
"The individual market is the wild, wild west of insurance," she says.
If you have health insurance, but it doesn't cover a service you need, you're underinsured. For example, you're pregnant but your insurance doesn't cover care you need through pregnancy or childbirth.
8. Pre-existing condition
If you have a history of illness or a medical condition that existed before you applied for insurance, private insurance companies may refuse to insure you. Diseases like cancer or diabetes are examples of pre-existing conditions that may make it difficult for a person to be approved for private health care coverage. Insurance companies may also refuse to pay for any care related to a pre-existing condition, Rodgers says.
An exchange is one way to expand coverage to the uninsured. Anyone who doesn't have access to health care would be placed in a group called an exchange, where they could choose from a variety of private and public health plans, Rodgers says.
10. Electronic medical records
Electronic medical records let doctors and other health care professionals share information about patients across different healthcare settings, like hospitals and doctors' offices. Electronic medical records could prevent doctors from duplicating costly tests that increase the cost of medical care, Brindis says. Lowering what health care costs will be important if the government tries to expand coverage to everyone.