Don’t go short cut and mess it up. Address each question separately like you did last week.  You end one covering every point and doing a very good job.

Don’t go short cut and mess it up. Address each question separately like you did last week.  You end one covering every point and doing a very good job.

The article attached has information that will help create a good work.

You can get article to question 1a. Please cite all work thoroughly. No rejection please. 

1a What is the National Health Insurance? 

B: Evaluate selected healthcare policy models and frameworks

1C: Is Medicare effective? 

1D:What about the VA Health System? How do sociopolitical factors influence these systems? 

1E:What can you do as a DNP nurse to formalize support to advance health care policies or agendas?

What is a Health Insurance Exchange? Use this part to develop great introduction

Section 1311 of the ACA requires each state to establish a health insurance exchange by January 1, 2014. The fundamental purpose of a health insurance exchange is to create an online marketplace for the sale and purchase of health insurance for customers (consumers). The exchange is required to serve two markets: the individual market and the small group market. The exchanges are structured to benefit customers by providing choice, transparency, and convenience, in which one chooses among competing health insurer providers (both public and private).

Marketplace competition is how everything is purchased, from books to shoes to food. Everything, that is, except health insurance. The health insurance exchanges were designed using this business model and current understanding of the economic drivers of health care. The benefits of using the marketplace model are obvious to anyone who has ever shopped at a Costco (Klein, 2009). The products are clearly priced, standardized for ease of comparison, and written in clear language to assess quality. Buying in bulk can lead to cost savings. 197Health insurance exchanges are created to provide this same type of information and transactional opportunity. Essentially, the exchanges are designed to increase access for uninsured or underinsured Americans to quality and affordable health insurance by expanding the size of the insurance coverage pool. (The Henry J. Kaiser Foundation, 2013b)

Customers are also protected by ACA regulations that ensure insurance companies (issuers) that choose to sell their products (plans) through an exchange are not deceptive. Issuers are required to comply with other consumer protections, such as offering insurance to every qualified applicant and meeting the private market reform requirements in the ACA. However, exchanges are not issuers (insurance companies); rather, exchanges contract with the insurance companies who will provide insurance products available for purchase through exchanges (Fernandez & Mach, 2013).

Exchange Purchasers

Individual Purchasers

The health insurance exchange is a marketplace that offers an individual the ability to compare health insurance plans. Each state was to create a market for the individual consumer to purchase health insurance, although states also had the options of partnering with the federal government to create an exchange or having the state’s residents use a federal exchange. Individuals are required to have health insurance or face a fine (tax) imposed by the federal government. Dependent on an individual’s income, he/she may qualify for a reduction in the overall cost of the health plan premium, known as federal subsidies. This is a way to reduce the overall out-of-pocket cost of the consumer and help to make insurance more affordable. Individuals may also qualify for Medicaid. Qualified health plans (QHPs) sold on the insurance exchanges cannot be priced differently outside of the insurance exchange (Peterson & Fernandez, 2010), but an insurance company can offer other plans off the exchange with different pricing.

Table 20-1 depicts scenarios of how individuals and those up to a family of six can potentially qualify for tax subsidies, Medicaid, and cost-sharing reductions (CSRs), which are additional out-of-pocket reductions.

Health Insurance Exchanges

Expanding Access to Health Care

Coral T. Andrews, Deborah B. Gardner

“Follow the path of the unsafe, independent thinker. Expose your ideas to the dangers of controversy. Speak your mind and fear less the label of ‘crackpot’ than the stigma of conformity. And on issues that seem important to you, stand up and be counted at any cost.”

Thomas J. Watson

The health insurance exchange has been described “as arguably the single most important element of health care reform. It is the bridge between the current health care system we have and the system we want” (Klein, 2009, para. 3). Before the Affordable Care Act (ACA) went into effect, health insurance provided little security. Instead, it provoked apprehension and fear. As many as 129 million insured Americans, nearly one in two people, could be discriminated against because of preexisting conditions such as heart disease, diabetes, or cancer, or for that matter even pregnancy (Hilzenrath, 2009; U.S. Department of Health and Human Services [HHS], 2011). For other Americans, many knew that if they were diagnosed at some point with a serious illness it could leave them unable to access affordable coverage. This often resulted in people being trapped in ill-suited jobs or even dropped from their coverage. Vice President Biden stated in a recent speech about health care insurance before the ACA “… that every family was one job loss or one illness away from seeing the worst of the insurance system” (as cited in Simas, 2014). With the implementation of the ACA (Public Law [PL] 111-148, as amended) insurance access is changing. No longer are individuals with preexisting issues uninsurable. If you lose coverage or lose a job that had coverage, there will be a way to access care. Now there is a new way for families to have access to affordable health insurance.

This chapter outlines the required functions of exchanges and differentiates exchange types, the coverage offered, and implementation challenges. The roles that nurses can play as the exchanges evolve are presented and an assessment of the impact of the health insurance exchanges after the first year is discussed.

What is a Health Insurance Exchange?

Section 1311 of the ACA requires each state to establish a health insurance exchange by January 1, 2014. The fundamental purpose of a health insurance exchange is to create an online marketplace for the sale and purchase of health insurance for customers (consumers). The exchange is required to serve two markets: the individual market and the small group market. The exchanges are structured to benefit customers by providing choice, transparency, and convenience, in which one chooses among competing health insurer providers (both public and private).

Marketplace competition is how everything is purchased, from books to shoes to food. Everything, that is, except health insurance. The health insurance exchanges were designed using this business model and current understanding of the economic drivers of health care. The benefits of using the marketplace model are obvious to anyone who has ever shopped at a Costco (Klein, 2009). The products are clearly priced, standardized for ease of comparison, and written in clear language to assess quality. Buying in bulk can lead to cost savings. 197Health insurance exchanges are created to provide this same type of information and transactional opportunity. Essentially, the exchanges are designed to increase access for uninsured or underinsured Americans to quality and affordable health insurance by expanding the size of the insurance coverage pool. (The Henry J. Kaiser Foundation, 2013b)

Customers are also protected by ACA regulations that ensure insurance companies (issuers) that choose to sell their products (plans) through an exchange are not deceptive. Issuers are required to comply with other consumer protections, such as offering insurance to every qualified applicant and meeting the private market reform requirements in the ACA. However, exchanges are not issuers (insurance companies); rather, exchanges contract with the insurance companies who will provide insurance products available for purchase through exchanges (Fernandez & Mach, 2013).

Exchange Purchasers

Individual Purchasers

The health insurance exchange is a marketplace that offers an individual the ability to compare health insurance plans. Each state was to create a market for the individual consumer to purchase health insurance, although states also had the options of partnering with the federal government to create an exchange or having the state’s residents use a federal exchange. Individuals are required to have health insurance or face a fine (tax) imposed by the federal government. Dependent on an individual’s income, he/she may qualify for a reduction in the overall cost of the health plan premium, known as federal subsidies. This is a way to reduce the overall out-of-pocket cost of the consumer and help to make insurance more affordable. Individuals may also qualify for Medicaid. Qualified health plans (QHPs) sold on the insurance exchanges cannot be priced differently outside of the insurance exchange (Peterson & Fernandez, 2010), but an insurance company can offer other plans off the exchange with different pricing.

Table 20-1 depicts scenarios of how individuals and those up to a family of six can potentially qualify for tax subsidies, Medicaid, and cost-sharing reductions (CSRs), which are additional out-of-pocket reductions.