1. Why are those who most need health insurance least able to buy it? Juniper Moore, RN Management of Health Care Resources NUR 5304

2. Statistics-America  2009 –  64.2% group insurance through an employer down from 73.4% in 2000  5% private non-group remains stable  30.8% uninsured or on government subsidized  Premiums –  15% loading charge  85% claims experience

3. Loading Charge  Administrative costs  Marketing costs  Reserves  Profits

4. Claims Experience  Benefit coverage  State mandates  Demographics  Industry  Region  Medical inflation rate  Cost-containment policies-copay, deductible, benefit, utilization, case mgmt., PPOs

5. Medical Loss Ratios  Keeps insurance competitive  Quality vs. Quantity  Regulated by the PPACA IN 2010

6. How Health Insurance Markets Work Adverse Selection  Claiming low-risk, hiding pre-existing conditions to have lower premiums  Enrolling in a policy when sick then drop when well  PPACA mandate

7. How Health Insurance Markets Work Preferred Risk Selection  Gearing marketing toward the low risk demographic  Offering health club coverage/discount/incentives  Enrolling doctors in the younger/healthier areas  Encouraging aged to drop a policy

8. Additional Legislative Changes Affecting the Health Insurance Market  Insurer vs consumer incentives  Community rate  Experience rating  Insurance exchanges

9. Reference  Feldstein, P. J. (2011). Why are Those Who Most Need Health Insurance Least Able to Buy it? In J. Davis (Ed.), Health Policy Issues (5th ed., pp. 71-84). [PDF Full Text]. Retrieved from http://web.b.ebscohost.com.lcu.idm.oclc.org/ehost/ebookviewer/ebook/bm xlYmtfXzUxNjIzOF9fQU41?sid=cfdc374a-da2c-4094-9b97- e79cd1177d7b@sessionmgr114&vid=0&format=EB&rid=1