Essay Example on Government Health Insurance Programs: Coverage & Eligibility

There are different types of health care insurances offered by the government. The coverages are specific and target a particular group of people depending on their qualifications towards the protection (Sommers et al., 2017). Among the major government health insurance programs available include; Medicare, SCHIP, VHA programs, TRICARE, and IHS program. Each of the programs targets a specific group of people depending on the nature of their needs and also the kinds of services they offer to the government. However, the following are not the only insurance agencies in the US since there are more than 900 insurance companies providing health services (Sommers et al., 2017).

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Child Health Insurance Program (CHIP) is an insurance cover for children and pregnant mothers who cannot pay for Medicaid insurance cover. Several insurance companies have different health policies and different modes of health coverage with each covering specific conditions (Barnett & Vornovitsky, 2016). Furthermore, an increase in private insurance companies has increased the spectrum of services offered at different costs. Insurance covers come in handy during emergencies and other health-related situations that required agent medical attention especially in vulnerable groups such as children and expectant mothers (Obama, 2016). Health insurance covers promote financial stability reducing the challenges posed by financial uncertainties (Barnett & Vornovitsky, 2016). Therefore, it is imperative every citizen to enroll in any other available health insurances offered by the government depending on their ability to register and the health care needs category of the individuals.

Health care service insurance program covers access to health care services at a an affordable cost. More so, specified medical procedures and care such as surgery and specialized treatment are expensive and generally acquired at a more affordable price to individuals covered under an insurance cover. Due to the full range of insurance covers, single insurance can comfortably cater for all family members within the same household (Manos et al., 2016). More so, since the insurance covers allow choosing various health facilities, a variety of medical attention can still be supported under the same insurance coverage.

The insured has to pay a monthly or annual upfront fee. The medical insurance company will share all the associated medical risks with all the insured members under the same insurance cover (Manos et al., 2016). Depending on the company policies, some insurance organizations agencies only cover specific medical conditions stipulated in agreement policy, and other terms will be left out. It is the patient's responsibility to cater to medical expenses outside the insurance policy. However, some insurance agencies provide all medical situations appertaining to all the insured under the same medical cover.

Since most of the time, people don't get ill but still pay their monthly and annual insurance fees, the insurance companies have responsibilities of collecting as many premiums as possible to cater to all the enrollees in the insurance cover (Ding et al., 2015). Therefore, most of the insurance agencies have contracts with specific physicians, hospitals, and other medical-related agencies where people can access medical services at reasonable and favorable prices (Obama, 2016). More so, some of the most critical questions one needs to ask is what does the medical insurance cover explicitly take care of to evaluate the suitability of various insurance companies. Even though private insurance companies offer more intensive and high-quality services, their monthly premiums are costly as compared to government insurance covers (Ding et al., 2015). Additionally, since the services offered by private companies are expensive, the number of people accessing the insurance services is few hence making access to medical care and other services very efficient as compared to insurance services by the government.

Child Healthcare Insurance Program, formerly referred to as State Child Healthcare Insurance Program (SCHIP), is a program established by the department of health and offers insurance covers to families with children (Holly & Ernie, 2017). The plan was developed to cover children from families that were earning moderately but could not afford to get insured by Medicaid. The CHIP program was passed into law in 1997, and since then has been operational, offering insurance services to uninsured children (Wong et al., 2015). The statutory authority for the CHIP program is found in the social security act. It was formulated as an aftermath for the failure of President Clinton’s comprehensive health care reform proposal. Its inclusion in the balanced budget act created a suitable environment for its incredible support from the key government leaders. It was the largest funded medical insurance organization by the tax revenue collected in the US, and it has covered the most significant number of children since its establishment.

In 2009, CHIP was extended to accommodate pregnant women and an addition of 4 million children (Wong et al., 2015). CHIP was formulated as a federal-state program just like Medicaid, and the state governments were given the flexibility to design their CHIP programs. The flexibility was to allow them to function depending on the needs of the individual states effectively. Even though CHIP covered more than 7.6 million children in 2010, the number of uninsured children continued to rise, especially from families that could not qualify for CHIP insurance covers. Families ranked to be in the federal poverty level as employers refused to pay the monthly premiums. Due to the high number of children dropping out of the SCHIP programs, the states were costed a lot of money since they were forced to use funds from emergency care.

CHIP has a lot of benefits to its members. Apart from just offering cheap and affordable medical services, CHIP has a lot of financial relief to its members. The insurance covers preventive and wellness visits in various health facilities. All the insured members can access medical attention and consultation services, even when they are not sick for free. Another advantage of CHIP medical cover is that it offers free maternity and newborn care (Nguyen, 2016). Therefore it relieves its members from maternity bills and other birth-related complications. More so, pregnant women receive free prenatal care before delivery. Other specialized treatments, such as mental and behavioral therapy are also available in the CHIP medical insurance.

More so, some medical equipment can be costly. Devices that help people recuperate are very fundamental in aiding recovery. Therefore, patients with injuries, disabilities, and other chronic medical conditions that require specialized attention are catered to in the insurance policy (Herland et al., 2017). The insurance program also takes care of transportation and other ambulation costs during emergencies. Furthermore, other pediatric services, laboratory services, inpatient, and outpatient medical services are also covered in the insurance cover. The cost of drugs and prescription services are also taken care of by the CHIP program. It is important to note that patients do not spend even a single dollar when they visit a health facility (Herland et al., 2017). Therefore, people need to ensure they are covered by any government insurance policy, which makes access to medical services easier.

The government has a lot of impact on the nature of healthcare delivery. In many government-funded health insurance agencies, the insured and enrollees only pay less than 5% of the annual salaries for these medical services (Atun et al., 2015). Therefore, the premiums paid by the enrollees are insufficient to cater to all the medical requirements of the members. Even though not every member paying the dividends is likely to fall sick at the same time, some medical conditions require a lot of funding, which involves a lot of resources to operate effectively. A lot of funds are received from both the national and state government (Atun et al., 2015).

The government's funding for medical services has a lot of impact on the accessibility of medical services within a country. More so, some medical conditions require a lot of specialized attention and therefore are very expensive. The government funds these services and subsidizes the cost for certain medical services, making them affordable. The government has a responsibility to improve infrastructure and to provide relevant medical accessories that are fundamental in the proper functioning of these health facilities. Payment of medical personnel is another responsibility to cater to healthcare workers through their professional insurance covers since they face many work-related hazards when providing medical care.

Conclusion

In conclusion, if congress would fail to renew the funding for the CHIP program, millions of children will not access efficient medical services (Leininger & Levy, 2015). More so, a lot of strain will be placed on the state's expenditure since a lot of funds will be used to provide emergency care. Additionally, mortality rates are likely to increase nationally since a lot of people will not receive specialized care for chronic and acute medical conditions. This will lead to increased fatalities. Without adequate funding from the government, the insurance programs are likely to fail, which calls for proper budgeting of health care insurance by the national government.

References

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Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015. Washington, DC: US Government Printing Office.

Ding, H., Black, C. L., Ball, S., Donahue, S., Fink, R. V., Williams, W. W., ... & Dean, A. K. (2015). Influenza vaccination coverage among pregnant women—United States, 2014–15 influenza season. Morbidity and Mortality Weekly Report, 64(36), 1000-1005.

Holly, R., & Ernie, G. (2017). Captive as an Insurance Formula for Risk Management: Advantages and Disadvantages. Bulletin of Taras Shevchenko National University of Kyiv. Economics, (191).

Manos, M. M., Leyden, W. A., Resendez, C. I., Klein, E. G., Wilson, T. L., & Bauer, H. M. (2016). A community-based collaboration to assess and improve medical insurance status and access to health care of Latino children. Public Health Reports.

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Wong, C. A., Asch, D. A., Vinoya, C. M., Ford, C. A., Baker, T., Town, R., & Merchant, R. M. (2015). Seeing health insurance and HealthCare. gov through the eyes of young adults. Journal of Adolescent Health, 57(2), 137-143.

Herland, M., Bauder, R. A., & Khoshgoftaar, T. M. (2017, August). Medical provider specialty predictions for the detection of anomalous medicare insurance claims. In 2017 IEEE international conference on information reuse and integration (IRI) (pp. 579-588). IEEE.

Leininger, L., & Levy, H. (2015). Child health and access to medical care. The Future of children/Center for the Future of Children, the David and Lucile Packard Foundation, 25(1), 65.

Nguyen, C. (2016). The impact of health insurance programs for children: evidence from Vietnam. Health economics review, 6(1), 34.