Week 4 Discussion - Economics of Healthcare

Week 4 Discussion(Economics of Healthcare)

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were cared for before passage of the Affordable Care Act, and what may lie ahead for them should the legislation be repealed.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."