1. Ambulatory patient services. [Outpatient care]
2. Emergency services.
3. Hospitalization. [Inpatient care]
4. Maternity and newborn care
5.Mental health and substance use disorder services, including behavioral health treatment.
6. Prescription drugs.
7. Rehabilitative and habilitative services and devices.
8. Laboratory services
9. Preventive and wellness services and chronic disease management;
10. Pediatric services, including oral and vision care.
Health insurance plans must cover these benefits https://en.wikipedia.org/wiki/Essential_health_benefits
Right now, it’s all ten or none. Pay a fine if you choose none……. How about a budget version: (2) Emergency Services, (6) Prescription Drugs, & (1) Ambulatory patient services [Outpatient care]? Limit eligible clients to those who make $20K/year or less.
Let’s change the paradigm from younger healthy people would rather pay a fine than go for all ten. My new proposed paradigm is let the poor choose the three most important!
I know what it’s like to work over 40 hours/week with three part-time jobs and no insurance: adjunct instructor at a community college, construction assistant, and substitute teacher. This was my career from 1994-1999. I’d developed asthma in 1987. Trust me, summer is construction asst. only, and that faded out of the picture after I got a full-time teaching job (2001-2006), followed by COPD (2005).
Why did I choose those three benefits? Emergency Room visits are very expensive, and in the USA, we let the sickly get help and hopefully pay later. I got on Medicaid by showing my record of ER visits from 2008-2012 to social workers, despite living in Texas—the largest state not to expand Medicaid.
I could afford an inhaler and nebulizer fluid, but not Advair. Fortunately, I learned about botanicas from living in a predominantly Mexican-American neighborhood and got gordolobo (mullein leaves) and eucalyptus.
I went to clinics that generally served the poorer part of the population. Through “Ambulatory patient care [Outpatient care],” more would be able to afford the office visits themselves and have a regular doctor.
I hope my “Budget ACA: 3-10” brings a helpful new angle to American Health Care. It’s such a hotly debated topic, and we seem to have more difficulties than most OECD nations. My first edition was mistaken in choosing 9. Preventive and Wellness Services and Chronic Disease Management over 1. Ambulatory Patient Services [Outpatient care]. Outpatient care is more basic.I bet plenty of poor people would rather buy “Budget ACA: 3-10” than pay a fine–looking forward to feedback.