[Updated after passage of the healthcare reform law, March 2010.]
Payment for healthcare in the United States is a combination of public and private:
- Citizens age 65 and older have access to Medicare, a federal government program that covers the basics of their healthcare needs at no direct out-of-pocket cost to them. Medicare does not pay for all drugs, nor all medical services. These older citizens may purchase additional coverage from private insurers for those services not covered by Medicare.
- Private health insurance through employers is available to employees of businesses that offer health insurance as a benefit. This is the major source of healthcare payment for most people under age 65. Employees may be able to choose from a number of private plans, or the company or organization they work for may be large enough that it insures its employees itself. Employees generally pay for part of the coverage cost themselves in the form of premiums, which are monthly amounts paid into the system.
- Americans under age 65 who cannot afford to purchase health insurance, either because they are disabled, or because they don't earn enough income (each state sets a maximum earning limit) may participate in state-run programs that provide payment for basic health services. These state-run services are supplemented for children through a federal program called SCHIP (State Childrens Health Insurance Program.) This program will be expanded and rearranged under healthcare reform laws.
As of 2009, there were an estimated 47 million Americans who were not covered for healthcare services for a variety of reasons, as discussed in the Coverage section of this Healthcare Reform overview. Further, there are an estimated 25 million Americans who are underinsured. If a family member suffered a health problem of any magnitude, they would learn that their insurance would not be adequate. In fact, the journal Health Affairs cites one study that estimated that half the bankruptcy filings in the United States stem from medical problems, despite the fact that more than 75% of the bankruptcy filers had health insurance.
In another study reported in the journal Health Affairs in late 2007, this lack of insurance was also shown to affect mortality. An estimated 101,000 people die each year because they do not have health coverage.
With the passage of healthcare reform in March 2010, these numbers change so that by 2014, 32 million more Americans will have coverage. There will still be an estimated 15 to 16 million people in the United States who will not have coverage either by choice or because they are not eligible (example: illegal aliens.)
As healthcare reform is being implemented,discussions center on who is covered, what services they are covered for, and rationing.
