In November 2017, President Trump directed "the Department of Labor to investigate ways that would "allow more small businesses to avoid many of the [Affordable Care Act's] costly requirements."[81] Under the ACA, small-employer and individual markets had "gained important consumer protections under the ACA and state health laws — including minimum benefit levels."[81] In a December 28, 2017 interview with the New York Times, Trump explained that, "We've created associations, millions of people are joining associations. ...That were formerly in Obamacare or didn't have insurance. Or didn't have health care. ...It could be as high as 50 percent of the people. So now you have associations, and people don't even talk about the associations. That could be half the people are going to be joining up...So now you have associations and the individual mandate. I believe that because of the individual mandate and the association".[85]
According to a 2007 study, about 59% of employers at small firms (3–199 workers) in the US provide employee health insurance. The percentage of small firms offering coverage has been dropping steadily since 1999. The study notes that cost remains the main reason cited by small firms who do not offer health benefits.[66] Small firms that are new are less likely to offer coverage than ones that have been in existence for a number of years. For example, using 2005 data for firms with fewer than 10 employees, 43% of those that had been in existence at least 20 years offered coverage, but only 24% of those that had been in existence less than 5 years did. The volatility of offer rates from year to year also appears to be higher for newer small businesses.[67]
Health insurance is a type of insurance coverage that pays for medical and surgical expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly. It is often included in employer benefit packages as a means of enticing quality employees. The cost of health insurance premiums is deductible to the payer, and the benefits received are tax-free.
Health insurance premiums have risen dramatically over the past decade. In the past, insurers would price your health insurance based on any number of factors, but after the Affordable Care Act, the number of variables that impact your health insurance costs have been reduced dramatically. We conducted a study to look at how health insurance premiums vary based on these characteristics. In our data we illustrate these differences by using an example 21 year old. Older consumers will see higher rates with 30 year olds paying 1.135 times more, 40 year olds paying 1.278 times more, 50 year olds paying 1.786x and 64 year olds paying 2.714 times the cost listed.
However, with the Patient Protection and Affordable Care Act, effective since 2014, federal laws have created some uniformity in partnership with the existing state-based system. Insurers are prohibited from discriminating against or charging higher rates for individuals based on pre-existing medical conditions and must offer a standard set of coverage.[31][32]
In general, the amount the employer must include is the amount by which the fair market value of the benefits is more than the sum of what the employee paid for it plus any amount that the law excludes. There are other special rules that employers and employees may use to value certain fringe benefits. See Publication 15-B, Employers' Tax Guide to Fringe Benefits, for more information.
States regulate small group premium rates, typically by placing limits on the premium variation allowable between groups (rate bands). Insurers price to recover their costs over their entire book of small group business while abiding by state rating rules.[74] Over time, the effect of initial underwriting "wears off" as the cost of a group regresses towards the mean. Recent claim experience—whether better or worse than average—is a strong predictor of future costs in the near term. But the average health status of a particular small employer group tends to regress over time towards that of an average group.[75] The process used to price small group coverage changes when a state enacts small group reform laws.[76]
Germans are offered three kinds of social security insurance dealing with the physical status of a person and which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance. Long-term care insurance (Gesetzliche Pflegeversicherung) emerged in 1994 and is mandatory.[24] Accident insurance (gesetzliche Unfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace.[citation needed]

Hospital indemnity insurance provides a fixed daily, weekly or monthly benefit while the insured is confined in a hospital. The payment is not dependent on actual hospital charges, and is most commonly expressed as a flat dollar amount. Hospital indemnity benefits are paid in addition to any other benefits that may be available, and are typically used to pay out-of-pocket and non-covered expenses associated with the primary medical plan, and to help with additional expenses (e.g., child care) incurred while in the hospital.[19][95]
Supporters of a public plan, such as Washington Post columnist E. J. Dionne, argue that many places in the United States have monopolies in which one company, or a small set of companies, control the local market for health insurance. Economist and New York Times columnist Paul Krugman also wrote that local insurance monopolies exist in many of the smaller states, accusing those who oppose the idea of a public insurance plan as defenders of local monopolies. He also argued that traditional ideas of beneficial market competition do not apply to the insurance industry given that insurers mainly compete by risk selection, claiming that "[t]he most successful companies are those that do the best job of denying coverage to those who need it most."[20]
ageing, menopause and puberty; AIDS/HIV; allergies or allergic disorders; birth control, conception, sexual problems and sex changes; chronic conditions; complications from excluded or restricted conditions/ treatment; convalescence, rehabilitation and general nursing care ; cosmetic, reconstructive or weight loss treatment; deafness; dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc); dialysis; drugs and dressings for out-patient or take-home use† ; experimental drugs and treatment; eyesight; HRT and bone densitometry; learning difficulties, behavioural and developmental problems; overseas treatment and repatriation; physical aids and devices; pre-existing or special conditions; pregnancy and childbirth; screening and preventive treatment; sleep problems and disorders; speech disorders; temporary relief of symptoms.[40] († = except in exceptional circumstances)
Private insurers offer a variety of supplemental coverages in both the group and individual markets. These are not designed to provide the primary source of medical or disability protection for an individual, but can assist with unexpected expenses and provide additional peace of mind for insureds. Supplemental coverages include Medicare supplement insurance, hospital indemnity insurance, dental insurance, vision insurance, accidental death and dismemberment insurance and specified disease insurance.[19]

The deal would not expand health insurance and cover members’ spouses and children. — Katie Johnston, BostonGlobe.com, "Bus drivers on Martha’s Vineyard are expected to vote on contract Sunday," 28 July 2019 Other federally funded researchers, from ecologists to geneticists, told Science about restrictions on electricity use, travel to conferences, health insurance, and office supplies. — Lizzie Wade, Science | AAAS, "Mexico’s new president shocks scientists with budget cuts and disparaging remarks," 23 July 2019 That dip is important because players become eligible for post-career benefits like health insurance and pensions after three years. — Jenna West, SI.com, "Report: NFL Owners Suggested 18-Game Schedule With 16-Game Limit for Players," 12 July 2019 The single-payer talk set off other discussions about the role of health insurance and the cost of care. — Jon Greenberg, Scientific American, "Democrats Divided on “Medicare for All” in First Debate," 27 June 2019 Citing deficits that have totaled $16 million in the past decade, symphony management has proposed a new contract that would include a roughly 20 percent pay cut for musicians but retain health insurance and other benefits year-round. — Mary Carole Mccauley, baltimoresun.com, "Former BSO music director David Zinman visited the players' picket line Monday," 24 June 2019 Currently, those who may have some income but lack other key necessities, like health insurance and access to quality education, are invisible in official poverty data. — Debra Brucker, The Conversation, "US poverty statistics ignore millions of struggling Americans," 24 June 2019 One last concern: Mainly because more businesses will be offering health insurance and getting the related tax break, the rule will increase the deficit by about $50 billion over ten years, in the administration’s own estimation. — Robert Verbruggen, National Review, "Trump Is Expanding Obamacare . . . in a Good Way," 16 June 2019 The delays could result in H-4 visa-holders losing out on jobs, health insurance, and even drivers’ licences, according to the lawsuit. — Ananya Bhattacharya, Quartz India, "H-4 visa holders sue the US government for delaying their work applications," 10 June 2019

Health insurance is a benefit provided through a government agency, private business, or non-profit organization. To determine cost, a provider estimates collective medical expenses of a population, then divides that risk amongst the group of policy subscribers. In concept, insurers recognize that one person may incur large unexpected expenses, while another may incur none. The expense, then, is spread among a group of individuals to make health care more affordable for the common good of all. In addition, public health programs like Medicare, Medicaid, and SCHIP are federally-funded and state-run to provide additional medical coverage to those in vulnerable groups who qualify, such as seniors and those with disability.
Having health insurance is important for several reasons. Uninsured people receive less medical care and less timely care, they have worse health outcomes, and lack of insurance is a fiscal burden for them and their families. Moreover, the benefits of expanding coverage outweigh the costs for added services. Safety-net care from hospitals and clinics improves access to care but does not fully substitute for health insurance. These findings are supported by much research, although some cautions are appropriate in using these results.
Through the 1990s, managed care insurance schemes including health maintenance organizations (HMO), preferred provider organizations, or point of service plans grew from about 25% US employees with employer-sponsored coverage to the vast majority.[69] With managed care, insurers use various techniques to address costs and improve quality, including negotiation of prices ("in-network" providers), utilization management, and requirements for quality assurance such as being accredited by accreditation schemes such as the Joint Commission and the American Accreditation Healthcare Commission.[70]
(US specific) Provided by an employer-sponsored self-funded ERISA plan. The company generally advertises that they have one of the big insurance companies. However, in an ERISA case, that insurance company "doesn't engage in the act of insurance", they just administer it. Therefore, ERISA plans are not subject to state laws. ERISA plans are governed by federal law under the jurisdiction of the US Department of Labor (USDOL). The specific benefits or coverage details are found in the Summary Plan Description (SPD). An appeal must go through the insurance company, then to the Employer's Plan Fiduciary. If still required, the Fiduciary's decision can be brought to the USDOL to review for ERISA compliance, and then file a lawsuit in federal court.
For many Americans, especially those who struggle to make ends meet, living paycheck to paycheck, health insurance may seem like an unnecessary expense. The opposite is true. While there are many smart ways to go about saving money, going without health insurance isn’t one of them. Forgoing coverage isn’t smart, nor will it save you money in the long run. The bottom line? Being uninsured is financially risky.

The shared responsibility provision is part of the Affordable Care Act, also known as ACA or Obamacare. The goal is to ensure that all US citizens and permanent residents have access to quality health insurance. Any non-resident aliens, including international students on F, J, M and Q visas (and certain family members of students) are not subject to the individual mandate for their first 5 years in the U.S. All other J categories (teacher, trainee, work and travel, au pair, high school, etc.) are not subject to the individual mandate for 2 years (out of the past six).


An individual with Cerebral Palsy will likely require specialized medical services throughout his or her lifetime. The expense for a chronic disability can greatly exceed the expense for standard care an individual without the condition incurs. Cerebral Palsy results in a chronic, physical impairment, which typically involves routine doctor visits, extended hospital stays, a range of therapies, planned surgeries, drug therapy, and adaptive equipment. Depending on the level of impairment, Cerebral Palsy usually requires a comprehensive, multidisciplinary health care team that may include any combination of the following: pediatrician, neurologist, radiologist, orthopedic surgeon, physical therapist, occupational therapist, and vocational therapist. Some individuals also require the assistance of a registered dietician, a speech pathologist, ophthalmologist, urologist, and a cosmetic dentist, amongst others.
Both before and after passage in the House, significant controversy surrounded the Stupak–Pitts Amendment, added to the bill to prohibit coverage of abortions – with limited exceptions – in the public option or in any of the health insurance exchange's private plans sold to customers receiving federal subsidies. In mid-November, it was reported that 40 House Democrats would not support a final bill containing the Amendment's provisions.[36] The Amendment was abandoned after a deal was struck between Representative Bart Stupak and his voting bloc would vote for the bill as written in exchange for the signing of Executive Order 13535.

Financial Assistance Available: Most uninsured individuals will qualify for financial assistance called a Health Insurance Premium Tax Credit to help make their insurance premiums affordable. The amount of financial assistance will depend on your income and family size. Individuals with low incomes may qualify for free or very low premiums. To find out how much financial assistance you may qualify for, check out the Kaiser Family Foundation’s subsidy calculator. 


Healthcare in Switzerland is universal[34] and is regulated by the Swiss Federal Law on Health Insurance. Health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).[35][36] It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.[34]
An employee who needs to request an exemption from the required enrollment in the HIP HMO Preferred Plan can do so by submitting an Opt-Out Request Form to EmblemHealth. An employee, or eligible dependent, must meet certain criteria and the request must be approved by EmblemHealth before the exemption is granted. The Opt-Out Request Form is available on the EmblemHealth website. 
Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 10%, 20% or 30%, depending on age. The Rudd Government announced in May 2009 that as of July 2010, the Rebate would become means-tested, and offered on a sliding scale. While this move (which would have required legislation) was defeated in the Senate at the time, in early 2011 the Gillard Government announced plans to reintroduce the legislation after the Opposition loses the balance of power in the Senate. The ALP and Greens have long been against the rebate, referring to it as "middle-class welfare".[14]
In July 2009, Save Flexible Spending Plans, a national grassroots advocacy organization, was formed to protect against the restricted use of FSAs in health care reform efforts, Save Flexible Spending Accounts is sponsored by the Employers Council on Flexible Compensation (ECFC), a non-profit organization "dedicated to the maintenance and expansion of the private employee benefits on a tax-advantaged basis".[109] ECFC members include companies such as WageWorks Inc., a benefits provider based in San Mateo, California.
Disability income (DI) insurance pays benefits to individuals who become unable to work because of injury or illness. DI insurance replaces income lost while the policyholder is unable to work during a period of disability (in contrast to medical expense insurance, which pays for the cost of medical care).[123] For most working age adults, the risk of disability is greater than the risk of premature death, and the resulting reduction in lifetime earnings can be significant. Private disability insurance is sold on both a group and an individual basis. Policies may be designed to cover long-term disabilities (LTD coverage) or short-term disabilities (STD coverage).[124] Business owners can also purchase disability overhead insurance to cover the overhead expenses of their business while they are unable to work.[125]
HSAs are one form of tax-preferenced health care spending accounts. Others include Flexible Spending Accounts (FSAs), Archer Medical Savings Accounts (MSAs), which have been superseded by the new HSAs (although existing MSAs are grandfathered), and Health Reimbursement Accounts (HRAs). These accounts are most commonly used as part of an employee health benefit package.[108] While there are currently no government-imposed limits to FSAs, legislation currently being reconciled between the House of Representatives and Senate would impose a cap of $2,500. While both the House and Senate bills would adjust the cap to inflation, approximately 7 million Americans who use their FSAs to cover out-of-pocket health care expenses greater than $2,500 would be forced to pay higher taxes and health care costs.

Public programs provide the primary source of coverage for most seniors and also low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and the Veterans Health Administration and benefits provided through the Indian Health Service. Some states have additional programs for low-income individuals.[43] In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid—up from 52 percent in 1997.[44]
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