Accountable health plan (AHP):  A health care organization or network which provides both health insurance services and health care is often called a health plan (or health care plan).  Some current health care reform proposals revolve around such organizations, which would be accountable for meeting federal requirements for providing certain standardized health services. 

Adverse selection:  A situation in which patients with greater than average need for medical and hospital care enroll in a prepaid health plan in greater numbers than they occur in a cross-section of the population.  A plan which somehow encouraged or allowed people to sign up when they were already ill would suffer from adverse selection.  Community rating would not only even out the premiums for health insurance by spreading the risk over a broad base, it also would reduce the chances that a group (community) would be so small as to permit serious adverse selection.

Cap:  A limit on the amount of money which may be spent for a given purpose. A global budget for health care for a community would be such a cap. 

Congressional Budget Office (CBO):  An organization, created by the Congressional Budget Act of 1974, which provides the US Congress with analyses of alternative fiscal, programmatic, and budgetary issues.  It has been involved in studying and making recommendations concerning the costs of alternative health care reform proposals. “Scores” a proposed bill by calculating the amount it will either increase or decrease federal spending and tax revenues.

Comparative effectiveness research:  Scientific studies that would assess the effectiveness of various medical treatments, medications, and devices.  A component of health reform, the research aims to improve quality of care and control costs.

Health Insurance Exchange:  System would allow uninsured individuals and small employers to purchase insurance by shopping at a federally-regulated, web-based marketplace similar to a travel web site. 

Guaranteed access:  Reform provision that would bar health insurers from rejecting applicants because of their pre-existing conditions.

Individual mandate:  Requiring people to purchase health insurance or pay a penalty.  Reform plans would give subsidies to those with middle incomes and below to afford a policy. 

Medicare Payment Advisory Commission:  An independent commission of doctors and health policy experts which makes recommendations to Congress on how to make medical care more efficient.

Mandate:  To require.  In health care reform, the term is being used to refer to federal or state-imposed requirements on insurance companies, employers, and so forth, to pay for health care or provide specific benefits. 

Out-of-pocket payments:  Direct spending by consumers for health care goods and services, including co-payments, deductibles, and any amounts not covered by insurance.

Pay-or-play requirement:  Requiring companies to offer health insurance to their employees or make a payment to the federal government to help pay for coverage of the uninsured.

Public Option:  A form of government-sponsored medical insurance that would be offered to the uninsured as one of the choices in the health exchange.

Reconciliation:  Streamlined procedure that the Senate may use to enact changes by a simple majority vote, removing the possibility of a filibuster.  Senate rules allow the reconciliation process to be sued only on a budget bill.

Single-payer plan:  A system under which medical care for all Americans would be paid for by the federal government. 

Socialized medicine: European-style health system where the government employs health care providers and owns and operates health care facilities. 

Sustainable growth rate:  Each year, Medicare sets fees for physicians’ services using a “sustainable growth rate” formula.  This target is updated annually to reflect inflation, the increase in the number of Medicare enrollees, and other factors. 

Tort reform:  A change in the way in which individuals who are “harmed” by the health care system may be compensated.  In the U.S., patients injured through malpractice or otherwise generally file a lawsuit seeking damages; such suits cost a great deal, take up a lot of time and resources, and may result in enormous sums to the patient. It has been suggested that alternatives might be more fair, result in faster settlements, and save money.  Tort reform is sometimes, in the health care context, referred to as “malpractice reform.”

Uncompensated care:  Medical care given to a patient who has no health insurance and can not afford to pay the out-of-pocket costs.  Hospitals pass the cost of uncompensated care along to their paying customers.

Universal Coverage:  A goal of health reform where all Americans have insurance coverage.

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No matter how you slice it, ECHI is a smart business decision.  Call the McLean County Chamber of Commerce today at (309) 829-6344.  Simply say:  Tell me about ECHI today!

© 2009 Employers’ Coalition for Healthcare, Inc.