In 2008, health care expenditures were over $2.3 trillion. This amount is considerably more than the $714 billion spent in 1990 and over eight times the $253 billion in 1980 (Kaiser, 2010). As the cost of health care continues to increase consumers, employers, and the government struggle to keep up. While it is quite apparent that expenditures are increasing at a fantastic rate, what is not so apparent is why. Equally frustrating is determining how the problem can be fixed. The 2008 presidential campaign focused heavily on health care reform with both major parties announcing reform proposals. After his election, President Obama released the Fiscal Year 2010 budget which included eight principles for health care reform. With the release of the budget, President Obama proposed to set aside $634 billion in a reserve fund specifically for health care reform (KFF Org, 2010). Despite a number of oppositions (from both sides of the political coin), the Affordable Care Act (ACA) was signed in as a law on March 23, 2010. Considered to be landmark legislation, the ACA was developed in an attempt to alleviate the crushing cost of health care. The ACA’s primary goal is to help provide affordable care to every individual starting in 2014. Reforms provided by the ACA are also expected to “end some of the worst abuses of the insurance industry” (HealthCare.gov, 2010). In effect, the ACA was established to “enhance the quality of care for all Americans” (Whitehouse.gov, 2010). The question remains, however…How will this reform affect the most vulnerable in our society? According to the Center for Disease Control (CDC), in 2010 there were 59 million Americans without health insurance which was an increase of four million from 2009. If the health care reform proceeds as planned how will it affect these millions of Americans? The reforms proposed by the ACA are expected to ensure health care coverage for all individuals, but close attention needs to be paid as to how these reforms are implemented to make sure that those whore without coverage now will be covered in the future and that the many that are underinsured are still able to afford care.
The plight of the underinsured and the
uninsured is not new to this country. It
has been an ongoing problem which has been addressed many times over. For decades individuals, physicians,
researchers, the government, and third party groups have tried to figure out
ways in which to protect this very vulnerable group of people. As medical research and practice continued to
advance, more and more individuals were in need of insurance. In 1940, only 9% of the US had medical
insurance and the demand was increasing at an alarming rate (Sultz & Young,
2011). As this demand grew, insurers
were able to deal with the increasing costs by spreading out premiums over
larger groups of peoples. As a result,
more than 74% of Americans were covered by insurance by the year 1996 (Sultz
& Young, 2011). The bulk of the
insurance, however, was provided by large private companies. In the 1940’s, a number of bills were
proposed to aid those who were unable to afford care or private insurance
costs. None of these proposals were ever
brought to a vote. In the 1950’s,
actions were made by Congress to help individuals who were receiving public
assistance to obtain affordable health care.
“This action permitted, for the first time, Federal participation in the
financing of medical care for costs incurred by public assistance recipients” (Hoffman,
2007). Around this time, Congress
realized that the number of aged individuals requiring access to medical care
was increasing as well. In 1965, as a
result of the perceived needs of low-income individuals and families and the growing
elderly population, Congress passed legislation to help those who were unable
to afford private insurance and the aged who were requiring more extensive and
lengthier care. This legislation marked
the birth of the Medicare and Medicaid programs in the US.
Health Insurance for the Aged and Disabled,
more commonly known as Medicare, was first implemented in this country in
1966. At its inception, Medicare covered
most individuals over the age of 65 with coverage extended to patients with
end-stage kidney disease, those entitled to Social Security benefits for at
least two years, and individuals who are not covered by another insurance who
wish to pay a premium for Medicare coverage in 1973. In 2001, patients with Lou Gehrig’s disease
were also granted coverage. In a
nutshell, Medicare provides assistance in the cost of hospital inpatient care,
home health aide, nursing facilities, and hospice care. Additional support can also be received (at
little to no cost) for doctor’s visits, specialty care (dentist, chiropractor,
and podiatrist), and outpatient hospital care and extended home health aide,
and other services. Medicare can also
provide assistance with the cost of prescription medications. In the middle of the year of 1966, when
Medicare was first introduced, around 19 million consumers enrolled. By 2007, that number had risen to 44 million
(Hoffman, 2007). Coverage under Medicare
provides older individuals (65 and up) with healthcare at little to no cost
depending on the services provided. For
the most part, this patient population is made up of people who are no longer
working and bringing in a regular paycheck but who are more likely to need
significant medical care and/or hospitalization.
In addition to providing assistance to the
aged population, The Social Security Act allowed for the provision of care for
individuals and families with low income.
Medicaid became a law in 1966 and “is the largest source of funding for
medical and health-related services for America’s poorest people” (Hoffman,
2007). Though the framework for Medicaid
is established by Federal guidelines, each state is responsible for its own
individualized program in regard to eligibility, type/scope of care, duration
of care, and ratio of payment (if any) made by the recipient. Such state to state differences in
eligibility requirements can lead to a great deal of
frustration and confusion as a patient may be
eligible for coverage in one state but not in another. Despite these differences, however, Medicaid
was established to help those who are unable to pay for medical care or private
insurance. Like Medicare, Medicaid’s
goal is to significantly decrease the number of Americans who are without
health insurance.
When discussing vulnerable population groups
in relation to health care and insurance, we must also consider the
children. The State Children’s Health
Insurance Program (SCHIP) of the Social Security Act allows expanded coverage
and aid to uninsured children of lower income families. SCHIP’s goal is to provide care for the
children who were previously falling through the cracks of the system. Children of lower income families who were
ineligible under previous guidelines are now able to receive assistance. Under provisions established by the program,
a child may be eligible for assisted aid even if the parent is not. Generally these programs provide coverage for
doctor’s visits, hospital care, routine care, specialized and long-term care,
and prescription medications.
The
Affordable Care Act makes many changes not just inside the health care
industry,
but within all industries. The ACA seemingly takes
the steps necessary to assure not only the
uninsured, but the under-insured will have some sort
of health care coverage. The health care
reform law requires that all Americans have health
insurance, which means employers will need
to prepare for a new wave of employees who will need
insurance coverage. With health care
costs rising and salary increases remaining small,
employers may need to get creative when it
comes to compensation and benefits in 2011 to ensure
they communicate their value effectively
and motivate and engage employees. For example,
cost-conscious employers may offer more
benefits to attract and retain talent, such as
flexible work options, including adjustable work
schedules or telecommuting. Vacation buy and sell
programs, where employees can purchase or
sell back extra vacation days to their employer, are
another low cost creative option likely to gain
appeal. (Marzulli, 2011).
With
all the changes coming about due to the new Affordable Care Act there are many
employers having to search for creative and innovative
ways to cut costs. One of the creative
ways employers seem to be turning to are wellness
incentive type programs which include but
are not limited to the following: education,
preventive care, fitness and nutrition. (Loehrke,
2011). The employers who have developed wellness
programs have recently been asking their
employee's to voluntarily provide a health risk
assessment. Does this mean that your employer is
delving into your personal affairs? Not necessarily.
Employers cannot require medical
information unless they reasonably believe that the
employee cannot or will not be able to
perform an essential function of their job due to a
medical condition, or if the employee may
pose a threat to themselves or others due to that
condition. (Loehrke, 2011). Thus, many
employers are still trying to find ways to decrease
health care costs.
Decreasing
health care costs is a goal of employer's even for employee's who take care of
aging loved ones. It's no surprise that employees
who care for older relatives may cost employers
more in terms of reduced productivity and higher
absenteeism. A recent study by the Met-Life
Mature Market Institute now finds that family
caregivers tend to have higher health care costs as
well. The study estimates that United States
employers pay 8 percent less per year in health
care costs for employees without those
responsibilities. This could potentially cost
United States employers $13.4 billion per year,
according to the report. (Baker, 2010). Among
the chronic conditions more prevalent in caregivers
than non-caregivers: depression, costing one
particular company an estimated $6,380 in increased
medical expenses; hypertension combined
with coronary artery disease, costing $30,073; and
diabetes costing $14,979. (Baker, 2010).
Within
some companies it looks like employee's are being receptive to the creative ideas
their employers are having. Is this because
employee's are realizing that these programs could
save them money in the long run too? "Only 31
percent of employees who had negative feelings
about the way their medical benefits were handled
felt good about their health care plans"
(Wells, 2010).
Bear in mind that the new health care reform
act protects many individuals who would
soon be uninsured, and/or, underinsured, some due to
ineligibility. "Claims auditors estimated
that an average 3 percent to 8 percent of enrolled
employees' dependents would be ineligible.
Assuming a $1,900 average annual cost per dependent,
savings can be substantial. Plans with 3
percent ineligibility per 10,000 dependents would
save $570,000; those with 8 percent
ineligibility might net a return of about $1.5
million" (Wells, 2010). Many of
these previously
ineligible individuals are adult children who will
now remain covered until age 26. (Tyler, 2010).
The previous savings employer's have by not covering
these individuals may now be a potential
cost increase and possibly force some employers to
increase premiums for health care coverage
of their employees', spouses and dependents. "A recent analysis by Hewitt Associates
reports
average premium increases for 2009-2010 at 6 and 6.9
percent, respectively, and projects an 8.8
percent average premium increase for 2011"
(Loehrke, 2011). Who will be impacted by the
provision requiring employers to make coverage
available for all children until they turn 26?
Beginning in 2014, even an adult child who has
access to coverage through his or her employer
will be eligible for coverage through a parent's
plan. This impact may be substantial with a
projected increase of up to 4 percent of total plan
costs. This impact should be minimal for plans
which are employees only. (Tyler, 2010). The financial incentive to change to employee
only
coverage appears strong, many employers are not at
this time saying they expect to make the
change to employee only coverage. The financial
incentive is strong especially since coverage
generally costs employers much more than the $2,000
per employee annual penalty as addressed
within the health care reform act. (Tyler, 2010).
Employers are simply looking at the difference
in cost of insuring an employee compared to the cost
of the penalty. This means that business
leaders look at benefits from a cost standpoint. If
the burden is more in providing coverage then
they will more than likely drop the benefit of
dependent coverage for their employees. (Tyler,
2010). This would mean dependents, and in some cases
spouses would be amongst the millions
of uninsured. Employers are finding additional
changes for their previously uninsured employees
as regulated within the new ACA law.
Many
employers have found themselves in a quandary and in need of guidance from the
government on how to interpret the Affordable Care
Act which was signed into law in March
2010. One of the pieces of this reform act employers
seem to be looking for is how to define full-
time employee status. The employers are asking for
specifics on how to measure the 30-hour
workweek requirement for a full-time status.
(Sammer, 2011). This change in the law
means,
employees who did not meet full-time status before
and were ineligible for health care coverage
may now meet the requirement. So, what does this
mean to you and your employer? What this
means is if you were previously considered part-time
you could possibly now by law be deemed
full-time and eligible to receive the benefits of a
full-time employee. What it means for your
employer is they would now be required to provide
the same health care benefits, as they do to
all
full-time employees. "Growth in the average total health benefit cost per
employee in the
United States picked up steam in 2010, rising 6.9
percent to $9,562" (Miller, 2011). There is a
provision within the Affordable Care Act for
employers with health plans in existence when the
law was signed to be "grandfathered". This
provision has several regulations not released until
June 17, 2010 by the Obama administration. (Miller,
2011). According to the regulations, a
sponsor that wants to keep a plan grandfathered
cannot cut or significantly reduce benefits, raise
co-insurance charges, raise co-payment charges by
more than $5, adjusted annually for inflation,
raise deductibles significantly, reduce employer
contributions by more than 5 percentage points,
or change insurance companies. (Tyler, 2010). These
grandfathered plans still could not exclude
coverage of pre-existing conditions or set annual or
lifetime coverage limits, but they can avoid
the reform law's requirements for additional
reporting on employees' W-2 tax forms. (Tyler,
2010). Many employers' view the additional W-2
reporting requirements in the top provisions
impacting costs.
(Tyler, 2010).
We
have already started to see changes come about from the ACA. Beginning in June
of 2010 we started seeing Medicare beneficiaries who
reach the Part D "donut hole" get a $250
rebate and a change toward those with pre-existing
conditions being offered insurance until
2014. (Lankford, 2010). In September 2010 the
provisions for covering dependent children up to
age 26 was revealed. We also saw the new regulation
requiring insurers to cover certain
preventive services and prevention of imposing
lifetime limits on the dollar value of coverage.
They also can no longer rescind coverage except for
fraud, or exclude pre-existing conditions on
children. So far for the 2011 year Medicare
recipients will now get free preventive services and a
50% discount on brand-name drugs purchased in the
Part D donut hole. (Lankford, 2010). We
also saw reimbursements for over-the-counter drugs
in tax-favored medical accounts become
disallowed.
The projection for 2013 is for Flexible spending account contributions
to be limited
to $2,500 per year. (Lankford, 2010). However, the
threshold for deducting medical expenses on
a tax return rises from 7.5% to 10% of adjusted
gross income, those age 65 and older are exempt
through 2016. In 2014 according to the new law we
will see all U.S. citizens and legal residents
being required to have health insurance. There will
be penalties of $95 or 1% of income, rising to
$695 or 2.5% of income in 2016. We will also see
people younger than 65 who earn up to 133%
of the poverty level become eligible for Medicaid,
and a tax credit for those singles earning
$44,000 or less, and $80,000 or less for families to
buy coverage. In 2018 health plans will
be
hit with a 40% tax on the portion of coverage worth
more than $10,200 for individuals or
$27,500 for families. (Lankford, 2010).
Another
change began at the start of 2011. Individuals who earn more than $85,000 or
$170,000 if married filing jointly will have to pay
a high-income surcharge for Part D premiums.
(Lankford, 2010). The law does appropriate $5
billion for a high-risk pool, in effect from June
2010 until 2014 to help people otherwise locked out
of the insurance system to buy subsidized
policies. The new pool's policies must cap annual
out-of-pocket spending at $5,950 for
individual coverage or $11,900 for families (not
including premiums). (Lankford, 2010).
Despite
the positive changes for United States citizens there is a great deal of
negativity
regarding the ACA as it is currently written.
"Dan Wolterman, president and CEO of
Memorial
Hermann Health System in Houston says it's because
the law is flawed and needs revisions.
However, he does say that the ACA offers a platform
to begin a necessary realignment of the
stakeholders in the provision of quality healthcare.
However, he's concerned, as are many other
senior healthcare executives who participated in a
survey by Health Leaders magazine. They feel
that the law as written pays disproportionate
attention to access. In other words, insuring the
uninsured. "(Betbeze, 2010). Mr. Wolterman
states, "The pay or play provisions on both the
employer and individual are set much too low.
Incentives are strong to opt out. I don't believe in
the intermediate term that the number of uninsured
will go down. In fact, we run a very good
chance that they will go up as employers opt out.
Penalties were set artificially low
intentionally." (Betbeze, 2010). In the Health Leaders survey many respondents
express concern
that the access problem can't be fixed without
massive change in the delivery system, addressing
such concerns as fee-for-service financial
incentives that have been left in place during the
transition period.
Wolterman goes on in saying "The federal government is cutting
their
reimbursement and disproportionate share funding. If
you improve your quality, your
reimbursement per unit of service will go down and
your bottom line will go down as
well."(Betbeze, 2010). When asked about the
law's provision of an independent payment
advisory board under the executive branch, Wolterman
says, "If you read the fine print in the
law, this is not an impartial group, it's not
accountable to Congress, and it fundamentally changes
how Medicare rates and budgets have been done.
Although they can override the board's
decision, they would have to substitute other cuts
to take the place of anything they override. Not
a lot of people in our industry understand that
implication." (Betbeze, 2010).
There
is a question of whether there will be enough providers to take care of
everyone.
Younger physicians are wanting a life outside of
their practice with fewer hours there is the
pressing need for more primary care. Congress
inacted the ACA requiring all citizens of the
United States to have health insurance, but the law
does not make provisions for the increased
need of health care providers. In the years ahead,
there is the looming reality of millions
of uninsured entering the health care system, never
mind the crunch of the aging baby boomers
eventually
needing not only medical help, but also government assistance. Physicians are
facing
the reality of a 23% Medicare pay cut that was
scheduled to take effect December 1, but which
was subsequently delayed by Congress. Nearly 13% of
516 responses to a recent survey done by
American Academy of Family Physicians said they
would consider no longer seeing patients if
Congress failed to override the mandatory pay cuts.
(Commins, 2011). This demonstrates a
serious threat to Americans' access to healthcare.
This will make many patients, children, their
parents, and their grandparents face the all too
real prospect of losing their doctors. The cuts by
Medicare could force doctors out of business. If
that happens all patients in the community
would lose access to needed healthcare regardless of
the type of insurance coverage. So, in
essence it would be like Medicare patients were uninsured or underinsured. But, we
have to face
the stark reality that our physicians are also a
business. They cannot continue to run that business
if 30% of
their customers were going to reduce their payments by 25% or more. (Commins,
2011). "Although
health care providers debate their individual and personal obligations to
provide uncompensated care, the system itself
finessed the problem for a long time by shifting
the costs of care from the uninsured to the insured.
This unofficial but practical approach to
indigent care was ethically tolerable as long as the
reimbursement system for paying patients was
so open ended that the cost of treating the
uninsured could easily be passed on to paying
patients." (Sultz, 2011).
The primary goal of today’s health care reform is to
ensure quality health care to all individuals in this country regardless of
age, race, health status, or socioeconomic background. It is the steps that must be taken in order
to achieve this goal that come into question.
There is concern among some primary stakeholders who fear they may not
receive what they believe they are entitled.
There are others who feel the need to guard what they already have and
who don’t want to give up anything even if it means allowing those who have
little (or nothing) equal access and care.
People (and businesses) don’t want to feel as if they have less at the
end of this journey than when they started.
At best, it is individuals and businesses holding tight to what they
have for fear of losing it all. At
worst, it is the age-old tug of war between the Haves and the Have Not's. A small sample of the stakeholders affected
by the ACA includes the consumers, employers, and healthcare facilities.
“First and foremost among health care stakeholders are
the patients who consume the services” (S&Y, 2011). It is the consumers, the people, the ACA is attempting to protect with proposed reforms with
those who are presently uninsured being the biggest beneficiaries of the
legislation. According to the Census
Bureau, 16.7% of people in America did not have health coverage in 2009. This percentage is equal to 50.7 million
individuals. In the same year, the
number of individuals with insurance actually dropped from 255.1 million in
2008 to 253.6 million (the first decrease since data collection began regarding
health insurance in 1987). The reforms put into action by the ACA are “expected
to extend coverage to over 30 million individuals who would otherwise be
uninsured by 2019” (McMorrow, 2010). As
noted earlier, the end result of these reforms can be a good thing. Some consumers, however, are concerned that
they will lose some of their coverage and access due to these reforms. Because Medicaid
and Medicare enrollment
parameters will be expanded with the ACA some individuals who were not
previously eligible for the programs now will be. As a result, these individuals may no longer
be eligible for the plans they previously subscribed to. Because some private facilities choose not to
accept Medicaid and Medicare because of their low rates of return, the
individuals might have to find different providers. In addition to the possibility of losing
their providers, consumers fear that the health care system simply will not be
able to tolerate a sudden influx of 30 million new patients. It’s a reasonable concern as “a general
shortage of primary care physicians has become increasingly apparent as more
physicians enter lucrative specialties” (McMorrow, 2010). Though there are provisions in place to help
with the emergence of such issues, some consumers are still worried. The ACA was established to help protect the
people of this country, yet some feel that it may do a great deal of harm to
those individuals who don’t really fit into either side of the
insured/uninsured coin before it reaches its full potential.
Employees, too, are feeling the pressure of the reforms
proposed by the ACA. Starting in 2010,
tax credits were made available to small businesses that offer health insurance
plans to their employees. These tax
credits will increase from 35% of health premiums paid to 50% in 2014. “The credit is designed to encourage small
employers to offer health insurance coverage for the first time or maintain
coverage they already have” (IRS.gov).
Large employers (more than 50 full-time employees) are not being offered
such incentives. Instead, larger
companies who choose not to offer insurance to their employees will be
penalized. Referred to as “Pay or Play”,
this provision could cost large companies $166.67 per month for every full-time
employee, excluding the first 30 (Healthcapital.com). Because of these reforms, some employers fear
they may have to ask employees to pay a higher percentage of health care
premiums. Other businesses may drop coverage
completely and simply offer higher wages to compensate.
Regardless of the
outcome for each business, the attempt to insure those who previously were
without insurance while at the same time maintaining affordable coverage for
those already insured is a matter many businesses are struggling with.
Health care facilities are the final group of
stakeholders in this sample who will be drastically affected by health care
reform in this country. The expected
number of newly insured individuals in this country as a direct result of the
ACA is 30 million. This number is expected
to generate around $40 million in revenue for hospitals by 2019 (Berenson &
Zuckerman, 2011). Though this sounds
like a generous amount of money, the increase will not be seen across the board
nor will it actually end up being quite that amount. “Some types of hospitals have historically
provided more care to uninsured patients, and these hospitals are likely to
gain the most in terms of revenue increase for the mostly uncompensated care
they have been providing to these patients” (Berenson & Zuckerman,
2011). In addition to this, hospitals
have agreed to certain provisions in regard to Medicaid and Medicare
reimbursement rates that will significantly offset the new revenue generated by
the 30 million newly insured patients.
Of concern, is not how much money each facility is likely to make as a
result of insuring the previously uninsured, but how these facilities will keep
up with the increased demand for services.
As previously noted, the number of primary care physicians has decreased
recently. With a decrease in providers
available and an increase in consumers looking for care there are few other
places for individuals to find care besides the hospital. The incidence of emergency rooms being used
for non-emergent situations is likely to increase as is time waiting to be seen
by a nurse or physician.
The Affordable Care Act is very altruistic in its design,
however with the way it is currently written does the new law effectively
provide for those who are uninsured or under-insured, or will it cause some
currently insured to become uninsured? There are many
Republicans, and
Democrats alike, who are attempting to repeal this law. Some simply because of
the way it is written, others because the impact to small businesses stands the
potential to be devastating to their bottom lines. The ultimate questions of
this law still remain unanswered: Will all individuals have some sort of health
insurance? and Who/How is this going to be paid for? The law provides that many
individuals without insurance will become insured under Medicaid, but under
what eligibility requirements? Another question comes to mind when discussing
eligibility: How does someone now become eligible under Medicaid, when they
were not prior to this law?
The ACA opens itself up to a lot of questions not just by
the Republican Party, but by Democrats, as well as, all United States citizens.
Many have looked forward to this kind of law for decades; however will any
health care reform law make everyone happy? Or, will the problems it attempts
to resolve continue for many more decades to come? Even though the ACA makes
requirements for all individuals to have health care coverage, will it
ultimately create even more uninsured due to some of its regulations? We have
discovered that employers of all sizes will have to make accommodations in
their benefits. We have found that even adult children up to the age of 26 will
be allowed to remain on their parent's health insurance, even if they are
employed themselves. We have learned that there are and will be penalties, not
just to employers, but to individuals who are uninsured. Does the Affordable
Care Act leave more unanswered questions than it attempts to resolve? This is
something that only you can decide.
Written by C. Ball, RN; A. Holmes, RN and M. Lawrence, RN
Written by C. Ball, RN; A. Holmes, RN and M. Lawrence, RN
References used:
Baker, B.(2010,July).
Caregivers incur higher health cost for
selves.Workforce
Mangement, 89(7), 8.
Berenson, R., &
Zuckerman, S. (2011, July). Timely analysis of
immediate health policy issues.
Retrieved from
http://www.rwjf.org/files/research/66028hospitals.pdf
Betbeze, P. (2010,
December ). Reform without results. Health
Leader, 13(12), 28-32.
Cantlupe, J. (2011,
March). The quest for quality, as healthcare
healthcare reform sharpens the focus on
quality outcomes,
the ability to achieve and demostrate
success becomes
increasingly important. Health Leaders, 14(13), 14-26.
Commins, J. (2011,
January). The demands on and by
physicians.
Denavas- Walt, C,
Proctor, B.D., & Smith, J.C. (2010,
September). Income, poverty, and health insurance coverage
in the United
States:2009. Retrieved from
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201003http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201003
.htm
Drew, C.(2011,
March). Health care reorm series: impact on
employers. Health Capital Topics. 4(3), Retrieved from
series.pdf
Hoffman, E.D., Klees,
B.S. , & Curtis, C.A. . (2007, November
1). Brief
summaries of medicare and medicaid. Retrieved
from http://ww.cms.gov/mediareprogramratesstats/downloadshttp://ww.cms.gov/mediareprogramratesstats/downloads
/medicaremedicaidsummaries207.pdf
Internal Revenue
Service, (2010). Affordable care act tax
article/0,,id=22080900.html
Kimbuende, E, Ranji,
U, Lundy, J, & Salganicoff, A. (2010,
March). U.S.
health care cost. Retrieved from
http://www.kaiseredu.org/Issue-Modules/US-Health-Care-http://www.kaiseredu.org/Issue-Modules/US-Health-Care-http://www.kaiseredu.org/Issue-Modules/US-Health-Care-
Costs/Background-Brief.aspx
Lankford, K. (2010,
June). Health reform, phase 1: what you
will see when. Kiplinger’s Personal Finance, 64(6), 20-21.
Loehrke, K. (2011,
April). The legalities of employee wellness.
Talent Management Magazine, 7(1),
32-34.
Martinez, M.E., & Cohen, R.A. (2010, March
24). Health
insurance coverage: early release if
estimates from the
national health interview survey,
january-september 2009.
Retrieved from http://www.cdc.gov/nchs/data/nhis/
earlyrelease/inur201003.htm.
Marzulli, T. (2011,
January). Making benefits work in 2011.
Talent Management Magazine, 7(1),
28-31.
Miller, S. (2011,
January). Per-employee health costs jump 6.9
percent. HR
Magazine, 56(1), 14.
Minisch-Pourshadi, K.
(2011, March). Caution leads to capital
budget cuts, delays. Health Leaders, 14(3), 30-34.
McMorrow, S. (2010,
July 6). Will the patient protection and
affordable and care act of 2010 improve
health outcomes for
individuals and families. Retrieved
from
http://www.urban.org/uploadedpdf/412127-2010-health-http://www.urban.org/uploadedpdf/412127-2010-health-
outcome.pdf
Sammer, J. (2011 ,
January). Navigating health care reform's
unclear mandates. HR Magazine, 56(1), 14.
Sultz, H.A., &
Young , K.M. (2011). Health care usa
Understanding its organization and delivery.
Sudbury, MA:
Jones & Bartlett Learning.
The affordable care
act. (2010). Retrieved
from
Tyler, K. (2010,
September). Health care reform now: first
Things first. HR Magazine, 55(9), 34-39.
U.S. Department of
Health & Human Service , (2011).
Understanding the affordable care act Washington,
DC:
Retrieved from http://www.healthcare.gov/law/introduction/
Index.htm
Wells, S.J.(2010,
July). Overseeing audits of your health plans.
HR Magazine, 55(7),
34-39.
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