Health Insurance Coverage

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Health Insurance Coverage

• Presented By The Notorious Nurses
• Anne Dean, Tsion Berhanu,
• Shaneen Fernandez, Rebecca Khim,
• Carrie Phillips Andrea Zipperer

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Health Care Insurance Coverage for
Self-Influenced Illness

• Alcoholism, Obesity, Smoking

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Coverage vs. Claim

• Pre-existing Conditions

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Four Options

• No Coverage whatsoever
• Coverage but not claims
• Coverage regardless (includes all claims)
• Coverage including initial claims when
  accompanied with behavior changes

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Health Insurance Denial for Self-influenced
Health Problems

• Self-influenced health problems
• Impact on healthcare costs/insurance rates

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Ethical basis for denying coverage

• Economic benefits
• Consumer Benefits
• Insurance company profits

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Promote independence and self accountability for
health

• Health Promotion/Illness Prevention
• Price sensitivity
• Reduce self-influenced health problems

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Measures to counteract health insurance coverage
denial

• Alternatives smoking cessation programs,
  government action and public persuasion to combat
  obesity, alcohol use, and smoking
• Lifestyle changes weight loss, physical
  activity, smoking cessation, and reduced alcohol
  consumption
• Alternative solutionsminimize the effects of
  self-influenced health problems while also
  reducing health insurance rates (allieduotes,
  insure.com)

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Denial of Insurance Coverage Claim by Claim

• Individual responsibility choice
• Self-influenced health behaviors
• Increased health hazards yields increase in
  health costs

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Annual Deaths Attributable to Cigarette
SmokingUnited States,19972001
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Is Healthcare coverage a right or a privilege?

• Equal access to healthcare
• Equal quality of care
• Equal price of coverage

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Consequences of unequal coverage

• Millions of men, women and children have no
  health coverage
• People without healthcare coverage find
  themselves in thousands of dollars of debt with
  medical bills
• Medical debt accounts for over half of all
  personal bankruptcies

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Diseases of addiction Smoking

• Nicotines chemical structure is similar to the
  neurotransmitter acetylcholine
• Within eight seconds of the inhaled puff of
  smoke, nicotine arrives at the brain causing
  release of dopamine
• The brain adapts to the new effects of the
  chemical and an absence can lead to severe mood
  swings and anxiety

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Diseases of addiction Alcoholism

• Three of the most important NTs with respect to
  alcohol are
• Glutamate (inhibited)
• Serotonin
• Dopamine
• Reward center of the brain

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Diseases of addiction Obesity

• Mental Health
• Eating disorders
• Bingeing (compulsively overeat)
• Bulimia Nervosa (binge and purge)
• Sugar bingeing produces dopamine in the brain
• Research is currently underway to determine if
  food additives are addictive

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Equal health insurance

• Smoking, alcoholism and obesity should be in the
  same category as depression and cancer

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Health Insurance companies have the option of
providing coverage for everyone, but,

• Limiting that coverage after a modifiable disease
  factor is identified
• Health Insurance companies would also help pay
  for the treatment necessary to change the
  modifiable disease factor
• The insured must be willing to actively change
  their behavior to reduce the cost risk to the
  health insurance company

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• The CDC has determined that if health insurance
  companies cover tobacco treatment cessation
  programs it increases the effectiveness of the
  treatment and the number of successful quit
  attempts
• This logic can be applied to programs that treat
  obesity and alcoholism

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• This is an inclusive option for health insurance
  - everyone is covered but compromises are made on
  both the part of the insurer and the insured
• Ultimately, the goal would be to lower the cost
  of health insurance for everyone

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This is not an easy issue to side on, especially
from a nursing perspective

• Insuring individuals who participate in these
  behaviors is extremely costly, and that cost is
  often dispersed among all insured, raising the
  cost for those individuals who have healthy
  lifestyles.
• This leads to many people not being able to
  afford insurance. One might also argue that
  there is little incentive for those individuals
  to change their life styles if they know that a
  tertiary solution is on the horizon.
• Why should I try to change my diet when I can
  just get that new stomach surgery and my appetite
  will just decrease automatically?

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The other side of the issue poses the question

• Do we really want people dying because they have
  fallen victim to the addictions of society?
• Tobacco and alcohol are indisputably addictive
  substances and for many, eating can also be an
  addictive behavior.

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Four Options

• Denying coverage for any individual who has a
  high-risk life style
• Providing coverage for all, but denying any claim
  that relates to a lifestyle factor
• Paying for the initial cost of rehabilitation for
  that client, but denying claims in the future
• Providing coverage for all, regardless of
  lifestyle

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The common thread throughout the exploration of
this issue is the role that we as nurses can
play, including

• Lowering health care costs through health
  promotion and illness prevention
• Improving the health of those who will
  potentially suffer from the consequences of their
  lifestyle decisions through our power to provide
  illness prevention and health promotion

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Resources

• Achman, L., Chollet, D. (2001). Insuring the
  Uninsurable An Overview of State High-Risk
  Health Insurance Pools. Retrieved November 5,
  2008, http//mathematica-mpr.com/publications/PDFs
  /uninsured.pdf.
• Alliedquotes (www.alliedquotes.com/resources/healt
  h-insurance-rates.html)
• Center for Disease Control (www.cdc.gov).
  (http//www.cdc.gov/tobacco/quit_smoking/ce
  ssation/coverage/.htm).
• Chitty, K.K., Black, B.P. (2007). Professional
  Nursing Concepts Challenges (5th ed). St.
  Louis, Saunders Elsevier.
• Eating your way into the Hospital and the
  Poorhouse (2004, September 16). Retrieved October
  13, 2008, from http//www.insurance.com/article.a
  spx/Eating_your_way_into_the_hospital_and_the_poor
  house_/artid/72.
• Edelman, C. L., Mandle, C. L. (2006). Health
  Promotion Throughout the Life Span (6th ed.).
  St. Louis, Missouri Elsevier Mosby.
• Health Insurance 360 (http//www.healthquote360.co
  m/individual_health_insurance/health_insurance_for
  _pre-existing_conditions.php) 
• HealthPac online a vision of quality healthcare
  for all (http//www.healthpaconline.net/health-car
  e-insurance.htm).
• Huether, S. E., McCance, K. L. (2008).
  Understanding Pathophysiology (4th ed.).
  St.Louis Mosby Elsevier.
• Insure.com (www.insure.com/articles/healthinsuranc
  e/weight.html).
•  Food and Addiction (http//www.yaleruddcenter.org
  /reports/pdfs/RuddCenterAddictionMeeting.pdf)
• Sturm, R. (2002). The Effects of Obesity,
  Smoking, and Drinking on Medical Problems
• and Costs. Health Affairs. Retrieved November 5,
  2008, http//content.healthaffairs.org/
• Alcohol Chemistry You (http//chemcases.com/alc
  ohol/alc-07.htmOnce20inside)
• Sturm, R., Ringel, J. S., and Andreyeva, T.
  (2004). Increasing Obesity Rates And Disability
  Trends. Health Affairs. Retrieved November 5,
  2008, http//content.healthaffairs.org/
•  Why Quit.com (http//whyquit.com/whyquit/LinksAAd
  diction.html)
• USAToday. (http//www.usatoday.com/money/workplace
  /2006-02-16-smokers-cost-more_x.htm)