Essay Instructions: Review a current newspaper article for local, regional, and national events that may have an impact on advanced practice nursing(Family Nurse practitioner) and health care.
Keep a reactions journal identifying pertinent events and follow their development for the duration of the course.
Identify how these events will affect advanced practice nursing and health care and describe practice implications.
Last year, I wrote about people who want to retire before they turn 65 ? meaning that they don''t yet qualify for Medicare ? but have no retiree health care benefits from their employers.
A reader wrote to tell me that I had certainly identified a problem but had been a little short in specific solutions, other than paying for private insurance, if you can get it.
Well, there still aren''t a lot of options. But with a little research, many people can come up with relatively affordable coverage for those years until Medicare kicks in.
According to the Employee Benefit Research Institute, a nonprofit and nonpartisan policy organization in Washington, some 23.4 million Americans are in the 55-to-64 age group. Four million of them, or about one-sixth, are retired. Of those retirees, 56.8 percent have coverage through their former employers, 13.7 percent buy individual polices and 17.2 percent have no health insurance. The remainder fall into other categories ? having coverage under Medicaid, for example.
Whatever you do, don''t try to get by without any insurance. Better to keep working, no matter how much you want out, because one serious health problem could put you on the welfare rolls. Paul Fronstin, an economist and director of the health research program at the institute, says people who go without insurance are "playing Russian roulette with a catastrophic illness."
Less than one-third of companies, mostly big ones, provide health benefits to retirees. In 1993, 46 percent did. A 1985 federal law, often referred to as Cobra, gives workers the right to continue their policies for up to 18 months, but only by paying the full premiums. After that, if you''re not 65, you''re on your own.
What happens next depends to a large degree on where you live. The states have varying laws that govern access to health insurance.
Twelve of them ? Idaho, Iowa, Kentucky, Maine, Massachusetts, New Jersey, New York, Ohio, Rhode Island, South Dakota, Utah and Vermont ? have what are known as guaranteed-issue laws. While details may vary, the laws generally mean insurance companies that offer individual polices have to sell you insurance regardless of pre-existing conditions, although there can be waiting periods if you are not switching from current coverage. Generally, the insurers can''t raise your individual rates, only the overall rates. Usually, they also can''t cancel your policy unless they pull out of the market.
But because the insurers in these states have to take on all comers, regardless of health, the policies can be very expensive. They are especially so in states like New York and New Jersey, which use so-called community rating systems. That means everyone''s premiums are the same, regardless of age. In some other states, the young are charged less, the older more.
"The trick is to balance affordability and access," said Robert Meehan, vice president for consumer and commercial markets at Horizon Blue Cross Blue Shield of New Jersey. "If anybody can buy, then affordability goes off the chart."
But if you live in one of these 12 states, you can at least get insurance with some legal protection. If you live elsewhere, your rates can be lower, but access might depend on your health and the vagaries or absence of state law. In some cases, you may be forced into state-financed high-risk insurance pools that can carry high premiums.
Some health care advisers suggest looking for a high-deductible major medical policy that can be considerably less expensive. The assumption is that if you are retiring early, you probably have enough savings to take care of minor and routine care. What you really need is protection against a catastrophic illness.
Horizon of New Jersey, for instance, offers such policies, one with an annual deductible of $10,000 a person and $20,000 a family. After that, you would have to pay 50 percent of your bills, until you laid out $5,000. Then the insurance would pay 100 percent. That means you might have to spend up to $15,000 for health care in a given year.
The rate for this plan is only $369.21 a month for a couple with no children. Horizon''s H.M.O., with a $30 co-payment for doctor visits, would cost the same couple $829.44 a month. A traditional fee-for-service plan that pays 80 percent of medical bills and has a $500 annual deductible would be $3,313.60 a month.
In fact, if you are in pretty good health, a major medical policy like Horizon''s might be better than Cobra coverage for 18 months, which in many cases can run close to $1,000 a month for a couple.
It''s important to shop around and to compare the details. A helpful Web site is eHealthInsurance.com. It provides rate quotations and benefits from several companies.
DON''T count on any help soon from Congress, where this is not viewed as an important issue ? at least not yet. The baby boomers could change that.
"Sometimes even a vocal minority can change things," Mr. Fronstin said. "In the case of the boomers, they''re such a large group that if they organize they can have an impact on policy like a Medicare buy-in."
He was referring to a failed 1998 proposal by President Bill Clinton to allow uninsured Americans, 55 to 64, to pay to enroll in Medicare.
One glimmer of hope is AARP. It is studying the possibility of offering health insurance to its members, along with other kinds of insurance it already offers, including Medigap, to supplement Medicare coverage.
Roberta Milman, the organization''s director of health products, said AARP was very much aware of the issue and its growing importance as the 70 million or so baby boomers begin to retire. "It''s one of our top priorities," she said.