0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a

0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Discussion Week 3 As an employee benefits manager it is my responsibility to work with the insurance companies and have a health insurance policy that can address the needs of all the employees. In 2014 the Affordable Care Act made it a requirement for everyone to have health insurance. Under the new law businesses that had more than 50 employees are required to provide insurance to their employees, and they have to satisfy both state and federal rules (Small Business Majority). Currently, there are two different groups that my employees fall under: the first group is within the age group of 20-30 year-olds who have no health issues that are known, and the second group is within the age group of 40-50 year-olds who have been diagnosed with chronic diabetes. I would want to take the route of health benefits as compensation for my employees so that it can play a role in recruiting employees and retaining them (Polsky et. al., 2005). This laws makes it necessary for the government and the employer to fulfill their obligations of have health insurance for their employees. Moral Hazards consist of asymmetric information that is between two parties and once there is a deal struck there is a changing in behavior of one of the groups (Nickolas, S., 2019). An adverse selection is when there is no symmetric information that is provided before a deal is set between two parties, the seller and the buyer (Nickolas, S., 2019). Since there are two different groups that must be provided insurance, moral hazards and adverse selection will impact the health insurance options that are provided. If one of the groups is hiding information that could be vital to selecting the health insurance, it can have a negative impact on the other group or cause a change in who qualifies for the health insurance and who doesn’t. There are many things that need to be kept in mind when designing a health insurance policy for my employees. The first step is to identify the objectives and budget, second is to prepare a need’s assessment, third is to bring together a benefits plan program, fourth is to communicate this plan with the employees and lastly, determine the effectiveness of this program. I would want to have a PPO plan set up for the employees, because they will be able to have more flexibility in who they see and their individual health care needs can be addressed (HMO vs. PPO Insurance Plans). Since there are different health concerns for the groups this would be the best route to take, because although the premiums might be higher, there is the flexibility that you can see a specialist without having to see your primary care physician first. References: HMO vs. PPO Insurance Plans. Retrieved from https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Compare-Health-Insurance-Plans/HMO-vs-PPO-Insurance.aspx Nickolas, S. (2019). Moral Hazard vs. Adverse Selection: What’s the Difference? Retrieved from https://www.investopedia.com/ask/answers/042415/what-difference-between-moral-hazard-and-adverse-selection.asp Polsky, D., Stein, R., Nicholson, S., & Bundorf, M. K. (2005). Employer health insurance offerings and employee enrollment decisions. Health services research, 40(5 Pt 1), 1259–1278. doi:10.1111/j.1475-6773.2005.00415.x Small Business Majority, (n.d). Laws Related to Health Insurance. Retrieved from https://healthcoverageguide.org/reference-guide/laws-and-rights/laws-related-to-health-insurance/ I agree with you that the employer should have some responsibility to provide health insurance to their employees. Although the government does provide some incentives to employers that provide coverage, the government should have some responsibility in providing health care. The Center for Medicare and Medicare Services does provide incentives for bundled payments.  In both underdeveloped and developed countries, insurance is free to the population. It is known that employees with chronic illnesses spend more on health care. Therefore, the employer and the government should provide plans that complement the other for the total population to achieve quality care at a lower cost. The employees with no known health issues can pick coverage where the deductible increases each year as usage increases. This could reduce the risk for the insurance company and eliminate the risk associated with the misuse of health care.  Under the Affordable Care Act, health coverage should have some regulation in use and guidance to insureds that have chronic illnesses (Mendoza, 2016). For employees with unknown conditions, abuse can be tracked, and healthy living incentives can provide a way for this population to recover costs related to higher health costs with quality outcomes. Employees that have diabetes can select coverage options which will cover the treatment and medications related to the condition. The insurance company can reduce the amount of risk, premiums and out of pocket expenses, of high- risk employees can incur (Ma, Qiu, and Bi, 2015). The opportunity for adverse selection could be less or eliminated. Also, both plans will be managed by a primary care physician adverse selection can also be eliminated. The primary care physicians would direct care and ensure a possible cure for the disease.                                                                                           References   Ma, B., Qiu, C., & Bi, W. (2015). An insurance contract with a low compensation period under adverse selection. Information Economics & Policy, 31, 67–74. doi: 10.1016/j.infoecopol.2015.04.005 Mendoza, R. L. (2016). Which moral hazard? Health care reform under the Affordable Care Act of 2010. JOURNAL OF HEALTH ORGANIZATION AND MANAGEMENT, 30(4), 510–529. doi:10.1108/JHOM-03-2015-0054
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
       Employers with more than 50 employees are not eligible to provide coverage for their employees through the Small Business Health Options Program (SHOP, n.d.). An employer with 50 or more employees is expected to provide coverage (SHOP, n.d.). Coverage will need to be a cost effective option for all with additional coverages or options for those with chronic issues. The Affordable Care Act states that individuals are expected to have coverage or face a tax penalty (SHOP, n.d.)         The tribe I currently work for practices this for insurance coverage. The insurance policy includes relatively competitive options with a standard deductibles. American Indian populations historically have a rate of diabetes within the population per capita. The tribe had to find a viable option for those with chronic diabetes. The route the tribe took was to find additional providers for this population that specialize in specific coverages for the chronically ill. The cost of coverage has not increased substantially within the past few years. There are different tiers of coverage and the options provided suit the diversity of the employee base. There is little “cost sharing” for high value treatments as described by Baicker and Levy (2015).          A higher deductible/ lower premium tier for the “healthy” group would be a viable option. Financial incentives for this group would also decrease cost to individuals. This would prevent adverse reaction from occurring, because it would encourage healthier lifestyle and prevent this population from declining coverage. At the same time financial incentives would encourage those who are considered a “moral hazard” to improve lifestyle.                                                                                                                                      References Baiker, K., & Levy, H. (2015). Cost sharing as a tool to driver higher-value care. JAMA Internal         Medicine, 175 (2), 399-400. Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition).          New York: Wiley. Sommers, B. D., Musco, T., Finegold, K., Gunja, M. Z., Burke, A., & McDowell, A. M. (2014). Health          reform and changes in health insurance coverage in 2014. Waltham, MA: New England Journal            of Medicine. Small Business Health Options Program (SHOP). (n.d.). Http://www.healthcare.gov/employers
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
                As an employee benefits manager, it is essential to recognize the needs of the company in which you work.  The primary responsibility of the employer is to assure they have adequate coverage benefits and incentives to want to continue to work for the company as an added benefit to their current salaries. With a company having only 50 employees, the business must provide access to health care through an insurance opportunity.  The Affordable Care Act does not require corporations to have health insurance benefits to their employees. However, any company with 50 or more employees not meeting the minimum standards are penalized by the government (Kaiser Family Foundation, 2019).  The scenario does not mention if the employees are all full time, but if attempting growth of a company, health insurance is a considerable incentive for employment,   especially a construction company that may have more on the job injuries than other professionals.             The government also has specific obligations or mandated benefits and standards that companies must provide (Getzen, 2015). Employers have a responsibility to treat their employees equally regardless of age, comorbidities, gender, or ethnicity.  Specific government required obligations to reduce amount of fees to the company include: insurance offered to 95% of its full-time employees and their dependents, the insurance must pay for a minimum of 60% of the health care expenses, and the employees must have affordable coverages less than 9.86% of their household incomes (Kaiser Family Foundation, 2019).             As a smaller company, there is a risk or adverse selection for the insurance companies that not enough money would be incoming because of the decreased number of employees without comorbidities requiring health care expenditures to add to the pool of funds within the insurance group.  Applying incentives through positive selection allows for the regular premiums, increasing profit margins, and allows for healthier staff and better preventative measures (Getzen, 2015).  As a construction company can have very physical activities, incentives for management of self-care such as gym memberships, smoking cessation, dietary plans, and regular primary care physician appointments should be incentives within the health program.  The moral hazard is assuring that there is no change after the deal has been made regarding any deal made for the insurance plans.            The employee benefits manager needs to design an insurance plan fair to each worker in any stage of life.  Managed-care plans such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) both offer base costs to the purchasers with options to the employee to choose from based on their appropriate lifestyle or health care needs.  The ability to utilize commercial based paid plans can reduce the number of coinsurances or copayments.  Depending on the location of the company, an HMO might only be required because there are fewer options for healthcare in more rural areas.  Recognizing that some employees require specialist care, it is beneficial to assure that cost and time is limited for their care, such as requiring referrals through gatekeepers to see specialists versus the direct access to specialist care.  In the PPO, individuals can select the providers of their choice, and there is more freedom for the employees and their families (Getzen, 2015).  Copayments are required costs by the enrollee to make them responsible for some percentage of cost out of the annual out-of-pocket maximum (Robinson, 2002).  Any copayment allows the employee knowledge of directly what the cost will be for the services required and strives to improve the use of primary care physicians for health care versus the overuse of emergency room visits for routine-based care.                   The utilization of a giant corporate HMO or PPO plan such as Blue Cross provides a bigger pool from which cost-sharing may exist and continues to keep costs lower including hospital-based care needs, pharmaceuticals, and outpatient services.  As the employee benefits manager, the number of individuals within the company, the location, and access to care, and the risk cost to the company and its potential for growth are primary concerns.  The recognition that some percentage of employees are diabetic is a concern, but should not deter the selection process, but maybe assure that coverages are available for disease prevention and management down the line.  An employee does not need to disclose and should not have to disclose personal health information to its employer to skew the insurance plans they provide or attempt to have the plans be more generous towards a specific population.    References Getzen, T. (2015). Health economics for the healthcare administrator (5th ed.). New York: Wiley. Kaiser Family Foundation. (2019, July). Employer Responsibility Under the Affordable Care Act. Retrieved from The Henry J. Kaiser Family Foundation website: https://www.kff.org/infographic/employer-responsibility-under-the-affordable-care-act/ Robinson, J. C. (2002). Renewed Emphasis On Consumer Cost Sharing In Health Insurance Benefit Design. Health Affairs, 21(Suppl1), W139–W154. https://doi.org/10.1377/hlthaff.W2.139
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Week 3 Health Insurance design in the workplace Top of Form Employee health insurance is about pooling resources to cover the group risk that could be any illness from road traffic accident to basic chronic diabetes as described in the scenario (Getzen, T. 2015). The company in the scenario provided, has 50 employees with 40%   categorized in the higher risk group because they have chronic diabetes, a potentially deadly disease if not managed well. This is less than half of individuals in the group. The rest are young people unlikely to need more than a yearly physical.         In order to design a suitable cost effective, beneficial health plan for the employees it is important to give them choices they can afford depending on their age and health status. It is also important to consider the out of pocket costs for health care. A young person that is living a predominantly preventive lifestyle, who gets a sudden head trauma is not going to seek proper treatment that comprises of costly co-pays and deductibles. Decades of evidence have shown that higher out-of-pocket prices reduce the use of health care across a range of settings, including hospitals, office visits, and prescription drugs (Baicker, K., & Levy. H., 2015).           The employer should design a system that favors the majority in the group giving them options to save money since they are a lower risk group and yet offering them the best insurance to be able to get the best level of health care when they need it. Adverse selection should be part of the design. This occurs when an employer subsidizes the cost of insurance because healthy workers opt out and in some cases go for Medicaid if they qualify resulting in higher premiums for the at risk older workers with chronic conditions (Getzen, T., 2015).         A good group insurance for 50 employees may include an option of an HMO plan and a more comprehensive PPO plan targeted at workers with chronic diabetes. Included in the design offered to all employees would be  a health coach offered to help those with chronic diabetes manage weight issues and blood glucose monitoring,  as a preventive measure, and for younger healthier individuals an attractive wellness initiative, that will engage them and offer incentives to keep healthy. Bottom of Form
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
As it should be, all businesses with workers are required by law to offer insurance ranging from compensation, unemployment insurance, and disability insurance depending on the location of the company. Currently, America has approximately three million counterparts with health insurance policies, given as an employee benefit or dependency (Getzen, 2015). However, the remaining ninth, purchase individual medical insurance coverage. This is why the obligation of the health providers and the government is crucial. Both the federal government and employers should ensure citizens within the population. Given that the population exhibits both health and sick people – especially with chronic illnesses, health insurance provisions should be provided to prevent deaths and support those who can hardly afford medical expenses. The integration of Obamacare had its main aim to improve the lives of citizens in the United States and globally. Therefore, it makes its obligation to ensure that employers provide health insurance to their employees. Penalties are a result if health benefits are not provided to the employees by their respective employers (Pilzer & Lindquist, 2014). Equally, the health organization should provide workers with shared responsibility coverage. It is also important that employers include health benefits and paid allowances for workers aged 40-50 with chronic illnesses. This is necessary to support them during and after their service delivery. Since health insurance is designed to give patients an affordable life, free from huge medical expenses – all employees should be entitled to a health insurance coverage which will create a win-win situation for both the employers and employees – employers will work for quality service delivery and the company benefits for more customers. The employer must provide health insurance coverage for the 20-30-year-old workers with no known health problems to support their health status in case of an emergency. Moral hazard in an organization occurs when one party (either the employer or the employee) has provided misleading information after an agreement has been made due to the belief of not experiencing consequences for their deeds (Nickolas, 2019). A moral hazard can impact the company’s service delivery and minimize the yielding capacity. Given that one party may decide to take unprecedented risks to gain more profits, it can subject failure to the organization’s system. Adverse selection, on the other hand, occurs when the employer or the employee in a deal possesses different and more accurate information than the other (Hayes, 2019). This is a disadvantage to the party with less information and it often leads to inefficiency in pricing strategy, services offered and quantity of goods provided. As a recommendation, the employer should provide life insurance coverage as it would stand for the families of the employees if there is an offsetting loss of income or perhaps death. References Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New York: Wiley. Hayes, A. (2019). Adverse Selection. Economics. Retrieved from https://www.investopedia.com/terms/a/adverseselection.asp Nickolas, S. (2019). Moral Hazard vs. Adverse Selection: What’s the Difference? Retrieved from https://www.investopedia.com/ask/answers/042415/what-difference-between-moral-hazard-and-adverse-selection.asp Pilzer, P., & Lindquist, R. (2014). Is Employer-Sponsored Health Insurance a Thing of the Past?. Retrieved 8 September 2019, from https://www.lifehealth.com/employer-sponsored-health-insurance-thing-past/
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Before the enactment of the Affordable Care Act of 2010 (ACA), businesses such as the mid-sized construction company and their employees were part of the uninsured population. During this time, around 28 percent of non-elderly adults were uninsured (Chase & Arensmeyer, 2018). Employer based insurance provides coverage for over 160 million Americans (Galvin, 2016). Access to ACA marketplaces and Medicaid in numerous states, has become somewhat critical to small business employers and their employees who may be low-income. To benefit the employees working at the mid-sized construction company, the employee benefits manager is obligated to mitigate any potential risk by providing insurance. Working at a construction company presents several risks that employees would like the security of insurance to share the financial burden should an event arise. Should insurance not be available at the company and an employee has low-income or becomes disabled, the government can provide insurance through Medicaid (Getzen, 2015). The company is comprised of 60% healthy employees who may or may not participate in the health insurance option. Adverse selection is probable due to the knowledge of twenty employees with chronic diabetes, requiring a more comprehensive plan. The benefits manger should offer benefits such as wellness, which would appease the healthier population to pay regular premiums (Getzen, 2015). If all the employees pay into the company insurance, there is a possibility of moral hazard which will impact insurance provisions. For those who are insured, if anything should happen at work or a sickness occur, the likelihood to visit the doctor is greater. Less pooling of risk will happen, which creates economic waste (Getzen, 2015). The type of insurance policy the benefits manager designs, should accommodate both the healthy employees and employees who need to suffer from chronic diabetes. A preferred provider organization plan would be suitable for the company in which the employee services are covered by selected physicians and hospitals. Since majority of the employees are healthy, the option is still available to pay extra for outside services while still maintaining a low premiums. A specialized cost sharing tool can also be included for the employees with chronic diabetes to visit the most appropriate treatment facilities to maintain their health. As suggested by Baicker and Levy (2015), if little to no cost sharing were an option for the employees who need more medical attention, it is possible for them to receive higher value care, improve their health overtime, and be able to keep their job. References Baicker, K., & Levy, H. (2015). Cost sharing as a tool to drive higher-value care. JAMA Internal Medicine, 175(2), 399–400. Chase, D., & Arensmeyer, J. (2018). The Affordable Care Act’s Impact on Small Business. Issue Brief (Commonwealth Fund), 2018, 1–9. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=30280862&site=eds-live&scope=site Galvin, R. (2016). How employers are responding to the ACA. The New England Journal of Medicine, 374(7), 604-606. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1056/NEJMp1514649 Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New York: Wiley.
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coverage During the World War II period, the US Congress imposed wage freezes to control high inflation in the economy. As a response, many employers began to offer health insurance to their workers in lieu of wage increases. In 1948, the Supreme court ruled that employee benefits, which included health insurance, were a legitimate part of union and management negotiations. health insurance then became a permanent part of employee benefits in the post war area. Then in 1954, congress made employer paid health care non-taxable. Employment based health care grew from that point forward. Employers began offering more extensive benefits. This began to be known as major medical expense coverage that protects against catastrophic or prolonged illness or injury. Rising premium costs limit the ability of many employers in modern times especially small businesses to offer health insurance. Even when benefits are offered by employers, limits may be placed on the ability of some employees to contribute toward purchasing employer-sponsored coverage. It can be due to the demographics of their employees and the cost of premiums and use of the coverage. Many companies offer different plan levels so the employee can chose which fits best and can avoid extra costs for all parties involved.
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Design of Health Insurance Policies The implementation of the Affordable Care Act (ACA) in October of 2013 made it possible for all uninsured citizens to obtain medical coverage. Expanding coverage for previously uninsured citizens would also increase the amount spent on health care nationally. The government encouraged states to expand Medicaid to cover disabled and low-income persons in exchange for subsidies. “The Oregon Health Insurance Experiment found that gaining Medicaid coverage resulted in a 40% increase in ED visits by beneficiaries compared with their counterparts who remained uninsured and must have had to pay for ED visits out of pocket,” Baicker and Levy (2015, p399). One way to control health care spending is through cost-sharing. Cost-sharing is one method of reducing expenses on the patient side and also used as a method to obtain a higher value of care. As with any pool of beneficiaries, there are some who require more health care than others so that question rises is it fair for all to pay the same copays? In addition to the government and states, employers faced the responsibility of insuring employees at reasonable rates also. Employers face the same issues as states in that a moral hazard is expected when insurance coverage is provided. According to Getzen (2015) a change in behavior that results from having insurance and that increases expected losses, such as the higher utilization of covered medical services by employees equates to a moral hazard. This is a direct connection to adverse selection in which people likely to sustain loss are more likely to purchase insurance. In looking at the scenario of a benefits manager designing a health insurance policy for a company with 50 employees, 40% of whom are considered older with a chronic disease; the remaining employees that are younger and have no known health issues, the best policy would be an open HMO. An open HMO is part of a managed-care organization that contracts with hospitals and physicians to form provider networks. HMOs ensure costs are contained but for employees/ patients that need more frequent medical care, such as the 40% with diabetes from the scenario, an open HMO seems to be the best option as they represent the adverse selection. “Patients desiring a little extra freedom of choice could enroll in a preferred provider organization (PPO) plan, which would allow them to occasionally use outside physicians or hospitals by paying extra,” Getzen (2015, p11). Benefit managers and policymakers should work to find the best solution for employees and citizens, but also design policies that are equitable. References: Baicker, K., & Levy, H. (2015). Cost sharing as a tool to drive higher-value care. JAMA Internal Medicine, 175(3), 399-400. Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New York: Wiley
0To prepare for this Discussion: Review the materials on critical reading strategies and on the MEAL plan for paragraphs.Read the provided article in the Learning Resources, taking note of where the a
Employer Obligations             The reason for health insurance is multi-faceted, but intended to continue care for individuals in both treatment and prevention that actually continues to lower healthcare costs.  As an employer, the obligation runs deeper in wanting to maintain the health of those without healthcare issues but also to ensure those with them are given the opportunity to be treated so that the workforce does not diminish.  With a large percentage of employees in the organization having health care issues, it is important to create a system that is both cost effective and comprehensive to ensure it is utilized and also valuable without impact on the organization (Sommers, Musco, Finegold, Gunja, Burke, & McDowell, 2014).  In this sense, health care is not only a moral obligation but also a business model to sustain the workforce.  Moral Hazard vs. Adverse Selection of Insurance             Ethically, employers should introduce benefits that have individualized choices because higher out-of-pocket costs tend to reflect in reduction of use in various healthcare settings (Baiker & Levy, 2015).   When families are required to pay more, healthcare becomes a burden and something that is often just had but not used.  One example is my current position, working for state government.  While one of the selling points are the benefits, insurance costs and premiums create a decision for my family of four as I am a single mother and the money I earn needs to be more towards our daily living costs.  Thankfully, myself and my children are healthy and use healthcare only in prevention with check-ups and annual visits, however, if that were to change, my current plan would not be enough to cover a large amount of care.  Recently I was unexpectedly hospitalized for pneumonia.  Staying in a hospital for over a week is costly enough but the coverage I have creates a great amount of stress for the bill when it arrives.              Adverse selection of healthcare is when there is an imbalance between healthy vs. unhealthy policyholders (Getzen, 2015).  With this scenario, 40% of people in need of healthcare will tend to sway the decision making of the workforce insurance policy.  This population will require more coverage so the purchase of insurance will be greater for the employer while the remaining 60% of “healthy” workers may not purchase a policy at all.  This can create a financial risk for the organization with higher costs and premiums that could in the end cost the company more in terms of preventative care (Getzen, 2015).              The Patient Protection and Affordable Care Act (ACA) attempted to address these challenges by making healthcare not only mandated but also eliminating things like pre-existing conditions that reduced the acceptance of insurance to the individual (Duggan, Goda, & Jackson, 2019).  With the recent effort by current administration to repeal the ACA, eliminating the individual mandate of people required to have insurance or be fined, the cost continues to fall on the employer, making selection of the right insurance policy/policies to be important to maintain the business.  While the number of uninsured/underinsured did fall with the implementation of the ACA, increasing 6.5% in Medicaid expansion states and 2.6% in states that did not, giving opportunity to many and taking some of the financial burden off employers even with mandates in place (Dugga, Goda, & Jackson, 2019).  Recommendations for Health Insurance Policy             Because of the 60% of younger workforce with minimal health care issues identified, a health care maintenance organization (HMO) should be one of the choices.  In a recent study done in Massachusetts between 2010-2012, the use of HMOs used physician cost control incentives, a better saving then Preferred Provider Organizations (PPO) that did not (Ho, Pakes, & Shepard, 2018).  With a younger and healthier workforce, the attention to use health care prevention should also include incentives to the policy holder as well as the employer.  In my current position, engagement in certain preventative methods like stopping smoking, attending annual health checks, health fairs, etc. provide incentives that make engagement not only good for the policy holder but also for the organization.  Giving policy holders tiered options is also important so that lower deductibles, lower costs, or matching health risk to healthcare can ensure it will be utilized.  For a small organization like this, with a large percentage in need of preventative care in pre-existing conditions, using an HMO can help to build a system that is not only ethically appropriate but also cost effective.              Reference Baiker, K. & Levy, H. (2015).  Cost sharing as a tool to driver higher-value care. JAMA Internal Medicine, 175(2), 399-400. Duggan, M., Goda, G. S., & Jackson, E. (2019). The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes. National Tax Journal, 72(2), 261–322. https://doi-org.ezp.waldenulibrary.org/10.17310/ntj.2019.2.01 Getzen, T. (2015). Health economics for the healthcare administrator (Laureate custom edition). New York: Wiley. Ho, K., Pakes, A., & Shepard, M. (2018). The Evolution of Health Insurer Costs in Massachusetts, 2010-2012. Review of Industrial Organization, 53(1), 117–137. https://doi-org.ezp.waldenulibrary.org/10.1007/s11151-018-9623-2