Ctamlouis Health

I hope you all had a wonderful Thanksgiving. Now that that’s over, Congress is back in session, and the Senate is tackling the health care reform issue.

One of the things that is being discussed in reforming our health insurance system is allowing people to buy insurance plans from other states where they might be able to find less expensive plans. I’m not sure how this is supposed to work, and here’s why.

One reason the cost of plans is lower in some states than is others is the number of mandated services a health plan is required to cover. The more a plan is required to cover, the higher the cost of coverage. For example, California has 56 required services that each plan must cover.   By contrast, Idaho has 13 state mandates. We aren’t at the top of the list by any means; Virginia has 60 mandates and Maryland has 66. Want to check out what kinds of things are mandated, click here.

Another area that needs to be addressed is how physicians and others are paid. HMO plans in California tend to be more expensive than PPO plans in the individual market, but you have lower out of pocket costs when obtaining care on an HMO plan. (The opposite is usually true in group health insurance. ) The reason this can be is through very specific networks of contracted doctors. Most people know that you don’t have coverage if you go outside the HMO network unless it’s an emergency. So maybe you just don’t offer HMOs between states.   But PPOs have networks too. If you see a contracted doctor you are covered at a higher level than non-contracted doctors. So if you are in California and buy a plan from Kansas, would you always be covered at the lower reimbursement rates?  Larger carriers like United Healthcare and Aetna have networks in most states, but what about the smaller, regional carriers without networks in other states? How would that work?

Another aspect of provider payment that affects premiums is how much providers are paid. Care in some states is less expensive than others, so how do you pay providers in the ‘expensive’ states versus the less expensive, and what will that do to the cost of insurance in those states where lower costs of care are factored into the cost of insurance? You could still end up with the problem of some people being ‘under insured’ depending on how reimbursement is worked out.

So be careful what you ask for, you may gt it. The more you want covered in a plan, the more it’s going to cost. Just remember the old marketing adage, if it sounds too good to be true, it usually is.

As the members of the class of 2010 prepare to flip their tassels to the left in May, there’s more than just studying to cross off of their to-do lists. While stressing over where to live and finding a job, many young adults do not address the issue of health insurance.

Reality will set in for some graduates when their parents’ plan or student insurance coverage expires, if it hasn’t already. Whether these current students are busy studying sociology or calculus, they need to make time to read up on their health insurance options before they suddenly find themselves uninsured.

“Thirty percent of people ages 19 through 29 are uninsured,” said Steve Trattner, president of Cinergy Health, in his article “Congratulations on Your College Graduation – Now Get Health Insurance. ”

“Instead of being smart about the frailty of life, this age group tends to believe they’re invincible or simply do not recognize the necessity of health insurance, especially as we confront seemingly ever-rising health care costs,” Trattner continues in the article.

CNN Senior Medical Correspondent Elizabeth Cohen agrees with Trattner’s viewpoint in her article, “What’s a Recent College Graduate to do about Health Insurance?” Cohen acknowledges that some students are trying to find health insurance, but “others, dubbed the ‘young invincibles’ think they don’t need it since they’re young and healthy. ” Cohen makes the point that all it takes is “a car accident, a cancer diagnosis” to put a 20-something college grad in “real trouble. ”

To save themselves the pain and hassle of acquiring medical debt on top of already-looming college loan debt, students should check out their options now.
Insurance laws vary by state. As of Jan. 1, 2009, Connecticut law states that “Every individual health insurance policy providing coverage of the type specified in [certain] subdivisions… shall provide that coverage of a child shall terminate no earlier than the policy anniversary date on or after whichever of the following occurs first, the date on which the child: Marries; ceases to be a resident of the state; becomes covered under a group health plan through the dependent’s own employment; or attains the age of twenty-six. ” This law does not apply to all insurance plans.

In “What’s a Recent College Graduate to do about Health Insurance?” Cohen suggests looking into the Consolidated Omnibus Budget Reconciliation Act (COBRA). According to the U. S. Department of Labor Web site, COBRA “gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances. ”

COBRA is not a free option. The Web site explains that “Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost of the plan. ”

It’s graduation time. Do you know where your health insurance is? Depending on your health plan, it might be gone. For many American students still covered under a parent’s insurance, health coverage ends upon graduation; they will be left to navigate the increasingly expensive and complicated world of health insurance as they struggle to find jobs.
Luckily for some, since 1994, 30 states have passed laws extending the age at which young adults are allowed to be dropped from their parent’s plan. In Massachusetts, insurance companies must cover children for two years after they lose dependent status or until age 26, whichever comes first. In New Jersey, a dependent may stay on his parent’s plan until 31 as long as he is unmarried. Connecticut, New York and Maryland, among others, all have similar laws that extend coverage, while California and Washington, D. C. have no such laws. Obama’s health care plan would guarantee that children remain eligible for their parent’s plan until age 26.
Despite these laws, young adults aged 18 to 25 are the most likely age group to be uninsured. According to the U. S. Census Bureau, in 2008, 28 percent of Americans aged 18 to 24 lacked health insurance. Given that only 11 percent of children under 18 lacked health coverage in 2004, this is a precipitous decline for those children who now fall into the 18 to 24 age group. The likelihood of being uninsured decreases with age over 25, and in total, 15 percent of Americans were uninsured in 2008.
The Independent talked to a number of seniors and recent graduates about their attitudes toward their health insurance decisions. On the whole, most seemed more interested in finding a job than in finding health coverage.

What You Should Know About Health Plans

In general, large monthly premiums mean small deductibles and small monthly premiums mean large deductibles.
A monthly premium is the amount of money you pay per month for your coverage. A deductible is the amount of money that you must pay out of your own pocket before the health insurance company will begin to pay for any health care costs. For example, if you have a the BlueChoice HSA plan from Blue Cross Blue Shield, your deductible is $2700 per year. In a given year, you will have to pay $2700 of your own money on medical expenses before Blue Cross will start to help you out. So, logically, if you are responsible for paying a large deductible, then you won’t be responsible for a high monthly fee, and vice-versa.

Your out-of-pocket expenses in one year will not exceed a set amount.
One of the most important aspects of health insurance is that even if you have a catastrophic year of medical problems, you will hopefully not go bankrupt. Let’s say you have been hospitalized and have already paid enough to cover your deductible. The BlueChoice plan says that once you have paid the deductible, hospitalization will only cost you $600 per day while Blue Cross pays the rest. However, you will not have to pay more than $5,250.

Some plans require that you pay coinsurance once you have reached your deductible.
Health insurance companies can specify a percentage of health expenses that you must pay until you have reached your out-of-pocket maximum.

When you visit the doctor or get a prescription, you usually only have to pay a co-pay and the insurance company will pick up the rest.
A co-pay is the fixed amount of money that your health insurance company charges for doctors’ visits or prescription medication. Co-pays for visits to specialists cost more than those to a primary care doctor, and co-pays for generic drugs are lower than for brand-name ones. If you have the BlueChoice plan, preventative care, like annual check-ups to your primary care doctor or OB/GYN are totally free, but if you choose to see a doctor for any other reason, you must pay the full cost of the visit until you have paid your deductible. After that, you only pay your co-pay.

You can save money, tax-free, for health care.
Health Savings Accounts (HSAs), created in 2003, operate just like savings accounts for health care expenses. If you have a plan with a large deductible, it will most likely offer you an HSA. You can deposit money into the account, before taxes, and it will accrue tax-free interest. You can withdraw the money to pay for a long and comprehensive list of “qualified” health care expenses. If you withdraw the money for any unqualified expenses you are subject to a ten percent fee.

The type of plan you have will determine your doctor “network. ” Visits to doctors outside of your network may not be covered by your plan.
A Health Maintenance Organization (HMO) plan has the most restrictive rules but it is usually are the cheapest option. You are required to have a primary care physician who will see you for most of your appointments and refer you to specialists if need be. Your plan will only cover visits with doctors who have specifically made an agreement with your HMO-your network. Another choice is a Preferred Provider Organization (PPO) plan, which does not require that you have a primary care doctor and offers a much larger network of approved doctors. You can also choose to see a doctor outside of the network, but this will cost you more.

The health bill passed by the House of Representatives Sunday would cost Nevada taxpayers an extra $613 million from 2014-2019, to provide health care to the needy.

According to early state estimates, the bill would make an additional 70,000 residents eligible for Medicaid. The state would be mandated to cover another 8,000 individuals who are now eligible but have not applied to be covered by the state health insurance program for the poor.

About 209,000 Nevadans are currently covered by Medicaid.

Including state and federal money, “the total cost of reform is $2. 3 billion,” said Mike Willden, director of the state Department of Health and Human Resources.

Willden went through the numbers for the Nevada Vision Stakeholder Group, formed to develop a plan for the future, looking ahead as much as 20 years.

Meanwhile, Gov. Jim Gibbons railed against the costs of the bill in a written statement Monday: “The bill disguises its true cost by shoving Medicaid expansions down to the state level and shuffling Congressional Budget Office estimates into later years so it appears to save federal tax dollars. It is an insult to those who truly care about meaningful health care reform. “

But Jon Sasser of Washoe Legal Services said during the Vision Stakeholder meeting the bill will expand the number of people eligible for Medicaid and that should put less stress on counties, which handle medically needy cases. “It means extra millions of federal dollars coming into our state,” Sasser said.

Most of the health care bill doesn’t kick in until 2014, Willden said. Some states are starting early, but Willden said he doesn’t see Nevada doing that because of its budget shortfall.

The federal-state dollar match for Medicaid is 50-50. Federal stimulus funds pushed that to a 64 percent federal match, saving the state $40 million to $45 million a quarter. But after the stimulus money expires Nevada will be back to picking up the 50 percent share, Willden said.

Willden said only 8 percent of the population is covered compared to 14 percent in other states. The state spends $435 per capita compared to the national average of $1,021.

What is health coaching?

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Frequently Asked Questions About Health Coaching

What is health coaching?

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Unlike personal training or counseling, YOU, the client, are the expert when working with a health coach. Whether you’re working toward general wellness or a more specific health-related issue, a health coach will focus on enhancing your quality of life. Our health coaches guide, motivate, provide customized resources, and help you to set achievable goals. Health Coaches do not diagnose, prescribe, or give advice. Instead health coaches use their expertise to provide you with tools, not opinions.

The role of a health coach is unique. A health coach will not just ask you if you have done your crunches for the day UNLESS that is what you want your health coach to do. Instead, the health coach is there to help you identify and achieve whatever goals you set for improved vitality by coordinating the many resources available to you through this and other programs.

Do I have to have a serious health issue to benefit from a health coach?

No. We know that no two people are exactly the same and your health status may vary from day to day. Health coaches help you to assess your level of health and well-being and to work on the issues at hand. Your health coach will provide the human touch to motivate you toward setting and achieving your goals through a personalized plan of action. However, if you do have a serious health issue, your health coach can help. If you need to modify your lifestyle due to an issue such as diabetes, high blood pressure, high cholesterol, and/or musculoskeletal injuries, a degreed and highly trained expert health coach can assist.

Who are the health coaches?

Our health coaches are high-level, seasoned professionals, experienced in behavioral change and in serving moderate-risk and sedentary, high-risk and high-stress populations. All Health Coaches hold degrees in Exercise Science, Health Education, Exercise Physiology, Counseling and Health Education, Counseling and Education, and each health coach has a minimum of a bachelor’s degree and at least 3 years of experience. In addition, 80 percent of our health coaches also hold a graduate degree in a related field.

I’m not sure health coaching is right for me. How do I decide?

If you would like someone to provide support, guidance and motivation that can help you achieve personal health and lifestyle goals, you will benefit from your relationship with a health coach.

How much time will health coaching take?

The time you devote to health coaching is entirely at your discretion. Communication between you and your Personal Health Coach will be as often as needed and will be determined on an individual basis. You will be paired with a health coach who will remain with you throughout your entire health coaching process. Communication between you and your health coach may occur every day, just once per week, or even less whether it is by email, journal or a combination of both.

If you would like to spend more time learning about your challenge and your solutions you have come to the right place. Through the health coaching program you will have access to a comprehensive library of lifestyle education and resource materials that will be hand selected by your health coach specifically for you. These resources come from nationally acclaimed resource providers.

What is health coaching?

Health coaching is a collaborative and personalized program that focuses on improving health and wellness. Health Coaching builds an individual’s capacity to achieve short- and long-term health and fitness goals. Participants in a health coaching program interact one-on-one with their health coach by telephone, instant messenger, email and online journal.

Most Americans are aware that buried somewhere in the 2,000-page health care reform bill are provisions for cutting the already- strapped Medicare program by billions of dollars. Few are aware that the bill also cuts expenditures on county hospitals currently serving the poor.

In Chicago, for example, those without health insurance go to the county hospital where they are treated without regard to whether they have health insurance. If the bill is passed, however, many of these county hospitals will either have to close their doors or deny treatment to those without health insurance.

Although the bill passed by the Senate has been depicted as using coercive means to require those currently uninsured to buy insurance they cannot afford, or as imposing additional new taxes on the American working man and family, that bill is based on a fundamental lack of understanding of how the health care needs of the nation’s poor are currently served.

The desperately poor, many of them unemployed, are not equipped to deal with complicated insurance programs, deductibles, co-pays and all the other accoutrements of the typical health care policy. They are poor, they are unemployed, they are sick, they need a place to go to be treated without red tape and procedural obstacles.

County hospitals across the country that have provided that place are now threatened with a cut-off of funding and in many cases with extinction by the current health care reform bill passed by the Senate.

A number of proposals for making health care affordable for all Americans have been put forward by those who have sought to be heard during the legislative process. All these proposals have been rejected by a Congress determined to impose government control of health care.

Among these rejected proposals is to allow people to buy health insurance they can afford. Currently, government mandates require a single man to buy maternity coverage he will never use, or to pay inflated premiums to insure against going insane. It would be similar to a government mandate requiring every person to buy a Rolls Royce instead of a Ford. And then when people can’t afford to buy the Rolls Royce, they’re without any car at all.

Another rejected proposal is to allow health insurance companies to compete across state lines, thus increasing the competitive pressure to provide affordable insurance. Proposals for modest curbs on the multimillion-dollar malpractice suits that divert billions of dollars away from health care and into the pockets of high-rolling trial attorneys have also been rejected.

Even proposals for limited but cost-effective catastrophic government insurance have been rejected by those determined to have government take over health care across the board.

A proposal by Arizona Gov. Jan Brewer to cut 300,000 people from the health care plan for the poor will likely “increase the misery index,” a Prescott doctor said.

Dr. Joseph Goldberger, chief medical officer for the Yavapai Regional Medical Center and a rheumatologist with a private practice, said about 15 to 20 percent of the patients he sees at his rheumatology consulting practice are insured by the Arizona Health Care Cost Containment System, the Arizona equivalent of Medicaid. Already, AHCCCS fees to doctors have been frozen, he said.

“The untold story is patients with or without insurance continue to get the care,” Goldberger said. “They get the most expensive care of all: ER care. Everybody else ends up paying for that through higher premiums. It has a significant impact. “Many of his arthritis patients need “very expensive” medications and “without insurance, they can’t afford them at all. The bigger problem is the access to medications. “

While that may not be life threatening in all situations, it certainly increases pain levels for arthritis patients.

In some situations, such as with a lupus patient who has kidney disease and can’t get access to chemotherapy, it could be life threatening, he said.

While Goldberger understands that the state is having budget problems and that education and health care are candidates for cost cuts, there are consequences, such as the loss of federal matching funds.

Health providers face a total cut of $67. 7 million in state and federal money, according to the Arizona Hospital and Healthcare Association. The association protested the plan to transfer AHCCCS’s remaining graduate medical education money and nearly all private disproportionate hospital dollars to other uses. Arizona’s hospitals have seen $278 million in state funding cuts since 2008, trade group officials said.

Reduction in payments for training doctors – the graduate medical education money – is particularly egregious, said John Rivers, the hospital association president and CEO.

The state and federal government traditionally reimburse hospitals that train doctors who typically go through a residency in a specific area of medicine after they complete their medical training and internships, Rivers said. However, if the state doesn’t put up the money for that training, then the federal government won’t contribute its share, Rivers said.

“If we’re not training doctors, I don’t see how that is good for the people of Arizona,” Rivers said. “One of the important by-products of training doctors here is this is where they end up practicing. If they get training somewhere else, they stay there. It’s a horrible outcome for the people of Arizona. “

Already the state has only 219 doctors for every 100,000 people, while the national average is 293 physicians for every 100,000.

It’s also shortsighted economically to cut into hospital budgets as hospitals create jobs, he said. And the cuts will shrink the state’s economy by $48. 8 million in federal Medicaid matching dollars that will now go to other states.

Hospitals in Arizona employ 73,300 people and contribute $11. 5 billion to its gross economic product, according to an Arizona State University study.

While the Yavapai Regional Medical Center is not a teaching hospital and is not affected by the graduate medical aspect of the budget cuts, said Brian Hoefle, the chief financial officer, the lack of disproportionate care money from the state would result in a loss of several hundred thousand dollars.

“Gov. Jan Brewer is talking about eliminating some of those programs,” said Hoefle. “It would be up to the Legislature to decide on cuts to AHCCCS. Just because the state isn’t covering certain populations anymore doesn’t mean they won’t get sick and end up in our ER. If there’s no payment for them, it shifts the costs to the paying customers. “

The state will lose $2 from the federal government for every dollar it cuts from AHCCCS, according to Hoefle.

“That’s very frustrating,” he said.

About 15 percent of patients who use YRMC are AHCCCS clients.

Meanwhile, the hospital has already seen large increases in bad debts and charity care over the past two years, Hoefle said. Charity care – wherein patients provide their financial information and are deemed unable to pay – has doubled from 2008 through 2009. While bad debtors – those who are unable or unwilling to pay but are not working with the hospital – have increased by 18 percent over the last two years.

“If the AHCCCS program is not going to pay hospitals, it’s going to fall back on hospitals to pay,” Hoefle said. People are “going to come to the hospital and we’re going to eat it. It ultimately affects commercial insurance. We raise our rates to insurance companies and those people who can pay will ultimately pay for the state’s lack of coverage. They’re talking about the hidden tax. Whoever is paying their hospital bills is paying for those who are not paying their hospital bills. Otherwise the hospital goes out of business. “

Health Risk Assessments (HRAs) are tools that identify and quantify an individual’s risk of

morbidity or mortality using demographic, medical and lifestyle information. “Health Risk

Assessments (HRAs) and Medicare”, an evaluation report completed by RAND for CMS, reached the

following conclusions.

• Effective Health Risk Assessment (HRA) plan have demonstrated beneficial effects on behavior,

physiological variables and general health status
• Interventions that combine Health Risk Assessment (HRA) feedback with the provision of Health

Plans are most likely to show beneficial effects
• To be effective, Health Risk Assessment (HRA) questionnaires should be accompanied by follow-up

interventions (e. g. , information, support and referrals)

High quality Health Risk Assessments (HRAs) offer, a computation for individual risk from the

following most common diseases and risk factors.

• Asthma
• Chronic Obstructive Pulmonary Diseaase (COPD)
• Diabetes
• High Blood Pressure
• Ischemic heart disease
• Major depression
• Stroke
• Overweight/Obesity
• Use of Tobaccos Products
• Mental health
• Immunizations

The Health Risk Assessment (HRA) collects and reviews information to predict a member’s

likelihood of experiencing the most common diseases.

Health Risk Assessments (HRAs): Demographic characteristics

A person’s age, gender and ethnicity are indicators of elevated risk for certain diseases. At

minimum, the Health Risk Assessment (HRA) should collect information, to the extent allowed by

law, information on the member’s age, gender and ethnicity.

The Health Risk Assessment (HRA) should include queries addressing the individual’s personal and

family history of diseases or risk factors for common diseases. The Health Risk Assessment (HRA)

must include queries to assess health risks related to the highly personal health characteristics

and behaviors listed below.

• Weight Management
• Nutrition
• Use of Tobaccos Products
• High Blood Pressure
• Cholesterol
• Exercise
• Alcohol consumption
• Traveling by motor vehicle
• Stress Management
• Mental health

Perceived Health Status

The Health Risk Assessment (HRA) should include queries that assess A person’s self-perceived

health status. The queries should allow an individual to rate their own health status on a

relative scale.

Disclosure of use of Health Risk Assessment (HRA) information

The organization should disclose how the information obtained from the Health Risk Assessment

(HRA) will be used and to whom it’ll be disclosed. The organization may offer the disclosure and

use information within the Health Risk Assessment (HRA) tool or reports or through written

communications.

Ability to save and print Health Risk Assessment (HRA) results

Internet-based Health Risk Assessment (HRA) should give the member the ability to save and print

his or her Health Risk Assessment (HRA) results. For paper-based Health Risk Assessments (HRAs),

the organization should have a mechanism in place for the member to receive a written copy of the

results.

Health Risk Assessment (HRA) Results

Companies should offer a printed or printer-friendly internet-based report for each individual

participant. The report may emphasis on either individual risks for specified diseases or on

Health.

Health Risk Assessment (HRA) computations may emphasis on either individual risks based upon

personal risk factors or on overall risk or health. The report should offer an explanatory

information to help them understand the outcome. Reports should clearly identify behaviors that

can lower risk for each risk factor, and recommend targets for improvement. Reports should

include resources (e. g. , community plan, internet-based information and materials) that can help

members change to a healthier lifestyle. At minimum, the organization should give computation for

individual risk from the following most common diseases and risk factors.

• Asthma
• Chronic Obstructive Pulmonary Diseaase (COPD)
• Diabetes
• High Blood Pressure
• Ischemic heart disease
• Major depression
• Stroke
• Overweight/Obesity
• Use of Tobaccos Products
• Mental health
• Immunizations

Health Risk Assessment (HRA) report

The Health Risk Assessment (HRA) should give internet-based print-friendly results and the

ability for the user to print the results. The Health Risk Assessment (HRA) report should include

a profile of individual risk level for personal conditions or diseases according to age, gender,

ethnicity and risk factors that were identified in the questionnaire. The report should clearly

identify behaviors that can lower the risk for each risk factor and recommend targets for

improvements.
Available Resources

The Health Risk Assessment (HRA) report should also include references to resources that can help

the member understand the Health Risk Assessment (HRA) results and assist the member in changing

to a healthier lifestyle.

The resources can include references to relevant internet-based information, materials and

community plan.

Many people today think that getting Florida individual health insurance to cover their insurance needs if they do not get this from their employer is out of the question due to cost. There are a great many people who feel that health insurance is too costly for them to afford and go without it. This can not only be detrimental to the health of any individual, but can also end up costing someone their life savings or their home if they wind up in the hospital and face a mountain of medical bills. For this reason, it is important to have health insurance as well as compare health insurance coverage.  

When you compare health insurance coverage, you can see the difference in the coverage that different companies will offer you as well as the rate for the coverage. When you are looking for Florida individual health insurance, it pays to make sure that you compare health insurance by way of coverage that is allowed and the amount of the monthly premiums for the coverage. The more comparisons you do when you are looking for Florida individual health insurance, the more you will see that having health insurance is affordable and usually a lot more affordable than you think.  

You want to compare health insurance coverage by way of what they will allow you. Some companies have a network of doctors from which you can choose when you are getting Florida individual health insurance. Other companies allow you to choose your own doctor. The type of coverage that you pick depends upon your own personal preference. There is also a difference between co payments for some companies as well as deductibles. The higher the deductibles, the lower the health insurance quotes, so this is something that an individual might want to take a look at if they are looking for a way to save on monthly premiums. It is much more affordable to have high deductibles when it comes to health insurance than low deductibles as you are basically getting Florida individual health insurance in this way to make sure that you are covered for a hospitalization.  

It is important for everyone who lives in the State of Florida to have Florida individual health insurance as this can help them not only prevent massive medical bills in case they have to go to the hospital but will also induce them to seek out medical care if they should need it. Many medical problems can be avoided by seeing the doctor before they become a problem that requires surgery or hospitalization. The more someone sees the doctor for regular checkups, the more they can enjoy good health. Those who are looking for Florida individual health insurance should make sure they compare health insurance that not only allows them to be covered in case of a major illness or accident, but also allows them to a see a doctor for preventative medical care. Both aspects of health insurance should be reviewed by anyone who is seeking to compare health insurance quotes.

The health care reform bills being debated in Congress threaten to shut out millions of immigrants. But Congress’ exclusionary policies toward immigrants will not simply leave immigrants worse off. They will inevitably jeopardize the nation’s economy and the health of all of us.

President Obama has prioritized health care reform to ensure that millions of Americans have a fair, affordable and efficient health care system. For immigrants, this vision is far from a reality. First, the current health care reform bill treats legal immigrants unfairly. Individuals who have waited years to come to the United States will be required to wait years in order to obtain affordable health care.

Immigrants are generally younger and healthier than the U. S. population at large. However, no one is immune to falling ill or having an accident. The current health care bill would require recently arrived, legal immigrants to wait five years to obtain the only option for affordable health care coverage, Medicaid. While low-income citizens will have access to Medicaid, the most vulnerable among us will continue to wait for affordable health care despite the fact that they pay taxes for the very programs from which they are excluded. There is no sound reason for Congress to discriminate against these individuals and prevent them from receiving basic medical care.

Congress and the White House also took an unprecedented step to prohibit individuals from buying — with their own hard-earned money — an American good that could help their families. The Senate version of the health care bill forbids undocumented immigrants from purchasing private insurance at full cost in the newly created insurance marketplaces. As a result, undocumented immigrants as well as their family members, who are often U. S. citizens or legal immigrants, will likely remain uninsured and will be forced to seek care in the emergency room.

The costs of providing health care for undocumented immigrants will not disappear after passing health care reform. It is unlikely that millions of immigrants, whose contributions keep up our standard of living and our economy functioning, will be deported. Instead, the cost of care will become the financial responsibility of the patient, the provider, the local and state governments, and every single taxpayer. Moreover, in order to exclude a few, there will be additional forms, documents, and bureaucrats that the rest of us will be subjected to. Buying the mandated health insurance could feel like a trip to the Department of Motor Vehicles. Taxpayers will have to pay millions for this additional red tape and delay, all to keep a few people from buying health insurance with their own money.

Providers, employers, consumers, religious leaders, and state and local governments recognize that these policies are short-sighted and will cost all of us more in the long-run. Policies that attempt to exclude and ostracize immigrants also disproportionately harm all communities of color and immigrant-rich states like California and New York, further widening existing inequities in our nation. Yet because immigrants live in all 50 states, the intended and unintended consequences and costs of these restrictions will be far-reaching.

Ending discriminatory and exclusionary policies in this final round of negotiations is not only a matter of fundamental fairness and sound economics. It is required in order to not leave all of us worse off. Congress has a short window of opportunity to remove the restrictions on legal and undocumented immigrants in the health care reform bill. Doing so will not jeopardize the passage of the bill. Failing to doing so, however, will leave all of us, immigrant or not, worse off and wondering what happened to the promise of health care reform.