85-610: Humana Inc. is a for-profit American health insurance company based in Louisville , Kentucky . In 2023, the company ranked 42 on the Fortune 500 list, which made it the highest ranked (by revenues) company based in Kentucky . It is the fourth largest health insurance provider in the U.S. Lawyers David A. Jones Sr. and Wendell Cherry founded a nursing home company in 1961. The company, known in 1968 as Extendicare Inc., became
170-750: A business partnership with Virgin Group , offering financial incentives to members for healthy behavior, such as regular exercise. On November 16, 2006, the Centers for Disease Control and Prevention (CDC) and Humana Inc. partnered to expand on traditional private-sector approaches to population health management. In 2010, Humana bought Texas-based Concentra Inc., which owns urgent-care and physical therapy centers, for $ 790 million, effectively returning to healthcare services. In May 2011, Humana announced it would be using mobileStorm to transmit protected health information to patients. In March 2015, Humana announced
255-540: A capitation only in the case of HMOs. California developed a solution to assist people across the state and is one of the few states to have an office devoted to giving people tips and resources to get the best care possible. California's Office of the Patient Advocate was established July 2000 to publish a yearly Health Care Quality Report Card on the top HMOs, PPOs, and Medical Groups and to create and distribute helpful tips and resources to give Californians
340-678: A 40 percent stake. In 2015, CD&R sold Hussmann to Panasonic for $ 1.5 billion. Clayton Dubilier & Rice Fund X LP completed fundraising in 2017 with $ 10 billion of investor commitments. CD&R acquired a 60% stake of Capco from FIS for $ 477 million in May 2017. In August 2017, the firm acquired the Waterworks division of HD Supply for 2.5 billion, and changed its name to Core & Main . In January 2018, Clayton, Dubilier & Rice acquired Ply Gem Holdings, Inc. and Atrium Windows & Doors. In October 2018,
425-504: A 60% interest in Humana , Inc's hospice and personal care divisions ( Kindred at Home ) for US$ 2.8 billion. In July 2022, CD&R purchased the remaining common stock of Cornerstone Building Brands , completing its acquisition. Also in July 2022, it was announced that CD&R were to acquire the facilities services business OCS Group. This was then followed by the merger of OCS and
510-750: A CD&R-managed fund and the remainder from senior debt and securities. In 2021, during its bid to buy out the UK supermarket chain Morrisons , the firm faced accusations of Asset Stripping , leaving Culligans 'saddled with over $ 850 million of debt', while UK politicians warned against leaving Morrisons prey to asset strippers. CD&R denied the accusations. Centerbridge Partners acquired Culligan in 2012. In 2005, CD&R teamed with Merrill Lynch , The Carlyle Group and Barclays to acquire The Hertz Corporation from Ford Motor Company for $ 15 billion. In 2011, CD&R and Ingersoll-Rand announced
595-527: A federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP , also a federal-state partnership that serves certain children and families who do not qualify for Medicaid but who cannot afford private coverage. Other public programs include military health benefits provided through TRICARE and
680-484: A letter to the insurance industry, threatened that bad actors may be excluded from new health insurance markets that were to open in 2014. Senate Republicans pointed out in a letter to Sebelius that a 1997 directive from the Centers for Medicare and Medicaid Services explicitly allowed HMOs to tell members about legislation and urge them to express opinions. Health insurance in the United States In
765-612: A leveraged buyout in 1987 of Borg-Warner's Industrial Products Division, spinning the division off into a standalone company, BW/IP International. Between 1987 and 1992 the firm added nine new partners, five of which had previous experience as CEOs. In 1988, the firm acquired Uniroyal Goodrich Tire Company and a 50% stake of B.F. Goodrich for $ 225 million; the Tire Company was sold to Michelin for $ 1.5 billion in 1989. In 1990, CD&R formed Lexmark from IBM 's printer and keyboard manufacturing business. The deal
850-410: A long and costly political battle, many labor unions chose to campaign for employer-sponsored coverage, which they saw as a less desirable but more achievable goal, and as coverage expanded the national insurance system lost political momentum and ultimately failed to pass. Using health care and other fringe benefits to attract the best employees, private sector, white-collar employers nationwide expanded
935-522: A partnership relating to Ingersoll's Hussmann division in which CD&R would acquire a 60 percent interest. In 2012, Joe Rice stepped down as chairman, succeeded by Don Gogel. In March 2013, CD&R partnered with the family owners of B&M retail, acquiring a 60 percent stake. In October 2013, the firm acquired a 60% stake in John Deere Landscapes (now SiteOne Landscape Supply) in partnership with Deere & Co., which retained
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#17327982997791020-520: A peak of 18% in Q3 2013 and rapidly fell to 11% in 2015. The proportion without insurance has stabilized at 9%. A 2011 study found that there were 2.1 million hospital stays for uninsured patients, accounting for 4.4% ($ 17.1 billion) of total aggregate inpatient hospital costs in the United States. The costs of treating the uninsured must often be absorbed by providers as charity care , passed on to
1105-516: A stake in Socotec in a deal valuing Socotec at $ 1.98 billion. In August 2020, CD&R bought Epicor from KKR for $ 4.7 billion. In January 2021, CD&R purchased Wolseley UK , the largest supplier of plumbing and building materials in the UK, from Ferguson plc for £308m. In October 2021, CD&R purchased Morrisons , a British supermarket chain, which subsequently had financial difficulties. In April 2022 CD&R acquired
1190-502: A wholly owned subsidiary. They were awarded their first TRICARE contract in 1995, and began serving military beneficiaries in 1996. From 2004 to 2009, HMHS was the managed care contractor for the Department of Defense Military Health System TRICARE South Region. In 2009, HMHS' Managed Care Support Contract was awarded to United Military and Veterans Services, a subsidiary of UnitedHealth Group . HMHS protested that decision and
1275-404: Is known as the fee-for-service business model. During the middle to late 20th century, traditional disability insurance evolved into modern health insurance programs. Today, most comprehensive private health insurance programs cover the cost of routine, preventive, and emergency health care procedures, and also most prescription drugs, but this was not always the case. The rise of private insurance
1360-458: Is the official health benefits provider of the PGA Tour and Champions Tour . The Humana Distaff Handicap is a Grade 1 race for thoroughbred fillies and mares , four-years-old and up. The race is run each spring on Kentucky Derby day at Churchill Downs and set at a distance of 7 furlongs for a purse of $ 250,000. In 1993, Humana founded Humana Military Healthcare Services (HMHS) as
1445-777: Is the presenting sponsor of the Grand Ole Opry and the National Senior Games . Since 1979, Humana has been a principal sponsor of the annual Humana Festival of New American Plays in Louisville, Kentucky. LPGA player Nancy Scranton was a spokesperson for Humana. In the past, PGA Tour player David Toms ' David Toms Foundation has partnered with the Humana Foundation to provide grants to several children's charities in New Orleans. Humana
1530-564: The American health care system changed in the 1980s, "one of its hospitals in Arizona lost a contract with the largest health-maintenance organization in the area [and] Humana created its own health insurance plan." In 1993, Humana had become the largest hospital operator in the country, owning 77 hospitals. Humana executives spun off hospital operations from health insurance operations to create Galen Health Care. The following year they sold
1615-659: The Government Accountability Office upheld the protest in late 2009. In 2011, HMHS regained the five-year contract to administer medical benefits to military members and families in the South region, a contract worth $ 23.5 billion. In 2018, this was moved to the new TRICARE East region during the TRICARE regional realignment. On December 22, 2022, the Department of Defense announced the award of
1700-545: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and went into effect on January 1, 2006. Medicaid was instituted for the very poor in 1965. Since enrollees must pass a means test, Medicaid is a social welfare or social protection program rather than a social insurance program. Despite its establishment, the percentage of US residents who lack any form of health insurance has increased since 1994. It has been reported that
1785-599: The National Association of Insurance Commissioners (NAIC) provide some degree of uniformity state to state. These models do not have the force of law and have no effect unless they are adopted by a state. They are, however, used as guides by most states, and some states adopt them with little or no change. However, with the Patient Protection and Affordable Care Act , effective since 2014, federal laws have created some uniformity in partnership with
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#17327982997791870-725: The Obama administration 's healthcare reform, a claim refuted by John Rother, AARP 's executive vice president. Douglas Elmendorf, the head of the Congressional Budget Office (CBO), supported the claim that Medicare benefits could be cut, but his comments were in reference to just one of several congressional bills. CBO estimates of another healthcare reform bill found that changes to premiums would vary. The Centers for Medicare and Medicaid Services instructed Humana to cease all such mailings to Medicare plan members pending an investigation. HHS Secretary Kathleen Sebelius, in
1955-714: The Veterans Health Administration and benefits provided through the Indian Health Service . Some states have additional programs for low-income individuals. In 2011, approximately 60 percent of stays were billed to Medicare and Medicaid—up from 52 percent in 1997. In the United States, Medicare is a federal social insurance program that provides health insurance to people over the age of 65, individuals who become totally and permanently disabled, end stage renal disease (ESRD) patients, and people with ALS . Recent research has found that
2040-547: The 1930s. The first employer-sponsored hospitalization plan was created by teachers in Dallas, Texas in 1929. Because the plan only covered members' expenses at a single hospital ( Baylor Hospital ), it is also the forerunner of today's health maintenance organizations (HMOs). In 1935 the decision was made by the Roosevelt Administration not to include a large-scale health insurance program as part of
2125-410: The 73 hospitals of Galen Health Care Inc. to Nashville-based Columbia Hospital Corporation of America for $ 3.4 billion. In 1998, one year after Jones had stepped aside as CEO, United Healthcare made an unsuccessful attempt to acquire Humana. Humana pulled out of the acquisition after United stock dropped $ 2.9 billion in value. In 2001, Humana was a cofounder of Avality. In 2005, Humana entered into
2210-472: The AMA's 1940s campaign against national health insurance, emphasizing private insurance as a symbol of freedom, shaped today's costly US healthcare system dominated by powerful medical lobbies. Some of the first evidence of compulsory health insurance in the United States was in 1915, through the progressive reform protecting workers against medical costs and sicknesses in industrial America. Prior to this, within
2295-801: The Affordable Care Act, with a rate of 10.9%, or 28.9 million people in 2019. Not only is this because the ACA does not address gaps for undocumented or homeless populations, but higher insurance premiums, political factors, failure to expand Medicaid in some states, and ineligibility for financial assistance for coverage are just some of the reasons that the social safety net is required for the uninsured. Most people who are uninsured are non-elderly adults in working families, low income families, and minorities. Social safety net hospitals primarily provide services to these populations of uninsured. For example, California's Public Health Care Systems are only 6% of
2380-687: The Haight-Asbury Free Clinic and the Berkeley Free Clinic) is a clinic that provides services for free and target the uninsured, typically relying on volunteers and lay health workers. Since people who lack health insurance are unable to obtain timely medical care, they have a 40% higher risk of death in any given year than those with health insurance, according to a study published in the American Journal of Public Health . The study estimated that in 2005 in
2465-472: The Humana building, and three days later Humana changed its policy and authorized the man's treatment. Michael Moore 's 2007 documentary Sicko used the video of Linda Peeno's testimony. On June 28, 2007, Humana declared that Peeno was never a Humana "associate" (permanent, full-time employee), but rather a "part-time contractor." Humana disputed portions of her Congressional testimony by saying that because
2550-570: The Patient Protection and Affordable Care Act, effective from 2014, about 34 states offered guaranteed-issuance risk pools, which enabled individuals who are medically uninsurable through private health insurance to purchase a state-sponsored health insurance plan, usually at higher cost, with high deductibles and possibly lifetime maximums. Plans varied greatly from state to state, both in their costs and benefits to consumers and in their methods of funding and operations. The first such plan
2635-734: The Senate in December 2009 with all Democrats voting in favor and the House in March 2010 with the support of most Democrats. Not a single Republican voted in favor of it either time. Historically, health insurance has been regulated by the states, consistent with the McCarran-Ferguson Act . Details for what health insurance could be sold were up to the states, with a variety of laws and regulations. Model acts and regulations promulgated by
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2720-505: The Socialist and Progressive parties, health insurance and coverage was framed as not only an economic right for workers health, but also as an employer's responsibility and liability- healthcare was in this context centered on working-class Americans and labor unions. Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II . The labor market
2805-502: The U.S. health care system. Public sector employers followed suit in an effort to compete. Between 1940 and 1960, the total number of people enrolled in health insurance plans grew seven-fold, from 20,662,000 to 142,334,000, and by 1958, 75% of Americans had some form of health coverage. By 1976 85.9% of the employed population 17–64 years of age had hospital insurance while 84.2% had surgical insurance. Still, private insurance remained unaffordable or simply unavailable to many, including
2890-561: The US by 1866, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, sickness coverage in the US effectively dates from 1890. The first employer-sponsored group disability policy was issued in 1911, but this plan's primary purpose was replacing wages lost because the worker was unable to work, not medical expenses. Before the development of medical expense insurance, patients were expected to pay all other health care costs out of their own pockets, under what
2975-585: The United States was established by Congress in 1798, when the Marine Hospital Fund was financed through a tax on maritime sailors' pay. Accident insurance was first offered in the United States by the Franklin Health Assurance Company of Massachusetts. This firm, founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. Sixty organizations were offering accident insurance in
3060-413: The United States, health insurance helps pay for medical expenses through privately purchased insurance , social insurance , or a social welfare program funded by the government . Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against
3145-480: The United States, there were 45,000 deaths associated with lack of health insurance. A 2008 systematic review found consistent evidence that health insurance increased utilization of services and improved health. A study at Johns Hopkins Hospital found that heart transplant complications occurred most often amongst the uninsured, and that patients who had private health plans fared better than those covered by Medicaid or Medicare. The Affordable Care Act of 2010
3230-561: The act by 2022. Repeal of the Individual Mandate The Tax Cuts and Jobs Act of 2017 effectively repealed the individual mandate, meaning that individuals will no longer be penalized for failing to maintain health coverage starting in 2019. The CBO projects that this change will result in four million more uninsured by 2019, 13 million more by 2027. Those who are insured may be underinsured such that they cannot afford full medical care, for example due to
3315-537: The cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give cash to the policy holder to replace wages lost because of illness or injury. The proposal was quite popular with the public, but it was fiercely opposed by the Chamber of Commerce , the American Hospital Association , and the AMA, which denounced it as "socialism". Foreseeing
3400-400: The cost of traditional Medicare. There is some evidence that Medicare Advantage plans select patients with low risk of incurring major medical expenses to maximize profits at the expense of traditional Medicare. Medicare Part D provides a private insurance option to allow Medicare beneficiaries to purchase subsidized coverage for the costs of prescription drugs . It was enacted as part of
3485-746: The costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare , which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program , which both provide assistance to people who cannot afford health coverage. In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and
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3570-407: The creation of a digital health and analytics division called Humana Studio H. In December 2019, the company announced it would acquire Enclara Healthcare from Consonance Capital Partners and Enclara management. In 2021, Susan Diamond, formerly occupying an interim position, was announced to be the new permanent CFO. Her appointment to the position comes with the company's focus being turned towards
3655-478: The decade diverted Congress's attention away from health reform. Shortly after his inauguration, President Clinton offered a new proposal for a universal health insurance system. Like Nixon's plan, Clinton's relied on mandates, both for individuals and for insurers, along with subsidies for people who could not afford insurance. The bill would have also created "health-purchasing alliances" to pool risk among multiple businesses and large groups of individuals. The plan
3740-415: The drama had no connection whatsoever with Humana. On May 30, 1996, Linda Peeno , a physician who was contracted to work for Humana for nine months, testified before Congress as to the downside of managed care . Peeno said she was effectively rewarded by her employer for causing the death of a patient, because it saved the company a half-million dollars. Peeno stated that she felt the "managed care" model
3825-613: The early 1960s, Congress rejected a plan to subsidize private coverage for people with Social Security as unworkable, and an amendment to the Social Security Act creating a publicly run alternative was proposed. Finally, President Lyndon B. Johnson signed the Medicare and Medicaid programs into law in 1965, creating publicly run insurance for the elderly and the poor. Medicare was later expanded to cover people with disabilities, end-stage renal disease , and ALS . Prior to
3910-445: The exclusion of pre-existing conditions , or from high deductibles or co-payments . In 2019 Gallup found while only 11% reported being uninsured, 25% of U.S. adults said they or a family member had delayed treatment for a serious medical condition during the year because of cost, up from 12% in 2003 and 19% in 2015. For any condition, 33% reported delaying treatment, up from 24% in 2003 and 31% in 2015. The first health coverage in
3995-508: The existing state-based system. Insurers are prohibited from discriminating against or charging higher rates for individuals based on pre-existing medical conditions and must offer a standard set of coverage. In 2007, 87% of Californians had some form of health insurance. Services in California range from private offerings: HMOs , PPOs to public programs: Medi-Cal , Medicare, and Healthy Families ( SCHIP ). Insurers can pay providers
4080-608: The firm acquired a stake in SmileDirectClub after investing $ 380 million. In 2018 CD&R acquired a 60% stake from the family owners of greeting card maker American Greetings, establishing a partnership. In January 2019, Clayton, Dubilier & Rice invested alongside the founder of WSH Investments Ltd., Alistair Storey, to take a major stake in the business. In July 2019, Clayton, Dubilier & Rice were included on Inc. ' s 50 Best Private Equity Firms for Entrepreneurs list. In September 2019, CD&R acquired
4165-481: The health insurance options for people with Medicare. Medicare Advantage was created under the Balanced Budget Act of 1997 , with the intent to better control the rapid growth in Medicare spending, as well as to provide Medicare beneficiaries more choices. But on average, Medicare Advantage plans cost 12% more than traditional Medicare. The ACA took steps to align payments to Medicare Advantage plans with
4250-430: The health segment of Social Security to the expansion of medical care and facilities. It considered unemployment insurance to be the major priority. Roosevelt assured the medical community that medicine would be kept out of politics. Jaap Kooijman says he succeeded in "pacifying the opponents without discouraging the reformers." The right moment never came for him to reintroduce the topic. Recent research highlights how
4335-575: The health trends of previously uninsured adults, especially those with chronic health problems, improves once they enter the Medicare program. Traditional Medicare requires considerable cost-sharing, but ninety percent of Medicare enrollees have some kind of supplemental insurance—either employer-sponsored or retiree coverage, Medicaid, or a private Medigap plan—that covers some or all of their cost-sharing. With supplemental insurance, Medicare ensures that its enrollees have predictable, affordable health care costs regardless of unforeseen illness or injury. As
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#17327982997794420-546: The home healthcare business, acquiring in April of the same year a 60% stake in Kindred at Home, an in-home care and hospice business. In April 2022, it was announced Humana would sell a 60% interest of its Kindred at Home division to the private investment company, Clayton, Dubilier & Rice , for US$ 2.8 billion. In February 2023, Humana announced they were exiting the employer-based commercial group insurance market. Humana
4505-478: The hospital was to be sold to a for-profit medical corporation and renamed "Ecumena", with subsequent changes to the hospital, both positive and negative, emanating from that change. The company claimed that the program infringed on the Humana trademark. Humana failed to block the airing of the show, but was successful at forcing NBC into showing a disclaimer at the beginning of the September 30 episode saying that
4590-516: The hospitals in the state, yet provide care for 38% of all hospital care of uninsured in California- 123,000 of which are homeless, and 3.6 million of which live below the federal poverty line. One way in which the US has been addressing this need for a social safety net (other than formally/state recognized safety net hospitals) is through the advent of Free Clinics , an example of a Federally Qualified Health Center. A free clinic (for example,
4675-406: The insured via cost-shifting and higher health insurance premiums, or paid by taxpayers through higher taxes. The social safety net refers to those providers that organize and deliver a significant level of health care and other needed services to the uninsured, Medicaid, and other vulnerable patients. This is important given that the uninsured rate for Americans is still high after the advent of
4760-446: The largest nursing home company in the United States. In 1972, Jones and Cherry sold the nursing home chain to purchase hospitals . In 1974, the partners changed the corporate name to Humana Inc. The name was meant to change public perception from 'warehousing' or indifferently treating people to providing a higher level of human care and, by extension, more humane care. It grew in the following years, both by business and in 1978 through
4845-449: The largest private equity firms in the world. Clayton & Dubilier was founded as a turnaround management shop by Martin H. Dubilier , Eugene Clayton and Bill Welsh in 1976. Joseph L. Rice III , a deal professional, putting the firm into investment business, joined in 1978, and the firm became known as Clayton, Dubilier & Rice in 1992. Clayton and Welsh retired from the firm in 1985 and Dubilier died in 1991. The firm executed
4930-429: The latter part of the decade. Funding for Medicaid and CHIP expanded significantly under the 2010 health reform bill. The proportion of individuals covered by Medicaid increased from 10.5% in 2000 to 14.5% in 2010 and 20% in 2015. The proportion covered by Medicare increased from 13.5% in 2000 to 15.9% in 2010, then decreased to 14% in 2015. The uninsured proportion was stable at 14–15% from 1990 to 2008, then rose to
5015-527: The managed care support contract for the TRICARE East Region to Humana Military. Humana filed a lawsuit in August 2019, alleging that 37 defendants engaged in a “far-reaching conspiracy” to “blatantly fix the price” of generic drugs. This follows a similar smaller lawsuit from October 2018. In 1987, Humana sued NBC over a story line in the television medical drama St. Elsewhere in which
5100-579: The new Social Security program . The problem was not an attack by any organized opposition, such as the opposition from the American Medical Association that derailed Truman's proposals in 1949. Instead, there was a lack of active popular, congressional, or interest group support. Roosevelt's strategy was to wait for a demand and a program to materialize, and then if he thought it popular enough to throw his support behind it. His Committee on Economic Security (CES) deliberately limited
5185-593: The new combined company, however the merger was blocked by a federal judge in January 2017. In February 2017, Aetna Inc. and Humana Inc. quashed a $ 34 billion merger agreement after judges ruled against the merger for a second time. In July 2018, Humana joined two private equity firms in the acquisition of Kindred Healthcare . The deal provided Humana with a 40% stake in the company's home health, hospice and community care businesses, called "Kindred at Home," for approximately $ 800 million. In August 2018, Humana announced
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#17327982997795270-420: The number of physicians accepting Medicaid has decreased in recent years because of lower reimbursement rates. The Affordable Care Act dramatically expanded Medicaid. The program now covers everyone with incomes under 133% of the federal poverty level who does not qualify for Medicare, provided this expansion of coverage has been accepted by the state where the person resides. Meanwhile, Medicaid benefits must be
5355-987: The oldest private equity investment firms in the world. Founded in 1978, CD&R has managed the investment of more than $ 30 billion in approximately 90 businesses, representing a broad range of industries with an aggregate transaction value in excess of $ 140 billion. Approximately half of CD&R's investments have involved corporate divestitures. CD&R had ownership stakes in, among others, B&M Retail, Envision Healthcare , The Hertz Corporation , Hussman International, Rexel (a distributor of electrical parts and equipment) and US Foods (a broadline foodservice distributor), Sally Beauty , Diversey, Inc. , VWR International , Brake Bros , Kinko's (now FedEx Office , previously FedEx Kinko's), Uniroyal Goodrich Tire Company and Lexmark . In June 2024, Clayton, Dubilier & Rice were ranked 11th in Private Equity International 's PEI 300 ranking of
5440-562: The passage of the Affordable Care Act. Employees who worked part-time (less than 30 hours a week) were less likely to be offered coverage by their employer than were employees who worked full-time (21% vs. 72%). A major trend in employer sponsored coverage has been increasing premiums, deductibles, and co-payments for medical services, and increasing the costs of using out-of-network health providers rather than in-network providers. Public insurance cover increased from 2000 to 2010 in part because of an aging population and an economic downturn in
5525-531: The patient's healthcare plan did not cover heart transplants, denial of coverage was valid. On September 21, 2009, the U.S. Dept. of Health and Human Services opened an investigation into Humana for sending flyers to Medicare recipients that the AARP characterized as deceptive. The mail was made to appear to contain official information about Medicare Advantage and prescription drug benefit information, but instead alleged that core Medicare benefits could be cut by
5610-409: The poor, the unemployed, and the elderly. Before 1965, only half of seniors had health care coverage, and they paid three times as much as younger adults, while having lower incomes. Consequently, interest persisted in creating public health insurance for those left out of the private marketplace. The 1960 Kerr-Mills Act provided matching funds to states assisting patients with their medical bills. In
5695-557: The population covered by Medicare grows, its costs are projected to rise from slightly over 3 percent of GDP to over 6 percent, contributing substantially to the federal budget deficit. In 2011, Medicare was the primary payer for an estimated 15.3 million inpatient stays, representing 47.2 percent ($ 182.7 billion) of total aggregate inpatient hospital costs in the United States. The Affordable Care Act took some steps to reduce Medicare spending, and various other proposals are circulating to reduce it further. Medicare Advantage plans expand
5780-430: The sale of Concentra to private equity firm Welsh, Carson, Anderson & Stowe and Select Medical Holdings Corporation for about $ 1 billion, with proceeds to fund a "$ 2 billion share buyback program and other corporate spending." In July 2015, Aetna announced that it would acquire Humana for $ 37 billion in cash and stock (approximately $ 230 a share at that time). Aetna and Humana shareholders would own 74% and 26% of
5865-402: The same as the essential benefit in the newly created state exchanges. The federal government will fully fund the expansion of Medicaid initially, with some of the financial responsibility (10% of medical costs) gradually devolving back to the states by 2020. Clayton, Dubilier %26 Rice Clayton, Dubilier & Rice, LLC ( CD&R ) is an American private equity company. It is one of
5950-612: The scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do not adequately meet their needs as of 2007. The share of Americans without health insurance has been cut in half since 2013. Many of the reforms instituted by the Affordable Care Act of 2010 were designed to extend health care coverage to those without it; however, high cost growth continues unabated. National health expenditures are projected to grow 4.7% per person per year from 2016 to 2025. Public healthcare spending
6035-413: The state-based pools shut down. As of 2017, some remain due to statutes which have not been updated, but they also may cover people with gaps in coverage such as undocumented immigrants or Medicare-eligible individuals under the age of 65. Persistent lack of insurance among many working Americans continued to create pressure for a comprehensive national health insurance system. In the early 1970s, there
6120-410: The takeover of American Medicorp Inc., which doubled the company's size, and grew into the world's largest hospital company in the 1980s. During this period, Humana developed the double corridor model for hospital construction. This design minimized the distance between patients and nurses by placing nursing support services in the interior of the building with patient rooms surrounding the perimeter. As
6205-481: The tools needed to get the best care. Additionally, California has a Help Center that assists Californians when they have problems with their health insurance. The Help Center is run by the Department of Managed Health Care , the government department that oversees and regulates HMOs and some PPOs. In 2024, California became the first U.S. state to offer health insurance to all undocumented immigrants. The state passed healthcare reform in 2006 in order to decrease
6290-567: The uninsured rate among its citizens. The federal Patient Protection and Affordable Care Act (colloquially known as "Obamacare") is largely based on Massachusetts' health reform. Due to that colloquialism, the Massachusetts reform has been nicknamed as "Romneycare" after then-Governor Mitt Romney. Public programs provide the primary source of coverage for most seniors and also low-income children and families who meet certain eligibility requirements. The primary public programs are Medicare,
6375-605: Was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits , such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers. The tax deduction
6460-540: Was 29% of federal mandated spending in 1990 and 35% of it in 2000. It is also projected to be roughly half in 2025. Gallup issued a report in July 2014 stating that the uninsured rate for adults 18 and over declined from 18% in 2013 to 13.4% by in 2014, largely because there were new coverage options and market reforms under the Affordable Care Act . Rand Corporation had similar findings. The proportion of non-elderly individuals with employer-sponsored cover fell from 66% in 2000 to 56% in 2010, then stabilized following
6545-399: Was accompanied by the gradual expansion of public insurance programs for those who could not acquire coverage through the market. Hospital and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations in
6630-523: Was designed primarily to extend health coverage to those without it by expanding Medicaid, creating financial incentives for employers to offer coverage, and requiring those without employer or public coverage to purchase insurance in newly created health insurance exchanges . This requirement for almost all individuals to maintain health insurance is often referred to as the "individual mandate." The CBO has estimated that roughly 33 million who would have otherwise been uninsured will receive coverage because of
6715-435: Was fierce debate between two alternative models for universal coverage. Senator Ted Kennedy proposed a universal single-payer system, while President Nixon countered with his own proposal based on mandates and incentives for employers to provide coverage while expanding publicly run coverage for low-wage workers and the unemployed. Compromise was never reached, and Nixon's resignation and a series of economic problems later in
6800-410: Was implemented In 1976. Efforts to pass a national pool were unsuccessful for many years. With the Patient Protection and Affordable Care Act , it became easier for people with pre-existing conditions to afford regular insurance, since all insurers are fully prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions. Therefore, most of
6885-412: Was inherently unethical. In 1999, season one of Michael Moore's TV series The Awful Truth reported on Humana refusing to pay for a diabetic patient with pancreatic failure needing a transplant. The man's policy stated it covered all of his diabetes -related expenses, but another section of the policy stated that it did not cover organ transplants. Moore conducted a fake funeral on the front steps of
6970-483: Was later codified in the Revenue Act of 1954 . President Harry S. Truman proposed a system of public health insurance in his November 19, 1945, address. He envisioned a national system that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for
7055-582: Was named one of the 30 Most Influential Private Equity Deals by Private Equity International in 2004. In 1998, Don Gogel was appointed CEO. Also in 1998, CD&R established an office in London. In 2001, Jack Welch, former CEO of General Electric, joined CD&R as a senior advisor. In 2003, CD&R purchased the global provider of water treatment products and services, Culligan International , from Veolia Environnement SA of France for $ 610 million, which included $ 200 million in equity from
7140-491: Was similar to the Nixon and Clinton plans, mandating coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively. Earlier versions of the bill included a publicly run insurer that could compete to cover those without employer sponsored coverage (the so-called public option), but this was ultimately stripped to secure the support of moderates. The bill passed
7225-608: Was staunchly opposed by the insurance industry and employers' groups and received only mild support from liberal groups, particularly unions, which preferred a single payer system. Ultimately it failed after the Republican takeover of Congress in 1994 . Finally achieving universal health coverage remained a top priority among Democrats, and passing a health reform bill was one of the Obama Administration's top priorities. The Patient Protection and Affordable Care Act
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