the buzz log
Decoding Health Care Buzzwords
President Obama's historic health care summit, billed as a bipartisan working session, was marked by a series of heated exchanges. It was also studded by a slew of buzzwords.
Mysterious phrases like "donut hole," "undercover patients," and "premium discrimination" have been bandied about by both sides. The terms may be obvious to lawmakers, but for the rest of us, a glossary might come in handy.
Donut Hole: Don't let the delicious-sounding name fool you. In Medicare, the donut hole is a hated, hated term. Simply put, it's the gap in prescription-drug coverage. The Los Angeles Times explains that seniors enrolled in the Medicare Part D plan "pay just 25% of the cost of their drugs, but only until they reach a threshold of $2,830." After that, seniors must pay 100% of the cost until they hit $4,550, at which point the government will pay 95% of the bill. That gap is called the donut hole, and nobody likes it, especially the seniors who have to fill it with their own money.
Undercover Patients: James Bond in the waiting room? Not quite. This is a plan to send actors into doctors' offices to see if they are willing to break the rules of Medicare. Why? Medicare fraud is a big problem. As The Wall Street Journal puts it, this is "not unlike mystery shoppers ferreting out bad customer service at stores." It's not currently in Obama's health care plan, but the president said he would consider adding it.
Premium Discrimination: HealthReform.gov explains this phrase with several easy-to-understand examples. Right now, health insurance companies are allowed to deny coverage based on health status. Also, premiums can vary wildly depending on a person's age, gender, etc. The government refers to this as premium discrimination, and many feel it's an unfair practice.
Preexisting Condition: Yet another hot-button issue. Perhaps the best-understood buzzword, it refers to health problems people have before they apply for health insurance. These conditions can prevent an applicant from obtaining health coverage, or force the person to pay a higher premium and fees. The actuarial logic predicts that due to the preexisting condition (which can be anything from asthma to breast cancer), the applicant is more likely to get ill. The insurance provider is then more likely to lose money. As businesses, they don't like that.