In Carina Fourie & Annette Rid (eds.), What is Enough?: Sufficiency, Justice, and Health. New York: Oxford University Press. pp. 267-280 (2016)

Govind Persad
University of Denver
This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement of that goal by reducing unnecessary subsidies to better-off households would better accord with a sufficientarian approach to health care.
Keywords essential health benefits  Affordable Care Act  financial risk protection  out-of-pocket costs  impoverishment  catastrophe  universal health coverage  sufficientarianism  health insurance
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