In general, the only people who should be enrolling off-exchange are those who are 100 percent certain that there is no way they will qualify for a premium tax credit during the year – keeping in mind that the premium tax credits are available well into the middle class and are larger in 2018 than they were in 2017 in order to offset the higher premiums. (A family of four earning $98,400 is eligible for premium subsidies in 2018.)
When a clearer distinction is intended, healthy is used to describe the state of the object, and healthful describes its ability to impart health to the recipient. Vegetables in good condition are both healthy (i.e., not rotten or diseased) and healthful (i.e., they improve the eaters' health, compared to eating junk food). By contrast, a poisonous plant can be healthy, but it is not healthful to eat it.
Based on the principle of solidarity and compulsory membership, the calculation of fees differs from private health insurance in that it does not depend on personal health or health criteria like age or sex, but is connected to one's personal income by a fixed percentage. The aim is to cover the risk of high cost from illness that an individual can not bear alone.
Just as there was a shift from viewing disease as a state to thinking of it as a process, the same shift happened in definitions of health. Again, the WHO played a leading role when it fostered the development of the health promotion movement in the 1980s. This brought in a new conception of health, not as a state, but in dynamic terms of resiliency, in other words, as "a resource for living". 1984 WHO revised the definition of health defined it as "the extent to which an individual or group is able to realize aspirations and satisfy needs and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities". Thus, health referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional and social health referred to a person's ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living. This opens up many possibilities for health to be taught, strengthened and learned.