13) Health Care Reform Basics

Question 1

What was the main goal of ObamaCare?

Answer 1

To incr access

Question 2

Did the ACA work out the way it was intended to and why?

Answer 2

No → It failed to lower costs

Question 3

True or False: The ACA was very expensive for the federal govt?

Answer 3

True → Implementation and support over 10yrs would cost $940bil

Question 4

What were some things that ACA changed?

Answer 4

• Could no longer be denied from coverage bc of a pre-existing condition
• Got rid of the lifetime limit on benefits → Reaching the end of coverage and paying out-of-pocket was no longer a thing

Question 5

What things did ACA do to incr coverage?

Answer 5

• Individual Mandate →
• Employer Requirements
• Expanded Public Programs (Medicaid Expansion)
• Subsidation of Premiums and Cost-Sharing
  
  • For those who couldn’t afford their premiums or cost-sharing requirements
  • Employers got tax breaks/discounts so they could pay their employees’ premiums
• Decr cost-sharing for payers → Private insurance companies got federal subsidies
  
  • This isn’t a thing anymore bc of you know who

Question 6

Why is the fact that reductions of cost-sharing for payers doesn’t exist anymore important?

Answer 6

Insurance companies are now passing their fees on to buyers and backing out contracts w/certain providers

Question 7

True or False: Under ACA, money is a big incentive?

Answer 7

True

Question 8

True or False: Bc of ACA, there are no longer any exclusions bc of pre-existing conditions

Answer 8

True

Question 9

True or False: Bc of ACA, anything considered an “essential health benefit” has to be covered.

Answer 9

True

Question 10

What did ACA do for medicare part D?

Answer 10

Got rid of the gap btwn levels of coverage

Question 11

Comparative Effectiveness

Answer 11

Funding of studies to see what’s effective and what isn’t to determine what insurance will cover

Question 12

Innovation Center at Medicare

Answer 12

Provides financial incentive to HCP’s to try new things

Question 13

Explain Medicare Advantage payment cuts

Answer 13

Did not give direct payment cuts to providers; Cuts were towards govt health and certain facility types

Question 14

Under ACA, did the independent payment advisory happen and why?

Answer 14

No bc there was too much resistance

Question 15

Describe the estimated effect of health care reform for 2019

Answer 15

• Medicare and employee-sponsored coverage would stay the same
• Medicaid/CHIP would incr → Bc of expansion
• Individual coverage would incr → Its new
• # of Uninsured would drop

Question 16

True or False: Bc there are so many parts of ACA, a lot of work would need to be done to dismantle it should a repeal happen

Answer 16

True

Question 17

Define Essential Health Benefits and give examples

Answer 17

Federal law of care that must be covered in the state-offered Health Insurance Exchange → Baseline coverage

• Ambulatory Services
• Emergency Services
• Hospitalization
• Maternity/Newborn Care
• Mental/Behavioral Care
• Prescription Meds
• Rehab!
• Lab Services
• Preventive/Wellness/Chronic Disease Management
• Pediatric Services (Including oral and vision)

Question 18

Health Insurance Marketplace

Answer 18

Place for individuals and small businesses to compare the price, quality, and other things for different health insurance options

• Primary purpose was to create competition in the health insurance market, improve choices, and give small businesses the same purchasing abilities that big businesses have

Question 19

Explain the decision of National Federation of Independent Business vs Sebelius

Answer 19

Challenged ACA bc they thought it was unconstitutional to require everyone to have health insurance

• Said Individual Mandate was constitutional → Everyone should have health insurance
• Said Medicaid expansion was unconstitutional → Could not take away a state’s Medicaid funding if they didn’t accept the expansion → Made the expansion optional so each individual state (governor) could decide if they wanted it and only ACA funding would be withheld

Question 20

What could have happened if FIB vs Sibelius had been approved?

Answer 20

It would have decr risk sharing bc the only people seeking health insurance would be sick

Question 21

Individual Mandate

Answer 21

As of 2014, required most people to have a minimum level of health coverage for themselves and their dependents and if they don’t, they’ll be fined

Question 22

True or False: Under the Medicaid Expansion, the federal govt would fund 100% of states’ costs for the expansion btwn 2014 and 2016 and then gradually decr to 90% in 2020

Answer 22

True

Question 23

What is the Medicaid expansion a combination of?

Answer 23

Federal and State Law

Question 24

What did the Medicaid Expansion require coverage of?

Answer 24

10 Essential Health Benefits

Question 25

As of November 2017, how many states adopted the Medicaid Expansion? Describe the pattern.

Answer 25

33 states have adopted

• Primarily coastal/Democratic states
• Southern states didn’t adopt and they have the worst health and the most poverty

Question 26

How did 2017 Congressional Action affect ACA?

Answer 26

• Repealed the individual mandate
• Defunded the implementation of ACA
• Can no longer deduct health care from taxes

Question 27

What is the pattern of public opinion of ACA?

Answer 27

When one party is happy, the other is not and there has never been a huge majority