13) Health Care Reform Basics Flashcards
What was the main goal of ObamaCare?
To incr access
Did the ACA work out the way it was intended to and why?
No → It failed to lower costs
True or False: The ACA was very expensive for the federal govt?
True → Implementation and support over 10yrs would cost $940bil
What were some things that ACA changed?
- 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
What things did ACA do to incr coverage?
- 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
Why is the fact that reductions of cost-sharing for payers doesn’t exist anymore important?
Insurance companies are now passing their fees on to buyers and backing out contracts w/certain providers
True or False: Under ACA, money is a big incentive?
True
True or False: Bc of ACA, there are no longer any exclusions bc of pre-existing conditions
True
True or False: Bc of ACA, anything considered an “essential health benefit” has to be covered.
True
What did ACA do for medicare part D?
Got rid of the gap btwn levels of coverage
Comparative Effectiveness
Funding of studies to see what’s effective and what isn’t to determine what insurance will cover
Innovation Center at Medicare
Provides financial incentive to HCP’s to try new things
Explain Medicare Advantage payment cuts
Did not give direct payment cuts to providers; Cuts were towards govt health and certain facility types
Under ACA, did the independent payment advisory happen and why?
No bc there was too much resistance
Describe the estimated effect of health care reform for 2019
- 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
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
True
Define Essential Health Benefits and give examples
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)
Health Insurance Marketplace
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
Explain the decision of National Federation of Independent Business vs Sebelius
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
What could have happened if FIB vs Sibelius had been approved?
It would have decr risk sharing bc the only people seeking health insurance would be sick
Individual Mandate
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
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
True
What is the Medicaid expansion a combination of?
Federal and State Law
What did the Medicaid Expansion require coverage of?
10 Essential Health Benefits
As of November 2017, how many states adopted the Medicaid Expansion? Describe the pattern.
33 states have adopted
- Primarily coastal/Democratic states
- Southern states didn’t adopt and they have the worst health and the most poverty
How did 2017 Congressional Action affect ACA?
- Repealed the individual mandate
- Defunded the implementation of ACA
- Can no longer deduct health care from taxes
What is the pattern of public opinion of ACA?
When one party is happy, the other is not and there has never been a huge majority
