(422 E2) affordable care act Flashcards
US health care compared to other countries
-lower life expectancy
-higher rates of suicide
-highest chronic disease burden
-highest obesity rates
-high premature death rate
McCarran - Ferguson Act (1945)
this act entrusted states with the authority and responsibility for regulation of the business of insurance due to lack of oversight
Hill - Burton Act (1946)
provided national direct support for community hospitals by providing money and standards for the construction, planning and community service obligations
what was goal for hospital beds determined by the Hill-Burton Act
4.5 hospital beds for every 1000 people in the population
medicare (1965)
health insurance program for people 65 years & older + people with disabilities
-no income requirement
-broken into part A,B,C & D
medicaid (1965)
health insurance program for people w/ low income and limited resources
-a state based program
what happens with patients without an employer or government funded care
-public hospitals
-private hospitals charged patients based on ability to pay (“cost shifting” allowed them to provide “charity care”)
in 1970s/80, what system was put in place to control medical costs
medicare diagnosis related group
allowed for same cost for same disease across the board -> private hospitals could no longer cost shift so many pt turned away and it caused patient dumping
emergency medical treatment & active labor act (EMTALA, 1986)
requires hospitals with emergency department to provide medical screening exams to any individual who comes to the ED and requests an exam and prevents EDs from refusing to treat individuals w/ an emergency medical condition
-some people now use EDs as primary care which impacts wait times & staffing needs
health security act
provided universal coverage and basic benefit package when it came to health insurance and health coverage
did not pass
state children’s health insurance plan (SCHIP)
allows children from low income families to receive state funded health insurance
medicare modernization act (2003)
Most significant law in 40 years for senior health
Provides seniors and people with disabilities with some Rx drug benefit, more choice and better benefits (provided medicare part D, which allowed for prescription drug coverage)
comprehensive health reform in MA (2006)
goal: provide health insurance to nearly all MA residents
plan: share responsibility between employers and government
mental health parity and addiction equity act (2008)
insurers must compensate comparably for addiction and mental health services for mental health as they do for physical health conditions
affordable care act (2010)
-Health insurance exchanges
-Medicaid expansion
-Individual mandates to require health insurance
-Emphasis on preventive care
-Insurer regulations
-Potential overturn or revision with new administration
National Federation of Independent Business v. Sebelius (2012)
Upheld the individual mandate for health insurance …. (but ruled that the mandatory Medicaid eligibility expansion was unconstitutional)
tax cuts and jobs act (2017)
-starting 2019, individual mandate was removed
-families can deduct any medical expenses that exceed 7.5% of their income (before it was 10%)
with the affordable care act in place, where can a person get heath insurance
-from employer
-from health insurance marketplace
-from government
employer based insurance major changes d/t the ACA
-Encourages employers to provide insurance
-Created SHOP marketplaces to help small businesses offer insurance
-Employer Shared Responsibility Payment (>50 employees)
-90-day maximum wait period
-Benefits and coverage disclosure laws
-incentives for worksite wellness programs
health insurance marketplaces
-Subsidizes health insurance for low- and middle-income families
-A “one-stop-shop” to enroll
-Designed to ensure competition between health plans
-Sign up through state or federal exchanges
-Responsibility to monitor private insurance companies
kynect (KY marketplace)
-national model
-500,000 people obtained coverage
-expanded coverage for substance abuse and mental illness
-rate of uninsured individuals fell to 9%
changes in government insurance d/t ACA
Medicaid expansion was designed to cover people from approximately 48% up to 100% FPL
Medicaid eligibility requirements vary from state to state
Part of the ACA initial requirements was that ALL STATES WOULD HAVE A MINIMUM ELIGIBILITY REQUIREMENT OF ALL ADULTS WITH INCOMES ≤ 133% OF THE FPL
Ruled unconstitutional by the Supreme Court ->
States that have chosen to expand Medicaid benefits have minimum requirement of 133%; states that did NOT expand Medicaid benefits have varying minimum requirements.
the medicaid gap
Since expanded Medicaid eligibility was ruled unconstitutional, there is now a gap. People who make between 48% and 100% of the FPL are not eligible for Medicaid in states that have not opted for the Medicaid expansion (bumping it to 100-400%) and are also not eligible to purchase insurance through the state marketplaces
potential impact of individual mandate removal
Congressional Budget Office estimates 13 million fewer people will be insured
Government would save $338B by not having to pay their subsidies
Health care costs will rise because fewer people would get preventive care
Health insurance companies will lose money- healthy people may drop coverage, more proportion of sick enrollees
how is the ACA funded (fees, taxes, penalties, & costo controlling measures)
-fees: pharmaceutical & medical device companies
-taxes: “cadillac” plans, earn >200,000, tax on indoor tanning
-penalties: ppl who did not buy insurance prior to 2019, companies w/ >50 FTEs who do not buy insurance
-cost controlling measures: provider incentives, waste,fraud & abuse, prevention & wellness promotion, reductions in medicare spending
insurer regulations: the big changes
Bans against yearly and lifetime limits
Can no longer deny coverage for adults/children with pre-existing conditions
Can no longer drop clients when they get sick
All plans must include preventive care and contraception
Must cover dependent children until age 26
Cannot charge females and males differently
who and what does the ACA affect
Insurance companies:
* Can’t drop people
* Eliminate lifetime limits
* Restrict annual limits
Primary Care sector:
* Preventative services for all little or no costs after 2014
businesses
women, children, families
* stay on parents insurance until 26 years old
* Max out-of-pocket based on family income relative to poverty line
* mammograms, pap smears, and maternity services must be covered services
consolidated omnibus budget reconciliation act (COBRA, 1985)
mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment
-temporary
-may be required to pay the full premium for that coverage, including the coverage that was previously paid for by the employer
-very expensive & most people cannot afford it
-varies by state & situation
