ACA Flashcards
What is the main reason for the ACA
To reform health care financing
How was ACA mandated for states
- Individual Mandate –> Everyone must have coverage up to essential benefits
- Employer Mandate –> Companies with over 50 employees must have employee sponsored health insurance
- Medicaid Expansion –> expanded who becomes eligible
- Insurance Market Regulation
What part of ACA mandate was overturned and when
2018
Individual mandate (there is no longer a fee for not having health insurance)
What is the Insurance Marketplace and what is its purpose
Helps people shop for and enroll in health insurance
- Federal government has one but some states run their own
- Previous services were just via websites, call centers, and in-person help
- Small businesses can also use their own market place to make choices about providing health insurance to employees (SHOP)
How many titles under ACA
10
What is the purpose of ACA Title 1
Quality Affordable care for all americans (you cannot be denied based on discrimination or pre-existing conditions)
What is the purpose of ACA Title 2
Role of public programs - Extended Medicare and preserved CHIP
What is the purpose of ACA Title 3
Improving quality and Efficiency of Health Care - Provides incentives for quality care to be provided
What is the purpose of ACA Title 4
Prevention and Improving Public Health (calories counts and restaurants)
What is the purpose of ACA Title 5
Health Care Workplace - Modifies student loans for those going into health care to increase number of providers to combat shortage
What is the purpose of ACA Title 6
Transparency Program Integrity: Screens to decrease fraud in health care
What is the purpose of ACA Title 7
Improving access to innovative medical technologies
What is the purpose of ACA Title 8
Community Living Assistance, services, and Support: New option to finance long term care over time
What is the purpose of ACA Title 9
Revenue Provisions: Makes healthcare more afforable by tax cuts to middle class while raising taxes for others
What is the purpose of ACA Title 10
Reauthorization of Indian Health Care Improvement Act: Provides health services for native Americans and Alaskan communities to modernize health care
What is Open enrollment for ACA and are there exemptions
60 days at the end of the year you can enroll in health care or change plan
- You can drop COBRA and enroll in market place during enrollment period
Exceptions: Loss of coverage for some reason, loss of employment, gaining dependent, divorce, loss of dependent status, moving states, losing eligibility to Medicaid, change in immigration status, exhaustion of COBRA
What are Accountable Care Organizations and how are they rewarded for better quality care
Aim is to reduce the need for health care services
- Network of physicians, hospitals, skilled nursing, pharmacy, and specialists who take both clinical and financial care of patients (Breaks down silos and coordinates care, reduces duplication, costs, and lessens treatment
- Projects can be conducted to determine if bundle payment saves money for a specific situation and if it does it becomes required without congressional ruling needed
- Incentivizes improved care because if they don’t they are financially penalized
- Additional penalties for hospitals with high rates of infections, errors, etc.
ACA mandate for Large companies
Must supply coverage for employees (100+)
ACA Mandate for Small Companies
Up to 100 employees they have choice
Employees can either keep what they have or go through marketplace
- SHOP (Small business health options program)
- Subsidies for small companies with up to 25 employees that provide insurance
Key provisions by ACA
- Health care exchanges (individual and SHOP)
- Essential benefits package for individuals and small groups (Bronze, Silver, Gold, Platinum)
- Minimum essential coverage (Ambulatory services, ER, Hospitalization, Maternity/Newborn, Mental health/Substance abuse programs, Medications, Rehab (PT/OT/ Speech), Labs, Preventive/wellness/chronic disease management, Peds services (dental and Vision)).
- Consumer operated and oriented plan
- Subsidies (To reduce premiums and Out of Pocket costs) - Determined on sliding scale and for those buying within exchange
