ACA Politics Flashcards
Partisan views
Democrats
Republicans
Partisan views
Democrats
- government-oriented health care system w/ gov regulation
Republicans
- market-oriented system with relatively few government regulations
Support for ACA has _ over time and made it easier for Republican govs to _ and _
Support for ACA has decreased over time and made it easier for Republican gov to not setup exchanges and not expand Medicaid
Ideological differences in policy:
Interest groups can make changes to policy be viewed as _ _ _ taking from one group and giving to another
Ideological differences in policy:
Interest groups can make changes to policy be viewed as Zero-sum games taking from one group and giving to another
Ex: Rich vs Poor, small business vs corporations
What is public option?
Motivation of public option?
Public option fails, Senate attempts at a compromise: (2)
Goal of proposed plans?
What is public option?
- LARGEST BATTLE OVER PROVISION
- Proposal to allow those not covered by Medicare or Medicaid the option to purchase a public health insurance plan operated by the government
Motivation of public option?
- Motivation of lower provider reimbursement and lower administrative costs (Private pays more)
Public option fails: Senate attempts at a compromise (2)
- CO-OP plans: Non profit plan
- National plans administered by OPM: 2 plans: 1 private and 1 non profit
- PRIVATE PLANS^
Goal?
- increased competition lower admin cost
The ACA: What Liberals Didn’t Like
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The ACA: What Liberals Didn’t Like
- Some liberals: it wasn’t a “single payer” system
- Most liberals: it didn’t include a “public option”
- The “play or pay” mandate on employers wasn’t stronger
- The “Cadillac Tax” was included (especially opposed by unions)
- Unions historically negotiated for richer benefits
- Don’t see connection between generous plans and moral hazard
- The premium tax credit subsidies are too small, yielding unaffordable premiums
- States exchanges instead of national (more reg pressure)
- The abortion restrictions
- problem
- federal taxpayers’ money going to subsidize coverage, which could include abortion services
- solution
- each state could decide to outright prohibit coverage of abortion services in all exchange plans
- state exchanges with abortion coverage= two-check payment system
- problem
The ACA’s Redistribution of wealth from _ Families to _ Families:
The ACA’s Redistribution of wealth from High-Income Families to Low-Income Families:
The ACA: What Conservatives Didn’t Like
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The ACA: What Conservatives Didn’t Like
- Too many government regulations on employers, insurers, and providers
- Too many taxes
- Individual mandate
- Reductions to Medicare Advantage payments (as initially written)
- No tort reform to the malpractice system
- No cross-state insurance purchasing (to mainly circumvent state benefit mandates)
Why did conservatives want cross-state insurance purchasing?
private health insurance markets are subject to state regulation
Goal?
Concern?
Why did conservatives want cross-state insurance purchasing?
private health insurance markets are subject to state regulation
Goal
- circumvent state benefit mandate which conservatives often argue drive up the costs of health insurance considerably
Concern
- Healthy people living in states with high benefit mandates will shift to states with lower benefit mandates
What drives technocrats decisions?
The ACA: What Technocrats Liked
What drives technocrats decisions?
- underlying research on health issues and not politics
The ACA: What Technocrats Liked
-
Health Insurance Exchanges
- improve the efficiency of private health insurance markets
-
Pilot programs for Medicare payment reform
- Bundled payments, Accountable Care Organizations, CMMI
- Efficient payment models
- Bundled payments, Accountable Care Organizations, CMMI
-
The “Independent Payment Advisory Board” (IPAB) for Medicare
- alternative payment models for Medicare providers
-
The “Cadillac Tax” (partly):
- counterbalance the inefficient and inequitable employment-based tax exclusion
- Best thing would be to address is directly attack the inefficient tax exclusion in a more direct manner
- ACA Budget deficit neutral
What didn’t the technocrats like about ACA?
What didn’t the technocrats like?
-
Public Support for the ACA Never Really Surpassed 50%
- makes its future quite uncertain, as the political power shifts
- Didn’t have more public/ bipartisan support
- the ACA built on current system’s shaky foundation
- reform structure of healthcare system to make it less fragmented
-
Inequity of Exchange’s low-income subsidies
- Limited to those without employment-based insurance
- Vast majority of low-income workers will instead receive a lower, regressive exclusion (via the “play or pay” mandate)
- Will the “tough” provisions ever be implemented and/or not overridden?
- eventually implement the IPAB (and not have Congress override later)?
- eventually implement the Cadillac Tax in 2020 (and not override again)?
- Eventually override Medicare’s hospital payment reductions?
Insurance: Describe the horizontal inequity for low wage and high wage workers in insurance marketplace and what kind of insurance they would prefer
- horizontal inequity for lower-wage workers in favor of firms not offering coverage
- get better subsidies in exchanges (not based on tax rate)
- horizontal inequity for higher-wage workers in favor of firms offering coverage
How are exchange tax subsidies determined?
How are exchange tax subsidies determined?
- tax credits based on the second cheapest silver plan to yield specific premiums that are a fraction of one’s income.
-
flat tax credit amount
- doesn’t vary by metal tier
Why has ACA cost less than expected?
- Not all states expanding
Massachusetts Health Reform
Who passed?
How financed?
Main components mirrored what?
Difference in coverage at start Mass vs ACA?
Massachusetts Health Reform
Who passed?
2006 under Republican Governor Mitt Romney + Democrats
How financed?
No new state taxes (at first), largely re-shuffling federal money spent on uncompensated care
Main components mirrored what?
Main components: (Mirrors ACA)
- Commonwealth Choice Connector= Indv Exchange market
-
Commonwealth care subsidies (300%)= exchange market tax subsidy (100-400%)
- Ineligible for Medicaid and not offered EBI
- Individual mandate
- Employer mandate
Difference in coverage at start Mass vs ACA?
- Mass nonelderly uninsured rate was lower than national average
Hilliary indv mandate vs Obama indv mandate
Hilliary indv mandate
- EVERYONE
Obama indv mandate
- CHILDREN
Differences between ACA and what Obama ran on? (2)
Differences between ACA and what Obama ran on? (2)
- Indv mandate for children
- Nation health exchange instead of children
Before the ACA was passed there was _ partisan views between the parties
Before the ACA was passed there was increased partisan views between the parties
Where did the ACA begin being crafted?
How to end a filibuster? What after?
What strengthened the possibility of winning Cloture vote?
What happens when house and Senate pass different versions? How was this complicated?
Solution to not having 60?
Where did the ACA begin being crafted?
- in the house and senate committees
How to end a filibuster__? What after?
- Cloture vote: 60/100 votes to end
- Then, reg 51/100 to pass
What strengthened the possibility of winning Cloture vote?
-
Backroom deals
- EX
- 100% FMAP for Medicaid expansion in Nebraska
- FMAP accessible for states that have disasters- LA
- cadillac tax delayed
- EX
What happens when house and Senate pass different versions? How was this complicated?
- goes to conference committee to combine and both revote
- Democrats lost a seat to a death and special election for a Republican
Solution to not having 60?
- House passes Senate bill as is
- Fixer bill passed through reconciliation to make house happy (50 votes)
_ _ _ _ (AHCA) introduced by the House: Pass or fail?
_ _ _ _ (BCRA) introduced by the Senate: Pass or fail?
- Reductions to federal contribution to _ _
- Reductions and modifications to _ _ _ _ _
- Repeal of _ and _ _
- Repeal of various taxes affecting _ _ and _-_ _
- Allow states to deregulate _ _ rules and/or _ _ _
American Health Care Act (AHCA) introduced by the House: Pass
Better Care Reconciliation Act (BCRA) introduced by the Senate: Failed
- Reductions to federal contribution to Medicaid spending
- Reductions and modifications to individual market tax credit subsidies
- Repeal of individual and employer mandates
- Repeal of various taxes affecting healthcare industry and high-income families
- Allow states to deregulate community rating rules and/or Essential Health Benefits
