affordable care act Flashcards
US healthcare
spend more, access less frequently, worse outcomes (lower life expectancy, increased suicide, highest chronic disease burden, obesity rate, premature death rate)
5% spent on pop level, 95% on individual level
rank last related to qual, access, efficiency, equity
1800s
many health issues r/t social conditions (housing, sanitation, dysentery, cholera)
1850: accident insurance for steam boat and railroad travel
no health insurance: fam and friends provided most healthcare in home, hospitals crowded and unsanitary -> avoid, health expenses low
early 1900s
dangerous working conditions -> more factories, industrial revolution
rapid med advancements, increased trust
1906: FDA
food, drug, cosmetic act
FDA
RX drug regulation
1926: the baylor plan for teachers
monthly payments for HI converage
early “modern” insurance, extended to other professions
1930
great dep
hospitals follow win/win model -> steady income for hospitals and drs
1940s: McCarren fergusson act
states have authority and responsibility for regulation of business of insurance d/t decreased oversight
1946: hill burton act
national direct support for com hosptals, money and standards for construction and planning, est common service obligations
goal = 4.5 beds per 1000 people
1940s and 50s
unions emerge post ww2 -> many places start offering HI as benefit to get more workers
1965: medicare and medicaid
medicare: >65, disability, no income needed, A, B, C, D
medicaid: low income, limited resources, state based, income requirement
pts without employe of gov funded care
public hospitals
private hospitals charged pts based on paying ability
cost shifting -> allows to provide charity care
1970s and 80s
cost of hc increases
medicare dx related group (DRG) system -> 1983, to control cost
same payment for same disease across the board, regardless of factors
private hospitals could not shift income to support charity care
many turned away d/t lack of insurance, inability to pay
high profile pt dumping cases
1985: consolidated omnibus budget reconciliation acts (COBRA)
mandates insurance program which gives some employes ability to continue health insurance coverage after leaving employment
typically temporary (L determined by events and state), may be required to pay full premium, v experinsive (most cant afford)
1986: emergency medical treatment and active labor act (EMTALA)
req hospitals with ED to provide med screen exams to anyone that comes to ED and requests, cant refuse those with emergency
downsides: some started to use ED as primary care -> change wait times, staffing req
1993: state childrens HI plan (SCHIP)
before: health security act -> didnt pass d/t partisanship
universal coverage and basic benefit package, competition among HI, consumers had choice
children from low income families receive state health insurance
2003: medicare modernization act
most significant law in 40 yrs for senior health
seniors and people with disabilities with some RX drug benefit (part B), more choice about care and better benefit
2006: comprehensive health reform in MA
goal = provide health insurance to nearly all MA residents
plan = share responsibility btw employers and gov
considered precursor to ACA -> not national
issue = cost containment
2008: mental health parity act
insurers must compensate comparably for addiction and MH services for MH as they do for phys health (equity)
2010: - 2015, pt protection and affordable care act (obamacare)
HI marketplace -> HI exchanges
expand medicaid, individual mandates (individuals req to have HI), emphasize prevent, insurer regulations, potential overturn or revision with new admin
2012: national fed of indep business v sebelius
upheld individual mandate for HI but rules that mandatory medicaid eligibility expansion was unconstitutional -> not req
2017: tax cuts and jobs act
removed individual mandate -> 2019
fam can deduct any med expense that exceeds 7.5% of their income (used to be 10%)
HI with ACA: get it via
employer
HI marketplace
gov
employer based
major change
encourage employers to provide insurance
SHOP helps small businesses provide
employer shared responsibility payment (>50)
90 day max wait period -> before there was none
benefits and coverage disclosure laws
incentives for worksite wellness programs -> emphasize preventative care
HI marketplace
subsidize HI for low and middle income families -> too much for medicaid but too little for employer sponsored
1 stop shop to enroll
designed for competition btw health plans
sign up through state or fed exchange
responsibility to monitor private insurance companies
insurance from gov
medicaid expansion: 48 - 100% FPL
eligibility varies from state to state
all have minimum of all adults with incomes <133: FPL -> unconst
states w/o, have differing minimums
insurance from gov: subsidized insurance from marketplaces for 100 - 400% FPL
expansion voluntary -> problem of medicaid gap
those who make 48% - 100% FPL not elligible for medicaid in some states and cant purchase insurance through state marketplace
states that expanded -> impoverished uninsured fell
states that didnt expand -> not significant change
insurance from gov: individual mandate
pre tax cuts and jobs act
penalty for those not enrolled in health insurance
impact of removal: 13 mil fewer insured, hc costs increase bc decrease in preventative care, gov increases savings s/t not having to pay subsidies
insurance companies lose $ -> healthy people drop coverage, increase in number of sick enrollees
how is ACA funded
fees: pharm and med device companies
tax: cadillac plans, those that ear >200,000/yr, indoor tanning
penalties: uninsured (before 2019), companies with >50 full timers without insurance
cost controll measures: provider incentives, waste, fraud, abuse; prevention and wellness promo, decreased medicare spending
ACA outcomes
decreased uninsured, increased use of hc system
ACA insurer regulation changes
ban yearly and lifetime limits -> cancer and chronic/lifetime diseases
cant deny coverage for pre-existing conditoins
cant drop if get sick
cange charge M and F differently -> preg
cover dependents until 26
all plans must include preventative care and contraception
ACA affects on business
encourage to provide, SHOP marketplaces for small businesses (and tax credits), employer shared responsibility payment (>50), 90 day max wait period, benefits and coverage disclosure laws, incentives for worksite wellness
ACA women, children, fam
dependents -> 26, max out of pocket r/t poverty line
covered mammograms, pap smears, maternity services
healthcare future of US
current system is unstable, more $ for poorer outcomes, millions uninsured, partisan politics interfere with national decisions
