affordable care act

Question 1

US healthcare

Answer 1

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

Question 2

1800s

Answer 2

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

Question 3

early 1900s

Answer 3

dangerous working conditions -> more factories, industrial revolution
rapid med advancements, increased trust

Question 4

1906: FDA

Answer 4

food, drug, cosmetic act
FDA
RX drug regulation

Question 5

1926: the baylor plan for teachers

Answer 5

monthly payments for HI converage
early “modern” insurance, extended to other professions

Question 6

1930

Answer 6

great dep
hospitals follow win/win model -> steady income for hospitals and drs

Question 7

1940s: McCarren fergusson act

Answer 7

states have authority and responsibility for regulation of business of insurance d/t decreased oversight

Question 8

1946: hill burton act

Answer 8

national direct support for com hosptals, money and standards for construction and planning, est common service obligations
goal = 4.5 beds per 1000 people

Question 9

1940s and 50s

Answer 9

unions emerge post ww2 -> many places start offering HI as benefit to get more workers

Question 10

1965: medicare and medicaid

Answer 10

medicare: >65, disability, no income needed, A, B, C, D
medicaid: low income, limited resources, state based, income requirement

Question 11

pts without employe of gov funded care

Answer 11

public hospitals
private hospitals charged pts based on paying ability
cost shifting -> allows to provide charity care

Question 12

1970s and 80s

Answer 12

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

Question 13

1985: consolidated omnibus budget reconciliation acts (COBRA)

Answer 13

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)

Question 14

1986: emergency medical treatment and active labor act (EMTALA)

Answer 14

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

Question 15

1993: state childrens HI plan (SCHIP)

Answer 15

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

Question 16

2003: medicare modernization act

Answer 16

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

Question 17

2006: comprehensive health reform in MA

Answer 17

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

Question 18

2008: mental health parity act

Answer 18

insurers must compensate comparably for addiction and MH services for MH as they do for phys health (equity)

Question 19

2010: - 2015, pt protection and affordable care act (obamacare)

Answer 19

HI marketplace -> HI exchanges
expand medicaid, individual mandates (individuals req to have HI), emphasize prevent, insurer regulations, potential overturn or revision with new admin

Question 20

2012: national fed of indep business v sebelius

Answer 20

upheld individual mandate for HI but rules that mandatory medicaid eligibility expansion was unconstitutional -> not req

Question 21

2017: tax cuts and jobs act

Answer 21

removed individual mandate -> 2019
fam can deduct any med expense that exceeds 7.5% of their income (used to be 10%)

Question 22

HI with ACA: get it via

Answer 22

employer
HI marketplace
gov

Question 23

employer based

Answer 23

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

Question 24

HI marketplace

Answer 24

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

Question 25

insurance from gov

Answer 25

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

Question 26

insurance from gov: subsidized insurance from marketplaces for 100 - 400% FPL

Answer 26

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

Question 27

insurance from gov: individual mandate

Answer 27

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

Question 28

how is ACA funded

Answer 28

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

Question 29

ACA outcomes

Answer 29

decreased uninsured, increased use of hc system

Question 30

ACA insurer regulation changes

Answer 30

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

Question 31

ACA affects on business

Answer 31

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

Question 32

ACA women, children, fam

Answer 32

dependents -> 26, max out of pocket r/t poverty line covered mammograms, pap smears, maternity services

Question 33

healthcare future of US

Answer 33

current system is unstable, more $ for poorer outcomes, millions uninsured, partisan politics interfere with national decisions