Chapter 19 Flashcards
What was trump’s aim with the ACA?
- wanted to repeal ACA
- no increase in premiums
- no loss in coverage
- –> all unrealistic
Conservative critiques of the ACA
- increased taxes and fees
- Government forced mandate
- doesn’t focus on cost
- too centralized
- huge expansion of entitlements (i.e Medicaid and Medicare)
- over generous subsidies
- individual mandate is ineffective
What were the components of the ACA
- coverage on parents plan until 26
- essential benefits
- no cost sharing for preventative medicine
- hospital ensuring quality
- covering donut hole in Medicare Part D
- employee Mandate (pay or play)
What did the Republicans try to replace the ACA with ?
American Health Care Act (AHCA)
-passed in 2017
What were components of the AHCA?
In individual market -no underwriting -no mandate, but if not covered for 63 days -subsidies based on age, not income in employer mandate -repeal completely -maintain cadillac tax -maintain definition of dependent care
medicaid
- states could expand up to 2020
- fund fill block grant based on 2016
other
- barred planned parenthood from receiving funds
- repeal funding for cdc and nih
- states could waive out of covering essential benefits
how would the AHCA be funded?
- repeal all taxes except Cadillac tax
- repeal 3.8% tax on highest earners
- increase cap for HSA (health savings account)
- goal: give tax breaks to the wealthy (600billion)
what were the CBO’s estimates on AHCA?
- repeal over 900 billion in taxes
- loss of coverage (from those who choose to be uninsured, those who can’t afford without subsidies, and drop in employer based coverage)
- loss of cover as a result of tax plans (13 million estimated to lose coverage)
- premiums to increase(cause a downward spiral)
How did the Republicans try to repeal ACA?
- Senate introduced three bills:
- skinny bill : repealing all funding(no funding PERIOD), 17 million to be uninsured
- -> McCain gave speech before death
- Better Health Care for All
- Graham and Cassidy Bill
- -> turning Medicaid into block grants
- ->block grant ACA subsidies
ultimately: not repeal and replace because GOP had internal disagreements
What other approaches were used in the Senate to change the ACA?
- Bi-partisan approach: Alexander(R)-Murray(D)
- democrats: stop the repeal, medicare for all, and public option
What was the better health care for all bill?
-developed by work of 13 senators
-15 million would lose coverage
-repealed individual mandate
-lower tax credits
-states can lower pre-existing condition prohibition (lol back to stone ages)
-employer mandate would be dropped
died in july 2017, after not getting enough votes
-Medicaid: states can choose block or per capita grant
what were the republicans a failure in repealing and replacing?
-gop internal disagreements
-difficulty in using reconciliation process
-democrats were unified
Jimmy Kimmel
who is to blame with problems of the ACA?
people think trump and republicans is to blame
-most in support of the ACA
-
What was the Budget Agreement in 2018?
-it eliminated the penalty for non-coverage to 0
-end IPAB
-required Pharma to offer large discounts to drugs in donut hole
-Fund FQHC for 2 years
-reduce prevention funding
increase medicare premiums for those who make more than 200k (individually) and 250k(family)x
How did Americans view change on Medicaid?
- changed because of nursing homes: seniors thinking about long term care themselves
- 2/3 of Americans wanted Medicaid to be left alone
What was the regulatory approach ?
- executive order signed into place 2017,aimed to reduce economic burden
- goal: use regulations to undermine the ACA
- -> did this thru short term plans and associate health plans
- undermine market place
- meant to clarify, implement, and operationalize
what are Associate Health Plans?
-self employed/self purchase (small businesses purchasing health care)
- Exempt from ACA and ERISA laws (state law does not apply)
-plans violate ACA
- underwriting
-limited benefits
-narrow network
-
What are Short Term plans?
-provides coverage for less than a year (gap insurance)
-exempt from ACA requirements
-underwriting
-exclude pre-exisiting conditions
-doesn’t cover essential benefits
mlr=9%
-90% gets to be kept
-large cost sharing
-lower premiums
Part of regulatory approach Trump instituted
Health Reimbursement Arrangements (HRAs)
- Trump wants to expand
- allows employers to use tax exempt funds without linking to group health plan
- part of regulatory approach Trump instituted
What was the aim with HRAs, Short Term plans, and Associate Health Plans?
- undermine integrity of employer based coverage in ACA
- undermine market place
- healthy people will leave ACA and go elsewhere(like these Short term plans), causing premiums to increase
How else did Trump try to undermine ACA?
- creating work requirements for ACA
- never implemented
- large admin cost to do this - Healthcare.gov Money slashed
what are the competing views on Medicare?
- Trump- it is a welfare program to provide temporary help
- Democrats: it is a health program that helps the poor
- didn’t want work requirement: ppl need to be healthy first
- some people are already working of face barriers to finding a job
Legal Texas vs. US
- issue: ACA not constitutional because no tax credit and thus no tax penalty
- ruled unconstitutional and going to Supreme Court
What is the current state of ACA and how can it be built upon now?
- Expand Medicaid without restrictions
- Ban short term plans and other anti-ACA plans
- expand Medicaid
- enforce individual mandate,enhance subsidies
- Turn Medicaid into a block grant
what were bipartisan ideas that were agreed upon regarding the ACA?
- Drug pricing
- negotiate in medicare
- generic drug expansion
- price overseers - Balance billing(surprise billing)
- providers billing even though they didn’t negiotiate a price
- protects patients and will require providers to accept patients
