Class 12: Medical Care Flashcards
The US Health Care System
No guaranteed coverage for all citizens
State variation in coverage
Gaps in coverage (over time and across groups)
Huge spending, mediocre health outcomes
Many Americans receive subsidized healthcare through employers. Firms that offer insurance as a part of their compensation package
- Firms deduct the costs of health insurance on their taxes. This is reflected in the tax expenditure budget
In 2010 (before ACA)- 49.1 million uninsured non-elderly Americans
Medical Programs: How do Americans receive healthcare
Our system is based on insurance provision under both private and public systems which Americans use to access health care providers
Medicaid
- Income-tested
- Varies by state ( some categorical eligibility, some only income-eligible)
Medicare
- Universal provided to the elderly and certain other groups, age-conditioned
S-Chip
- Children
Employer-provided benefits
Credits to purchase plans on the ACA marketplace
- Some states have their own plans, others did not develop and their residents must use the federal plans
Medicaid: Public Insurance
Type of benefit
- In-kind
- Means-tested
- Categorical eligibility (this changed after the ACA in some states)
Funding
- Jointly financed by state and federal government
Administration
- Each states establishes and administers its own program
- Determines the amount, type, duration and scope of services within broad federal guidelines
- Must cover certain mandatory benefits, others are optional
- Federal guidelines require certain groups are covered: Qualified parents/Children/Pregnant women with low incomes/Older adults with low income/People with disabilities with low incomes
- States can extend benefits to other groups
The ACA changed the categories listed above to an income-test rather than only the specified groups
This is a large change for states that expanded their Medicaid programs
The Affordable Care Act and Medicaid Expansion
An expansion in Medicaid eligibility to nearly all adults with incomes at or below 138% of the federal poverty level effective Jan. 1, 2014
- While this expansion was intended to occur nationwide, the Supreme Court ruling on the ACA effectively made it a state option, and 26 states implemented the expansion by 2014
New streamlines Medicaid eligibility and enrollment policies and a single application for
- Medicaid
- CHIP
- Subsidized Marketplace coverage
All states must implement these simplifications, which are designed to better connect eligible people to coverage, regardless of whether they implement the expansion
Funding Medicaid Expansion
Feds covered 100% of the costs of expansion through 2016
2020 and beyond, feds will cover 90% of the Medicaid expansion
Supreme Court Ruling on the Affordable Care Act (ACA) allowed states to opt of Medicaid Expansion, became a state’s decision
Marketplace coverage under ACA
The ACA also provides federal premium tax credits for individuals with incomes between 100% and 400% FPL ($19,790 to $79,160 for a family of three in 2015) who are not eligible for other coverage and who purchase insurance through the Marketplaces
Patient Protection and Affordable Care Act - 2017
Previous Republican suggestions have been
- High-risk insurance pools
- Expanding health saving accounts
- Tax credits based on age (not income as the ACA does) to help pay insurance premiums
- Sharply reduce federal funding for state Medicaid programs
Many provisions of the Act have been quite popular
- Remaining on parents insurance for young adults
- Expansions of Medicaid, for certain actors in certain states as it represented an increase in who has access to health insurance
Cost containments, premiums in the Marketplace
- More challenging
ACA is complex legislation and was designed with many moving parts. It is difficult to think about the consequences of specific measures in isolation. This was not the design of the ACA
Patient Protection and Affordable Care Act- 2017/2018
It is unclear what will happen
The President campaigned on repeal of the ACA
- Congress failed to pass “Repeal and Replace” legislation
The President used the Executive Order to intervene in the healthcare market
The Tax Cut and Jobs act repealed the individual mandate to hold insurance in the Patient Protection and Affordable Care Act
The ACA was complex legislation with mechanisms in the tax code, incentives for insurance to enter the marketplace, enrollment periods, marked state variation
State Child Health Insurance Programs (S-CHIP)
1997: Expanded coverage to children up through 200% of FPL
8. 4 million children enrolled (2015)
(CHIP) provides health coverage to eligible children through both
- Medicaid
- Separate CHIP programs
CHIP is administered by states, according to federal requirements
The program is funded jointly by states and the federal government
States have flexibility to design their own program within Federal guidelines
Benefits vary by state and by the type of CHIP program
Medicare
Type of benefit
- In-kind
- Social insurance
- Universal benefit
- Entitlement
- Event conditioned (age eligibility, disability)
- Not means-tested
Magnitude
Medicare is the largest health program in the US
- Federal program
In 2017
- Medicare covered 58.4 million people: 49.5 million 65+, 8.9 million disabled
- Total expenditures
- 710.2 billion
Finances
Medicare’s two trust funds
- Hospital Insurance (HI) Trust Fund (pays for Part A benefits)
- Supplementary Medical Insurance (SMI) Trust Fund (pays for part B and part D benefits)
Trustees of the Medicare program issue an annual report on the expected condition of the program’s two trust funds over a 10-year (short-term) and a 75-year (long-term) period
