Exam #3: Political Activism Flashcards
Cost of Healthcare
National Health Expenditure
- -2.8 trillion dollars in 2012
- -17.2% of GDP
National Health Expenditures by Category (2011)
Hospital care: 31.5%
Nursing home facilities and continuing care retirement communities: 5.5%
Physician and clinical services: 20.0%
Prescription drugs: 9.7%
Who pays for healthcare?
Self-pay Employee insurance Government --VA --Medicare --Medicaid
Private vs. Public
Households: 28% Fed. Govn't: 26% Private Businesses: 21% State and Local: 18% Private Revenues: 7%
Distribution of Costs
10% of population accounts for 63% of all healthcare spending
1% of population accounts for 21% of all healthcare spending
50% of population accounts for 3% of all healthcare spending
40% of Medicare Costs occur in last month of life
Federal Agencies: Department of Health and Human Services
Public Health Service Center for Medicare and Medicaid services (formerly Health Care Financing Administration) Administration for Children and Families Administration of Aging Office for Civil Rights
Agencies under Public Heath Service
Agency for Health Care Research and Quality
CDC
FDA
National Institutes of Heath (NIH)
Health Resources and Services Administration (HRSA)
Indian Health Services
Substance for Abuse and Mental Health Services
Agency for Toxic Substances and Disease Registry
Social Security
In 1935, Social Security Act
Amendments:
- -Old Age and Survivor’s Insurance
- -Unemployment compensation
- -Disability Insurance
- -Medicare
- -Medicaid
When was Social Security formed?
1935
Old Age and Survivor’s Insurance
Provides monies to workers or family upon retirement, disability, or death
2 companies: Social Security and Disability
Federal Insurance Contributions Act (FICA)
- -FICA rate (2014)
- ->7.65% up to max of $117,000
- ->self-employed 15.3%
In 2014, benefits sent to 55 million
Amount based on average earnings and length of employment
Retirement age: 62 with partial benefits
–trending to be 67 before you can receive full benefits
3% contributing to 1% receiving SS
In 2014, SS benefits were sent to how many million?
55 million
Disability Insurance
8 million receiving benefits
–around 70% of people are denied Disability Insurance (years of abuse of the program have led to strict Fed. regulations on who can receive it)
Qualifications:
- -covered by social security 5-10 years
- -physical or mental disability
- -unable to work
5 month waiting period
Paid to worker or dependents
Unemployment Insurance
Protect workers out of work through no fault of their own Governed by states Qualifications: --no work for > 1 week --able to work and take job --previous job ended through no fault
Do not have health insurance when collecting unemployment insurance
Supplemental Security Income (SSI)
Provides direct cash benefits to aged or disabled with decreased income
Amount based on need, not on contributions made throughout your lifetime
Somewhere between $400-$600/month
- -however if that parson is receiving food stamps from SSI they need to subtract that amount
- -so they’re usually earning about $100-$200/month
Sent out to 5 million people per year
Medicare
Established in 1965
Funds 20% of all health services
Provides health insurance to citizen or permanent residents over 65 who have worked at least 10 years (Part A)
Can purchase Supplemental Insurance (Part B) for additional cost
Medicare Part A
Hospital room fee is covered Deductive is $1216 per benefit period (2014) Will pay some nursing home costs Hospice care is covered for 210 days Home health services
When are most Americans automatically enrolled in Medicare Part A?
Once they turn 65
Medicare Part B
Purchased through a private entity
After $147 deductive, Part B pays 80% of all allowable expenses (2014)
–physician services
–labs
–durable medical equipment (braces, walkers, canes…)
–outpatient services
–prescription drugs not self-administered
Cost $104.90/month (2014)
Medicare Part C
Medicare Advantage Plans
- -available only in select locations
- -managed-care options run by private companies
- -provide a few additional services
- -high plan cost paid by all members, not just those in Medicare Part C
If you have Part A, you’re also paying for people to receive the extra services through Part C but you yourself are not receiving those benefits
Medicare Part D
Prescription Drug Coverage
- -complex regulations
- -monthly fee purchased from private plans
- -cost: $0-$50 per month with $310 deductible, patient pays 35% up to $2850. Then patient pays 47.5% (brand name) and 72% (generic) up to $4550 (gap, donut hole). After that, patient pays about 5% for drugs. (2014)
Going to be changing because of the Affordable Care Act
Medicaid
Pays or medical services for low income Program designated by each state Majority in managed care plans Does not cover all poor Major financial support for persons in nursing homes (up to 45% cost)
Medicare/Medicaid Legislation
Quality Improvement Organizations
The Health Care Quality Improvement Act
Medicare/Medicaid Legislation: Early 1980’s
Drastic cuts to Medicare and Medicaid
Prospective payment system developed
Diagnostic Related Groups (DRG)
Medicare/Medicaid Legislation: Results of Prospective Payment System (PPS) - DRGs
Shorter length of stay
Increased patient acuity
Nursing home admissions increased x3
Increased demands on family, community, and home-care provider resources
Medicare/Medicaid Legislation: Past 10-20 years
Reimbursement for certified nurse-midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists
Nursing home care standards
Child health
Home economic stats for 2009
46,000,000 uninsured Americans
86.7 million uninsured over past 2 years
Medical bills account for > 60% of bankruptcies
Uninsured have 40-50% higher risk of death
100,000 lives could be saved yearly with universal primary care
Family health insurance cost $13,376/year
Home Economic Stats for 2014
Approximately 30,000,000 uninsured Americans
Medical bills account for > 60% of all bankruptcies
Family health insurance cost $15,473/year
Concerns about Healthcare?
Is health care a right or a privilege? If a right, whose jurisdiction? Is equity of care an entitlement? President Clinton - Health Security Act Increasing trend to universal coverage with combination of public/private sectors
Heath Care Reform 2010
Provides coverage 32 million currently uninsured
Creates interstate health insurance exchanges
Closes Medicare part D donut hole
Expands Medicaid to 133% of poverty level ($29,327/family of four)
Insurance companies may no longer deny children coverage with preexisting conditions
–in 2014, insurance companies may no longer deny anyone coverage with preexisting conditions
Children stay on parent’s plan until 26
In 2014, no lifetime limits
In 2014, everyone must purchase healthy insurance of face a $695 annual fine (low income exceptions)
Tax credits for small businesses
By 2018, all plans must cover preventative care
Paying for Healthcare Reform
In 2010, 10% tanning tax
In 2013, 3.8% investment income tax for families making > $250,000
In 2018, 40% excise tax on high-end health insurance plans > $27,500
Between 2011 and 2019
- -drug companies will pay 16 billion
- -insurance companies will pay 47 billion
- -medical device manufacturers pay 2.9% excise tax on sale of wares
Medicare Part C reductions over 10 years
Home health care reductions over 10 years
Select cuts to hospitals by 2019
Nursing and Healthcare Costs
Difficult to determine actual cost of nursing care
About 20-28% of hospitalization costs are related to nursing care
Economic value of RN nursing care:
–decreased patient complications
–decrease length of stay
–decreased patent deaths
Managing Healthcare Costs
Be aware of costs Provide evidence based care Higher level degrees Lifelong learning Patient education
Political Professionalism in Nursing
Political activism is part of the role of a registered professional nurse
Know your legislators and how they vote on issues important to you
Contact legislators about issues
Participate in political campaigns
Vote
I don’t know my legislators?
Call local board of Elections
local library
I don’t know their voting record?
vote-smart.org
Legislator Influence
Interest groups Political Action Committees (PACs) Lobbyists Grassroots lobbying --the best way to sway a legislator's vote
Writing to a Legislator
Address correctly Identify self as nurse and constituent Be brief and specific Use reasoning, good sense, and facts Include bill number, author, title, status Use correct grammar and spelling
Political Professionalism in Nursing
Participate in organizations concerned with legislative issues
Give testimony at hearing
Participate on advisory committees
Originate and encourage specific legislation
Becoming Politically Savvy
Know your Nurse Practice Act Join ANA Read American Journal of Nursing Awareness of speciality organizations legislative issues Read newspapers or web
Nursing and Politics
Nurses becoming more politically involved
ANA and other organizations update nurses on important issues
Individual nurses are encouraged to become acquainted with legislators
Identify voting records especially health care policies and nursing issues
What are 3 parts of the Healthcare Reform 2010?
- create interstate insurance exchanges
- close Medicare Part D donut hole
- expand Medicare to 133% of poverty level
How many Americans did not have health insurance in 2009?
46 million
In 2010, it increased to 52 million
In 2011, it decreased back to 46 million
