Health Care Reform Flashcards
When was ACA signed into law
2010
How was the ACA implemented
phased in gradually
What are some current issue with the climate of the government right now
strong ideas on both ends of the spectrum
progress is inhibited by hyper-partisan politics
law is enormous- to repeal it would have a massive impact on people, program, government and the economy
In general democrates
support government involvement
in general republicans
believe in less government involvement
What were some of the big issues in health care when the ACA was passed
- high costs
- high number of uninsured
- higher number of underinsured
- rising premiums/deductables
- underwriting
Before ACA was passed how many nonelderly were not insured?
1/5 or 18%
before the ACA if you had insurance there was still an issue what was it?
the deductible was so high you couldn’t even pay it
What is rescission?
The retroactive cancellation of a health insurance policy
What are/were the fundamental issues in the health care system
- access
- quality
- cost
The ACA helped to impact which of the 3 issues
- access
- Quality
what are some issues with access
-physician/provider availability
-health/wealth disparity
-pre-exisiting condition exclusion in non group
What are some issues with quality
-focus on treatment not prevention
-poorer outcomes than other western countries
-fee for services basis drives overutilization
fee for service drives what
over-utilization
What are the 5 fundamentals of ACA
- shared responsibility payment (individual mandate)
- medicaid expansion
- insurance exchanges and subsidies
- 10 required essential benefits
- revenue to pay for it
What is the individual mandate with the ACA
most often satisfied by
-employer-sponsored insurance
-individual insurance plan through health insurance exchanges
-government sponsored coverage medicaid or medicare
The individual mandate was suppose to be controled by who and prevent what
suppose to be controlled by the IRS but it didnt happen
to prevent the death spiral where young healthy people are not insured
What did the trump administration do in relation to the individual mandate
eliminated the fine for not complying with individual mandate
What is the employer mandate
> 50 employees, employer that does not offer health coverage will be fined 2,000$ per full-time employee
Employer must pay at least _____ of the cost associated with purchasing plan
60%
an employer >200 employees must automatically enroll employees in employer sponsoredplan
true
Prior to the ACA states were required to cover certain individuals if they participated in the medicaid program but this excluded what group
non disabled, non-pregnant adults without dependent children
What group was included in the medicaid expansion
non disabled, non pregnant adults without dependent children
Who funded the medicaid expansion
fed government funds 100% of expansion for first 3 years and then 90% after
Why did some states not chose to expand medicaid
some political
some financial
With the ACA was it optional for states to have a health care exchange?
no
What are 3 options for the states for running the exchange?
- design/run your own with help from federal grants
- sate and federal gov work together on designing and running exchange
- federal government runs it for you
does the exchange have a standard language
yes info allowed for comparison
does the exchange have a tiered system
yes bronze, silver, gold
What changed with ACA and guaranteed issue
-eliminates pre-existing condition exclusion
-eliminates option of rescission
What does the ACA allow 3:1 rating variation based off of
- age
- geographic area
- tabacco use
What changed with ACA limits
eliminates lifetime limits
severely restricts annual limits
What are the 10 essential benefits
- ambulatory care
- emergency service
- inpatient hospitalization
- maternity and newborn care
- mental health and substance use disorder services
- prescription drugs
- rehab services
- lab services
- preventative and wellness services
- pediatric services: includes dental and vision care
What is the biggest issue with cost of ACA
cost control
known reasons for high cost under ACA
- essential benefits in exchange- eliminates junk plans
- uninsured people can now buy insurance in the exchange
- pre-existing conditions covered
- no lifetime or very limited annual max
- no cost sharing for basic prevention
How did medicare reform impact quality?
payment reduction to hospital if those hospitals have too many preventable hospital readmissions
hospital value based program to pay hospitals according to pt satisfaction
How did medicare reform impact access
increased the number of primary care providers- funds available for training programs to increase the number of primary care doctors, nurses and public health professionals
community health centers- more money to expand community health
ACA extended coverage for young adults to stay on the policy until what age
26
aca requires that all new health plans offer ____ prevention benefits
free
medicare receive a free annual wellness visit
true
aca also made it so fast food and vending machine companies are required to disclose the nutritional content of each food item
true
After the ACA was implemented what happened to the rate of uninsured non-elderly
drop in uninsured rate to 10%
why are americans so unhealthy?
- health systems
- health behaviors
3.social and economic conditions - physical environments
Underinsured
extreme out of pocket cost that people are unable to pay if they do get hurt or sick
Compared to other countries where does out money in terms of healthcare spending?
inpatient/outpatient
prescription drugs
administrative cost
preventative
what one area does US not spend as much compared to other countries
long term care
Republicans focus on what in terms of health care
lowering taxes
shifting responsibility for health care from the federal gov to states
opposed the ACA
Democrates have done what for health care reform
passed the ACA in 2010
Describe medicare for all
universal health care
private insurance would not exists
could lower GDP spent on HC because it would get rid of administrative costs
medicare for all would have _____ cost sharing but _____ would go up
medicare for all would have very little cost sharing but taxes would go up
Do hospitals want medicare for all?
no because private payers pay hospitals about 100% mire than medicare
medicare for all is termed socialized medicine
no it is more accurately described as single payer similar to canadas system
What is the public option health plan?
health plan created by the gov to offer consumers a high-value, affordable alternative to fully private plans
What is bidencare: public option
premiums and cost sharing would be based on income
would allow people to go on medicare at 60 years old
fed gov would operate a plan administered by medicare that anyone could join
Has biden done anything for bidencare/
no
Would bidencare have cost sharing and premiums?
yes
price in colorado public option
what hospitals charge, generally represented as revenue per patient
cost in colorado public option
how much the hospital spend to operate and provide care for patients and is represented by hospital-only operating expense
are colorado hospitals making a profit/
yes 2nd highest profit in the nation
What is the best way to describe the colorado public option
public- private partnership where states contract with private companies to create a new insurance option to be overseen by but not run by the gov
What does the colorado public option most similiarily represent
medicare advantage part c
do hospitals in colorado have to take the colorado option
yes
Does the colorado option have standardizes benefits
yes
What does colorado project the colorado option will do to premiums
lower premium by 14% because the more competition will create a lower cost
Is there a waiver for the colorado option that offers a subside who are ineligible for ACA
yes if someone has low income and has lots of kids they can enroll in a waiver for a subsidie
what has biden done for health care reform
stoped trumps guidence to encourage states to require medicaid enrollees to work, volunteer or attend school
What is the CMS innovation 2021 comprehensive strategy
focus on the total cost of care moedel and embrace advanced primary care and affords very little attention to specialty and episodic models
Biden administration may give states more flexibility and strengthen the safety net improve affordability
true
ACA is now a decade old and what has changed?
not much despite coverage and quality efforts UC HC costs are still growing
Progressive tax
tax rate increases as income increases increasing burden on higher wage earners Ex: income tax
regressive tax
tax rate burdens lower wage earners more than higher wage earners
ex: sales tax
Flat tax
burden is the same across all individuals
Political Cost
how hard would it be to get to make this happen in today’s current political environment
economic cost
the net impact of the system design in overall cost for healthcare
Efficiency Cost
how complicated is the health care system in terms of paperwork, administrative structure, regulatory review
Preventative care what model
- medical home
- accountable care organizations
- bundled payments
care of major acute episodes
both bundled and ACO
ex: total joint replacements and MI
care of minor acute episodes
medical homes
care of chronic conditions
medical homes because of team based decision making on going management of health conditions
