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Health Care Delivery > Health Care Reform > Flashcards

Health Care Reform Flashcards

1
Q

When was ACA signed into law

A

2010

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2
Q

How was the ACA implemented

A

phased in gradually

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3
Q

What are some current issue with the climate of the government right now

A

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

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4
Q

In general democrates

A

support government involvement

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5
Q

in general republicans

A

believe in less government involvement

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6
Q

What were some of the big issues in health care when the ACA was passed

A
  1. high costs
  2. high number of uninsured
  3. higher number of underinsured
  4. rising premiums/deductables
  5. underwriting
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7
Q

Before ACA was passed how many nonelderly were not insured?

A

1/5 or 18%

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8
Q

before the ACA if you had insurance there was still an issue what was it?

A

the deductible was so high you couldn’t even pay it

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9
Q

What is rescission?

A

The retroactive cancellation of a health insurance policy

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10
Q

What are/were the fundamental issues in the health care system

A
  1. access
  2. quality
  3. cost
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11
Q

The ACA helped to impact which of the 3 issues

A
  1. access
  2. Quality
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12
Q

what are some issues with access

A

-physician/provider availability
-health/wealth disparity
-pre-exisiting condition exclusion in non group

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13
Q

What are some issues with quality

A

-focus on treatment not prevention
-poorer outcomes than other western countries
-fee for services basis drives overutilization

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14
Q

fee for service drives what

A

over-utilization

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15
Q

What are the 5 fundamentals of ACA

A
  1. shared responsibility payment (individual mandate)
  2. medicaid expansion
  3. insurance exchanges and subsidies
  4. 10 required essential benefits
  5. revenue to pay for it
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16
Q

What is the individual mandate with the ACA

A

most often satisfied by
-employer-sponsored insurance
-individual insurance plan through health insurance exchanges
-government sponsored coverage medicaid or medicare

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17
Q

The individual mandate was suppose to be controled by who and prevent what

A

suppose to be controlled by the IRS but it didnt happen
to prevent the death spiral where young healthy people are not insured

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18
Q

What did the trump administration do in relation to the individual mandate

A

eliminated the fine for not complying with individual mandate

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19
Q

What is the employer mandate

A

> 50 employees, employer that does not offer health coverage will be fined 2,000$ per full-time employee

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20
Q

Employer must pay at least _____ of the cost associated with purchasing plan

A

60%

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21
Q

an employer >200 employees must automatically enroll employees in employer sponsoredplan

A

true

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22
Q

Prior to the ACA states were required to cover certain individuals if they participated in the medicaid program but this excluded what group

A

non disabled, non-pregnant adults without dependent children

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23
Q

What group was included in the medicaid expansion

A

non disabled, non pregnant adults without dependent children

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24
Q

Who funded the medicaid expansion

A

fed government funds 100% of expansion for first 3 years and then 90% after

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25
Q

Why did some states not chose to expand medicaid

A

some political
some financial

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26
Q

With the ACA was it optional for states to have a health care exchange?

A

no

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27
Q

What are 3 options for the states for running the exchange?

A
  1. design/run your own with help from federal grants
  2. sate and federal gov work together on designing and running exchange
  3. federal government runs it for you
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28
Q

does the exchange have a standard language

A

yes info allowed for comparison

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29
Q

does the exchange have a tiered system

A

yes bronze, silver, gold

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30
Q

What changed with ACA and guaranteed issue

A

-eliminates pre-existing condition exclusion
-eliminates option of rescission

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31
Q

What does the ACA allow 3:1 rating variation based off of

A
  1. age
  2. geographic area
  3. tabacco use
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32
Q

What changed with ACA limits

A

eliminates lifetime limits
severely restricts annual limits

33
Q

What are the 10 essential benefits

A
  1. ambulatory care
  2. emergency service
  3. inpatient hospitalization
  4. maternity and newborn care
  5. mental health and substance use disorder services
  6. prescription drugs
  7. rehab services
  8. lab services
  9. preventative and wellness services
  10. pediatric services: includes dental and vision care
34
Q

What is the biggest issue with cost of ACA

A

cost control

35
Q

known reasons for high cost under ACA

A
  1. essential benefits in exchange- eliminates junk plans
  2. uninsured people can now buy insurance in the exchange
  3. pre-existing conditions covered
  4. no lifetime or very limited annual max
  5. no cost sharing for basic prevention
36
Q

How did medicare reform impact quality?

A

payment reduction to hospital if those hospitals have too many preventable hospital readmissions

hospital value based program to pay hospitals according to pt satisfaction

37
Q

How did medicare reform impact access

A

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

38
Q

ACA extended coverage for young adults to stay on the policy until what age

A

26

39
Q

aca requires that all new health plans offer ____ prevention benefits

A

free

40
Q

medicare receive a free annual wellness visit

A

true

41
Q

aca also made it so fast food and vending machine companies are required to disclose the nutritional content of each food item

A

true

42
Q

After the ACA was implemented what happened to the rate of uninsured non-elderly

A

drop in uninsured rate to 10%

43
Q

why are americans so unhealthy?

A
  1. health systems
  2. health behaviors
    3.social and economic conditions
  3. physical environments
44
Q

Underinsured

A

extreme out of pocket cost that people are unable to pay if they do get hurt or sick

45
Q

Compared to other countries where does out money in terms of healthcare spending?

A

inpatient/outpatient
prescription drugs
administrative cost
preventative

46
Q

what one area does US not spend as much compared to other countries

A

long term care

47
Q

Republicans focus on what in terms of health care

A

lowering taxes
shifting responsibility for health care from the federal gov to states

opposed the ACA

48
Q

Democrates have done what for health care reform

A

passed the ACA in 2010

49
Q

Describe medicare for all

A

universal health care
private insurance would not exists
could lower GDP spent on HC because it would get rid of administrative costs

50
Q

medicare for all would have _____ cost sharing but _____ would go up

A

medicare for all would have very little cost sharing but taxes would go up

51
Q

Do hospitals want medicare for all?

A

no because private payers pay hospitals about 100% mire than medicare

52
Q

medicare for all is termed socialized medicine

A

no it is more accurately described as single payer similar to canadas system

53
Q

What is the public option health plan?

A

health plan created by the gov to offer consumers a high-value, affordable alternative to fully private plans

54
Q

What is bidencare: public option

A

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

55
Q

Has biden done anything for bidencare/

A

no

56
Q

Would bidencare have cost sharing and premiums?

A

yes

57
Q

price in colorado public option

A

what hospitals charge, generally represented as revenue per patient

58
Q

cost in colorado public option

A

how much the hospital spend to operate and provide care for patients and is represented by hospital-only operating expense

59
Q

are colorado hospitals making a profit/

A

yes 2nd highest profit in the nation

60
Q

What is the best way to describe the colorado public option

A

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

61
Q

What does the colorado public option most similiarily represent

A

medicare advantage part c

62
Q

do hospitals in colorado have to take the colorado option

A

yes

63
Q

Does the colorado option have standardizes benefits

A

yes

64
Q

What does colorado project the colorado option will do to premiums

A

lower premium by 14% because the more competition will create a lower cost

65
Q

Is there a waiver for the colorado option that offers a subside who are ineligible for ACA

A

yes if someone has low income and has lots of kids they can enroll in a waiver for a subsidie

66
Q

what has biden done for health care reform

A

stoped trumps guidence to encourage states to require medicaid enrollees to work, volunteer or attend school

67
Q

What is the CMS innovation 2021 comprehensive strategy

A

focus on the total cost of care moedel and embrace advanced primary care and affords very little attention to specialty and episodic models

68
Q

Biden administration may give states more flexibility and strengthen the safety net improve affordability

A

true

69
Q

ACA is now a decade old and what has changed?

A

not much despite coverage and quality efforts UC HC costs are still growing

70
Q

Progressive tax

A

tax rate increases as income increases increasing burden on higher wage earners Ex: income tax

71
Q

regressive tax

A

tax rate burdens lower wage earners more than higher wage earners
ex: sales tax

72
Q

Flat tax

A

burden is the same across all individuals

73
Q

Political Cost

A

how hard would it be to get to make this happen in today’s current political environment

74
Q

economic cost

A

the net impact of the system design in overall cost for healthcare

75
Q

Efficiency Cost

A

how complicated is the health care system in terms of paperwork, administrative structure, regulatory review

76
Q

Preventative care what model

A
  1. medical home
  2. accountable care organizations
  3. bundled payments
77
Q

care of major acute episodes

A

both bundled and ACO
ex: total joint replacements and MI

78
Q

care of minor acute episodes

A

medical homes

79
Q

care of chronic conditions

A

medical homes because of team based decision making on going management of health conditions

Health Care Delivery (19 decks)

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