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Health Care systems And Policies > Healthcare Reform with Special Reference to the Affordable Care Act (IRAT, exam 2) > Flashcards

Healthcare Reform with Special Reference to the Affordable Care Act (IRAT, exam 2) Flashcards

1
Q

1946

A

First proclaimed in the WHO constitution: standard of health is a fundamental right of every human

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2
Q

1948

A

Universal Declaration of Human Rights

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3
Q

1966

A

International Covenant on Economic, Social & Cultural Rights (ICESCR)

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4
Q

ICESCR is recognized globally as

A

the key instrument for the protection of the Right to Health

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5
Q

ICESCR recognizes

A

the right of everyone to the enjoyment of the highest attainable standard of physical and mental health

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6
Q

how many parties does ICESCR have globally?

A

172

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7
Q

The Right to Health has been incorporated…

A

in many other international & regional human rights treatises and many national constitutions

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8
Q

1977

A

U.S. President Jimmy Carter signed the ICESCR resolution but the U.S. Congress has not yet officially ratified it

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9
Q

is U.S. a party to ICESCR?

A

no!
the only industrialized member of the United Nations that has not done so

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10
Q

right to health is

A

an inclusive right

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11
Q

right to health includes

A

access to healthcare & attention to social and environmental factors (social determinants of health)

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12
Q

examples of social determinants of health

A

Safe drinking water; adequate sanitation
Safe food plus adequate nutrition
Adequate housing
Healthy working & environmental conditions
Health-related education & information
Gender equity

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13
Q

The Right to Health Provision Covers (7)

A
  • Equal access to the highest level of health
  • Right to disease prevention, treatment, and control
  • Access to essential medicines
  • Maternal, child, and reproductive health
  • Equal, timely access to basic health services
  • Health education and information
  • Participation in health-related decision-making
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14
Q

essential medicines

A

are those that satisfy the priority healthcare needs of the population

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15
Q

priority is determined by

A

each country on the basis of current & future public health relevance

ie in relation to national disease prevalence

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16
Q

is what we constitute as an “essential medicine” in Ghana may be regarded as such in the US?

A

no!

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17
Q

The enjoyment of the highest attainable standard of health is

A

fundamental right of every human without any distinctions

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18
Q

everyone has a right to

A

a standard of living adequate for the health and well-being, social services, circumstances beyond his control

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19
Q

health and well-being include

A

food, clothing, housing and medical care

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20
Q

does everyone have a right to circumstances beyond his control (lack of livelihood)?

A

yes

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21
Q

Why is global health important for peace and security?

A

It relies on full cooperation of individuals and states

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22
Q

Government responsibility for health

A

Providing adequate health and social measures

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23
Q

U.S. Constitution on health care

A

It does not explicitly mention health or medical care and does not require governments to pay for medical expenses

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24
Q

Right to Health vs. Right to Health Care

A

The Right to Health is distinct from the Right to Health Care

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25
Q

Healthcare as a fundamental right in the U.S

A

The Supreme Court has not elevated healthcare to a fundamental right

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26
Q

Government obligations for persons under control (e.g., prisoners)

A

Entitled to adequate food, clothing, shelter, and medical care under the Eighth Amendment

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27
Q

U.S. Constitutional framers’ focus on government

A

They prioritized freedom from government over providing rights to services like healthcare

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28
Q

Proposals for healthcare rights in the U.S. Constitution

A

-F.D. Roosevelt’s “Second Bill of Rights” for adequate medical care
-Jessie Jackson Jr.’s amendment for the Right to Healthcare

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29
Q

since 1944

A

F.D. Roosevelt’s “Second Bill of Rights” for adequate medical care and achievement &enjoyment of good health

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30
Q

since Feb 2011

A

Jessie Jackson Jr.’s amendment for the Right to Healthcare

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31
Q

Article 1, Section 8, Clause 1 of the Constitution grants Congress

A

the “Taxing & Spending Power” to lay and collect taxes for the general welfare of the United States

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32
Q

Congressional power to regulate trade and commerce includes

A

regulating insurance companies and trade across state lines

33
Q

Major characteristics of the U.S. healthcare system (a lot :/)

A

-Complex, fragmented, and multiple sub-systems with no central governing agency.
-Difficult for patients to navigate
-technology-driven.
-Defensive medicine due to lawsuit fears
-high costs.
-Access to routine care primarily for those with insurance
-focus on acute care over preventive care
-Financing: 55% private funds, 45% public funds
-includes 5,700 hospitals, 15,900 nursing homes, and 11,000 home health care agencies and hospices
-Over 14 million people are employed
-Approximately 1,000 health insurance companies offer multiple coverage plans, with Blue Cross/Blue Shield providing around 70 different plans

34
Q

Characteristics of healthcare systems in other developed countries

A

Most have a unitary system with central government control, funded mostly by taxes, providing universal access to basic health services

35
Q

Approximately 17.1% of nonelderly people were uninsured as of late 2013 due to (5)

A

-High costs
-Lack of employer coverage
-Job loss
-Being self-employed
-Ineligibility for public health insurance

36
Q

reasons being uninsured (6)

A

-prefer to pay penalty
-don’t know how to get it
-immigration status
-told they were ineligible
-not eligible at work/unemployed
-don’t know/refused

37
Q

The uninsured are less likely to have (2)

A

-Usual access to care
-Access to proven preventive services

have implications for the overall cost of care

38
Q

The uninsured are more likely to (3)

A

-Use the emergency room for needed care
-Present late with medical conditions
-Go without needed health services

have implications for the overall cost of care

39
Q

Survey results from the Kaiser Family Foundation (KFF)

A

highlight the healthcare-related challenges faced by Americans

40
Q

People worried about… (medical stuff) (4)

A

unexpected medical bills
-health insurance deductible
-prescription drug costs
-monthly health insurance premium

41
Q

it is difficult for insured people to afford (3)

A
  • co-pays for doctor visits and drugs
    -cost of insurance
    -deductible paid before insurance kicked in
42
Q

percent who say it is difficult to afford the cost of prescription medicine

A

24%

43
Q

half of adults do not report putting off care due to costs: true or false?

A

false - they report it

44
Q

some say their conditions got worse as a result of skipping care: true or false?

A

true

45
Q

three in ten say they haven’t taken their medicine as prescribed due to costs: true or false?

A

true

46
Q

did not take as directed: 29% (3)

A

-not filled a prescription
-taken OTC drug instead
-cut pills in half or skipped doses

47
Q

about one in six say they have not put off vaccines to pay medical bills: true or false?

A

false - they put off vaccines

48
Q

2010

A

Affordable Care Act (ACA)

49
Q

Goals of the Patient Protection and Affordable Care Act (ACA) (3)

A

-Expand health insurance coverage
-Improve the quality of care and contain costs
-Regulate the insurance industry for better patient protections against abuse and high costs

50
Q

Key Features of the Affordable Care Act (ACA) (3)

A
  • improving quality & lowering costs
  • new consumer protections
  • access to health care
51
Q

improving quality & lowering costs include (4)

A
  • free preventive care
  • Rx discounts for seniors
  • protect against care fraud
  • small business tax credit
52
Q

new consumer protections include (2)

A
  • pre-existing conditions
    -consumer assistance
53
Q

access to health care includes (1)

A
  • health insurance marketplace
54
Q

Affordable Care Act (ACA) emphasizes (4)

A
  • benefits for women
  • young adult coverage
  • strengthening medicare
  • holding insurance companies accountable
55
Q

The ACA expands coverage by (8)

A

-Medicaid expansion for low-income adults
-Young adults can stay on parents’ plans until 26
-State and federal health insurance marketplaces
-Temporary health plans for those with pre-existing conditions
-Subsidies for adults up to 400% of FPL
-Tax credits for small businesses
-Incentives for employer coverage for early retirees
-The Individual Mandate

56
Q

The Individual Mandate under the ACA

A

starting 2014

individuals maintain minimal essential health insurance coverage or pay a shared responsibility payment to the federal government

57
Q

Exemptions include (individual mandate requirement under the ACA) (5)

A

-American Indians
-People in extreme financial hardship
-Individuals with religious objections
-Incarcerated individuals
-Undocumented immigrants

58
Q

Penalties assessed by the IRS were

A

2014: 1% of income or $95
2017: 2.5% of income or $695

59
Q

elimination of the penalties assessed by the IRS lead to

A

increased insurance premiums due to fewer healthy individuals enrolling

from 2019

60
Q

States that implemented their own Individual Mandate Penalty to stabilize insurance markets

A

Massachusetts
New Jersey
Vermont
District of Columbia

61
Q

States besides Massachusetts, New Jersey, Vermont, District of Columbia have attempted but failed to establish their own Individual Mandate Penalty: true or false

A

true

62
Q

ACA’s strategies for improving quality of care (2)

A

-Promotes care models like ACOs and Patient-Centered Medical Homes for chronic disease management
-Invests in Electronic Health Record systems for comprehensive patient information

63
Q

ACA’s strategies for containing costs (2)

A

-Supports community initiatives and public health infrastructure to prevent disease
-Ensures access to preventive care services without out-of-pocket costs

64
Q

ACA’s strategies for patient safety and reimbursement (2)

A

-Develops programs to enhance patient safety and reduce medical liability
-Reimburses providers with incentives based on performance metrics

65
Q

ACA’s drug discount initiatives for Medicare: CMS negotiates discounts for Medicare enrollees in the doughnut hole:

A

-2015: 55% for brand names, 35% for generics
-2018: 65% for brand names, 56% for generics
-Closure of the doughnut hole for brand-name drugs in 2019, generics in 2020

66
Q

ACA’s adjustments for Medicare Advantage Plans (2)

A

-Reduces excessive payments to Medicare Advantage Plans for cost-effectiveness
-Lowers Medicare expenditures by combating fraud and abuse

67
Q

Limits on the portion of premiums health insurance companies can

A

allocate for administrative overhead, ensuring more funds go toward patient care

ACA’s strategies for protecting patients from health insurance abuses

68
Q

ACA’s strategies for reviewing premiums

A

Supports states in reviewing health insurance premiums and preventing unreasonable increases

69
Q

ACA’s Patient’s Bill of Rights

A

Issues a Patient’s Bill of Rights to protect patients from abuses by the health insurance industry

70
Q

Before implementation of ACA (8)

A

-Annual and lifetime limits on coverage
-Excluded pre-existing conditions
-possible retroactive cancellations
-Higher uninsured rates among young adults
-Limited or no preventive service coverage
-Specialist access required primary care referrals
-Internal appeals for denied services
-reliance on insurers for information

71
Q

After Implementation of ACA (8)

A

-Annual and lifetime limits eliminated
-No denials for children with pre-existing conditions; protections extended to all ages
-Coverage can only be canceled for fraud
-Dependents can stay on parents’ plans until 26
-Preventive services covered without cost-sharing
-Direct access to pediatricians and OB-GYNs without referrals
-Internal and external appeals allowed for denied services
-www.Healthcare.gov for insurance information and options

72
Q

Constitutionality of the ACA (5)

A

-26 states challenged the ACA’s Individual Mandate and Medicaid expansion
-Mandate upheld as a tax; surcharge set to $0 in 2019
-States can opt to expand Medicaid without losing funding
-ACA includes consumer protections via the Patient’s Bill of Rights
-Some states maintain penalties for the uninsured

73
Q

states that maintain penalties for the uninsured

A

Massachusetts
New Jersey
California
Rhode Island

74
Q

Federal Tax Credits under ACA (4)

A

-ACA offers federal tax credits for insurance through state marketplaces.
-16 states have their own; 6.4 million use the federal marketplace.
-Supreme Court (2015) upheld credits nationwide, supporting ACA’s goals.
-Obama declared ACA a right for all Americans.

75
Q

ACA Implementation Results (2014 & Beyond) (4)

A

-23M gained insurance
-8M covered through Medicaid expansion
-Seniors saved $10M on prescriptions
-Premium growth slowed but rose in 2019 after penalty repeal

76
Q

23M gained insurance (ACA Implementation Result) (3)

A

-8M via exchanges
-7.8M on parents’ plans
-5M direct purchases

77
Q

Latest Developments in the ACA (4)

A

-IRS surcharge for Individual Mandate eliminated (Jan 2019).
-2018 lawsuit by 18 states (led by Texas) to strike down ACA.
-27 states (led by California) currently defending the ACA.
-Supreme Court decision pending.

78
Q

Public Opinion Polls on the ACA (3)

A

-55% of Americans view the ACA positively; 38% negatively.
-Persistent partisan divide in opinions.
-Misinformation and lack of understanding of key provisions are issues.

79
Q

Current Uninsured in the U.S. (5)

A
  • 10.9% uninsured in 2019; 8.5% in 2018.
  • Largest drop among low-income adults and Hispanics since 2013.
    -48% of uninsured adults cite high costs; others lack employer coverage.
    -Most uninsured are poor adults, especially in non-Medicaid expansion states.
    -Undocumented immigrants are ineligible for marketplace or Medicaid coverage.

Health Care systems And Policies (8 decks)

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