Lec 13 - Health Care Reform Basics Flashcards
The 2010 Health Care Reform includes:
The patient protection and ACA
The reconciliation act of 2010
The 2010 health care reform: Coverage: 32 million Americans presently ____________ for 95% coverage
Uninsured
2010 Health Care Reform: Cost: 940 billion dollars over _______ years
10
What 4 things led to the new law?
Cost of insurance - access
Cost of health care
Access - preexisting conditions
Lifetime limit on benefit
Overall approach to increasing coverage: \_\_\_\_\_\_\_\_\_ mandate \_\_\_\_\_\_\_\_\_ requirements Expansion of \_\_\_\_\_\_\_\_\_\_\_ programs Premium and \_\_\_\_\_\_\_\_\_\_\_\_\_ subsidies to individuals Premium subsidies to \_\_\_\_\_\_\_\_\_\_ Cost sharing \_\_\_\_\_\_\_\_\_\_ for payers ***
Individual Employer Public Cost-sharing Employers Reductions
What were 3 concerns about the new law?
Complexity
Cost
Mandate
What are the 3 overarching goals of health care reform?
Access to insurance
Improved coverage/benefits
Improved quality and cost reduction
Estimated Effect of HCR in 2019? What will stay the same?
Medicare
Employer Sponsored
Estimated Effect of HCR in 2019? What will increase?
Medicaid/SCHIP
Individual coverage
Estimated Effect of HCR in 2019? What will go down?
Uninsured
Essential Health Benefits: Packing of benefits that assure certain health plans offered in the state ______ ______ ________ provide a _______ of coverage, benefits, and services to their ___________
Health Insurance Exchanges
Baseline
Enrollees
T/F: Is this an essential health benefit?:
Ambulatory patient services?
T
T/F: Is this an essential health benefit?: Emergency services?
Yes
T/F: Is this an essential health benefit?: Hospitalization
Yes
T/F: Is this an essential health benefit?: Maternity and toddler care?
F; maternity and newborn
T/F: Is this an essential health benefit?: Mental health and substance use disorder services, including behavioral health treatment
True
T/F: Is this an essential health benefit?: Over the counter drugs
F, prescription
T/F: Is this an essential health benefit?: Rehabilitative and habilitative services and devices
T
T/F: Is this an essential health benefit?: Lab services
Yes
T/F: Is this an essential health benefit?: Preventive and wellness services and chronic disease management
T
T/F: Is this an essential health benefit?: Pediatric services, including oral and auditory care?
F, oral and vision
Health insurance marketplaces: Provide competitive marketplaces for individuals and small employees to directly compare available private health insurance options on the basis of ______, ________, _________ and other factors
Price
Quality
Services
Health Insurance Marketplaces: What is the primary purpose?
To ENHANCE competition in the health insurance market
Improve CHOICE of affordable health insurance
Give small business the same purchasing clout as large business
2012 Supreme Court Decision National Federation of Independent Business v. Sibelius: Court agreed to consider the constitutionality of two major provisions of the ACA: what were they? (List)
The individual mandate
The Medicaid expansion
Was the individual mandate upheld?
YES
The Medicaid expansion - unconstitutionally coercive of states, because states did not have adequate notice to voluntarily __________; affected a state’s existing federal Medicaid funds for ____________
Consent
Non-compliance
2012 Supreme Court Decision ….: A majority found that this issue was appropriately remedied by circumscribe great the Secretary’s enforcement authority, thus leaving the _________ expansion intact in the ____
Medicaid
ACA
Update on Individual Mandate: Requires most people to maintain a minimum level of ______ ______ ______ for themselves and their tax dependents in each months beginning in 2014.
Health insurance coverage
Update individual mandate: Can be satisfied by obtaining coverage through:
______ _______ Insurance
An individual insurance plan offered through health insurance ____________.
A ___________ health plan
________ sponsored coverage such as Medicare or Medicaid, or similar federally recognized coverage
Employer sponsored
Exchanges
Grandfathered
Government
Update individual mandate: To increase access to affordable health insurance, the ACA provides for the creation of health insurance exchanges that will offer __________ health plans, as well as advance payment of ________ tax credits to people with ________ incomes
Qualified
Premium
Qualifying
Update individual mandate: if individual mandate not met = _________ responsibility payment (financial ____)
Shared
Penalty
Medicaid expansion: To fund the expansion of Medicaid coverage, federal government will cover ____% of the states’ costs of the coverage expansion in 2014-2016, gradually decreasing to ____% in 2020 and thereafter
100
90
Medicaid expansion: Benefit package for the newly eligible Medicaid population must include the ____ _____ __________ of _______ _______ ______
ACA ten categories
Essential health benefits
Medicaid expansion: Effect of the Supreme Court’s decision: Medicaid expansion _________ for states.
If states do not comply with the Medicaid expansion, only ACA Medicaid expansion funds may be ________, not all or a part of a non-compliant state’s federal funds for the rest of the Medicaid program.
Optional
Withheld
How many states have adopted Medicaid expansion?
33
NJ Medicaid expansion: The _____ _____ ______ offering health coverage in NJ beginning in 2014
Federally-facilitated marketplace (FFM)
NJ Medicaid Expansion: NJ expanded Medicaid coverage to _____ ______ adults effective 1/1/14
Low income
Current status of 2010 Law:
________ continues
Individual mandate ________ by Supreme Court in July 2012
Medicaid participation determined by _______
Shift in political balance of power in _________ (Republican majorities in ______ and ____________)
2016 Presidential election
2017 Congressional action
Implementation Upheld States Congress House and senate
