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Healthcare Delivery- JD > Lec 13 - Health Care Reform Basics > Flashcards

Lec 13 - Health Care Reform Basics Flashcards

1
Q

The 2010 Health Care Reform includes:

A

The patient protection and ACA

The reconciliation act of 2010

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2
Q

The 2010 health care reform: Coverage: 32 million Americans presently ____________ for 95% coverage

A

Uninsured

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3
Q

2010 Health Care Reform: Cost: 940 billion dollars over _______ years

A

10

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4
Q

What 4 things led to the new law?

A

Cost of insurance - access
Cost of health care
Access - preexisting conditions
Lifetime limit on benefit

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5
Q 
Overall approach to increasing coverage:
\_\_\_\_\_\_\_\_\_ mandate
\_\_\_\_\_\_\_\_\_ requirements
Expansion of \_\_\_\_\_\_\_\_\_\_\_ programs
Premium and \_\_\_\_\_\_\_\_\_\_\_\_\_ subsidies to individuals
Premium subsidies to \_\_\_\_\_\_\_\_\_\_
Cost sharing \_\_\_\_\_\_\_\_\_\_ for payers ***
A 
Individual
Employer
Public
Cost-sharing
Employers
Reductions
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6
Q

What were 3 concerns about the new law?

A

Complexity
Cost
Mandate

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7
Q

What are the 3 overarching goals of health care reform?

A

Access to insurance

Improved coverage/benefits

Improved quality and cost reduction

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8
Q

Estimated Effect of HCR in 2019? What will stay the same?

A

Medicare

Employer Sponsored

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9
Q

Estimated Effect of HCR in 2019? What will increase?

A

Medicaid/SCHIP

Individual coverage

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10
Q

Estimated Effect of HCR in 2019? What will go down?

A

Uninsured

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11
Q

Essential Health Benefits: Packing of benefits that assure certain health plans offered in the state ______ ______ ________ provide a _______ of coverage, benefits, and services to their ___________

A

Health Insurance Exchanges

Baseline

Enrollees

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12
Q

T/F: Is this an essential health benefit?:

Ambulatory patient services?

A

T

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13
Q

T/F: Is this an essential health benefit?: Emergency services?

A

Yes

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14
Q

T/F: Is this an essential health benefit?: Hospitalization

A

Yes

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15
Q

T/F: Is this an essential health benefit?: Maternity and toddler care?

A

F; maternity and newborn

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16
Q

T/F: Is this an essential health benefit?: Mental health and substance use disorder services, including behavioral health treatment

A

True

17
Q

T/F: Is this an essential health benefit?: Over the counter drugs

A

F, prescription

18
Q

T/F: Is this an essential health benefit?: Rehabilitative and habilitative services and devices

A

T

19
Q

T/F: Is this an essential health benefit?: Lab services

A

Yes

20
Q

T/F: Is this an essential health benefit?: Preventive and wellness services and chronic disease management

A

T

21
Q

T/F: Is this an essential health benefit?: Pediatric services, including oral and auditory care?

A

F, oral and vision

22
Q

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

A

Price
Quality
Services

23
Q

Health Insurance Marketplaces: What is the primary purpose?

A

To ENHANCE competition in the health insurance market
Improve CHOICE of affordable health insurance
Give small business the same purchasing clout as large business

24
Q

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)

A

The individual mandate

The Medicaid expansion

25
Q

Was the individual mandate upheld?

A

YES

26
Q

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 ____________

A

Consent

Non-compliance

27
Q

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 ____

A

Medicaid

ACA

28
Q

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.

A

Health insurance coverage

29
Q

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

A

Employer sponsored
Exchanges
Grandfathered
Government

30
Q

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

A

Qualified
Premium
Qualifying

31
Q

Update individual mandate: if individual mandate not met = _________ responsibility payment (financial ____)

A

Shared

Penalty

32
Q

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

A

100

90

33
Q

Medicaid expansion: Benefit package for the newly eligible Medicaid population must include the ____ _____ __________ of _______ _______ ______

A

ACA ten categories

Essential health benefits

34
Q

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.

A

Optional

Withheld

35
Q

How many states have adopted Medicaid expansion?

A

33

36
Q

NJ Medicaid expansion: The _____ _____ ______ offering health coverage in NJ beginning in 2014

A

Federally-facilitated marketplace (FFM)

37
Q

NJ Medicaid Expansion: NJ expanded Medicaid coverage to _____ ______ adults effective 1/1/14

A

Low income

38
Q

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

A 
Implementation
Upheld
States
Congress
House and senate

Healthcare Delivery- JD (12 decks)

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