Lecture 3

Question 1

what are the 2 dimensions of universal healthcare?
which did obamacare attempt to achieve?

Answer 1

-everyone is covered
-everyone is guaranteed free services of healthcare

obamacare attempted to get everyone covered

Question 2

true or false

there are people still uninsured even after obamacare

Answer 2

true – 15-20 million are still uninsured

Question 3

WHY are there still 15-20 million americans uninsured even after the passage of obamacare?

Answer 3

the individual mandate no longer exists – was deemed unconstitutional by the supreme court

Question 4

true or false

insurers do not have to offer different levels of coverage for preexisting conditions

Answer 4

FALSE – they do. this is because of ACA

Question 5

are all private insurances regulated by the states?

Answer 5

before 2010, yes. obamacare made some private plans federal

Question 6

what are “preexisting conditions”

Answer 6

conditions that existed before changing jobs/insurance

Question 7

what was the transitional stop gap insurance before 2010?

Answer 7

COBRA

Question 8

Explain what COBRA is

Answer 8

guarantees EXACT SAME insurance coverage for those who have lost their job health coverage and are out of insurance for a LIMITED period of time

Question 9

as mentioned, COBRA is a transitional insurance that offers the same health coverage for a LIMITED time. how long is this time period?

Answer 9

18-36 months

Question 10

what is the downside of COBRA

Answer 10

it is temporary

Question 11

what is the major benefit of COBRA?

Answer 11

not only do you get insurance in a transitional period, but it is the EXACT SAME coverage as before

Question 12

are pre-existing conditions covered under COBRA

Answer 12

yes — you get the exact same benefits

Question 13

what kind of people is COBRA available to?

Answer 13

there is a limit – the previous business place of employment must have had a certain number of employees in the last year (20)

Question 14

differentiate between the premium ratings

Answer 14

experience rating and community rating

experience = dependent on health status. if you use healthcare more, it is a higher premium

community = uses GROUP rating

Question 15

most group insurance plans use experience rating or community rating to determine premiums?

Answer 15

community rating

Question 16

obamacare was an attempt at healthcare that is not ____, but ____

Answer 16

not FREE, but universal

Question 17

name 2 major upsides of what obamacare accomplished

Answer 17

1. coverage for preexisting conditions
2. subsidized healthcare purchases (MEDICAID EXPANSION)

Question 18

what does it mean that Obamacare “subsidizes healthcare purchases”

Answer 18

programs like CHIP and medicaid – financial grants. not everyone qualifies for it – only certain populations

Question 19

For states with EXPANDED MEDICAID, what is the requirement to qualify

Answer 19

must be 138% below the FPL (federal poverty level)

Question 20

as mentioned, for states with expanded medicaid, to qualify they must be 138% below the federal poverty level

is this a state guideline or a federal guideline?

Answer 20

FEDERAL

Question 21

Was obamacare designed for public or private health insurance? which is it geared more towards?

Answer 21

BOTH
geared more towards private

Question 22

explain how obamacare is geared more towards private insurance

Answer 22

-the way it reforms healthcare delivery in the private sector

Question 23

is obamacare geared more towards medicare or medicaid?

Answer 23

medicaid

Question 24

_____ has ACO’s

Answer 24

medicare

Question 25

how many states have expanded medicaid coverage?

Answer 25

41

Question 26

what happens to people who do not have insurance but do not meet the requirements for their state medicaid program?

Answer 26

obamacare's federal poverty level usually is low enough for them to qualify

Question 27

which is bigger -- ACA or COBRA

Answer 27

ACA

Question 28

Name 3 ways in which obamacare subsidizes healthcare

Answer 28

-medicaid/CHIP -reduced medicare reimbursements to healthcare providers under medicare advantage -premium tax credits -- depend on a person's income -- lowers their monthly insurance payments

Question 29

who started open enrollment? what does this mean?

Answer 29

obamacare a time period once a year 4-5 weeks when people can purchase/revise their health insurance benefits. (last chance for coverage by jan 1 is dec 15)

Question 30

what are "marketplace plans"

Answer 30

obamacare plasn

Question 31

what is a big upside that obamacare has over cobra

Answer 31

they have the 10 essential benefits -- not guaranteed under COBRA

Question 32

Can employer sponsered-plans be better than obamacare

Answer 32

yes -- could also be worseq

Question 33

true or false mental health/substance use disorder is part of the 10 essential benefits of marketplace plans

Answer 33

TRUE

Question 34

explain "emergency services" under the 10 essential marketplace benefits

Answer 34

you can get care from the closest hospital. no penalties for going to out of network hospital

Question 35

true or false pregnancy is considered the #1 preexisting condition

Answer 35

FALSE -- it used to be, but its not even considered a preexisting condition at all anymore

Question 36

rehab services and devices are a category of _____ care, and are not conventionally considered ___ care

Answer 36

custodial care, not medical care

Question 37

true or false custodial care is not conventionally considered medical care, bc it is provided by non-licensed caregivers

Answer 37

true

Question 38

obamacare offers catastrophic plans. explain what this is

Answer 38

designed for people who can't afford normal plans has very low monthly premiums but high deductibles

Question 39

of the 4 "metal" plans, which has the highest premium? which has the highest deductibles? which has the LOWEST deductibles?

Answer 39

platinum -- highest premiums but lowest deductibles (cost of care) bronze -- highest deductibles but lowest premiums

Question 40

true or false premium and deductible costs are directly proportional

Answer 40

false --- inverse as one goes up, the other goes down

Question 41

name the 4 types of marketplace plans

Answer 41

EPO -- exclusive provider organization HMO -- health maintenance organization POS -- point of service plans PPO -- preferred provider organization

Question 42

between the 4 types of marketplace plans, which is the most expensive?

Answer 42

PPO -- preferred provider organization

Question 43

between the 4 types of marketplace plans, which offers the LEAST access to facilities and networks? which offers the most access?

Answer 43

least access (most restrictive) = HMO most access (least restrictive) = PPO