Notes 6 Flashcards
Older, richer, high insurance rates?
On average, MA residents are both older and richer than US population, means higher rates of health care utilization, AND High rates of insurance coverage with low out-of-pocket costs = higher spending….BUT this doesn’t account for difference between MA and US.
Academic centers?
MA residents get more of their care at academic medical centers than US, more specialists per capita than anywhere else in US…means higher costs.
MA 2012 REFORM? (6)
1) Set benchmark for total spending in MA 2) Gotta register to be a provider 3) Provide price transparency 4) Expand NP and PA scope of practice 5) Give tax credits to small business 6) Study commissions
Set benchmark for total spending in MA?
we don’t wanna spend more on health care any more than gross state product as a whole, eventually we want more SLOWLY). A commission will monitor compliance with this target (if provider is out of compliance, they gotta file correction plans to explain how they’re gonna come back into compliance.
Provide price transparency?
Gotta be able to provide price transparency to consumers (how much out of pocket/insurance? In all the hospitals?)
Expand NP and PA scope of practice?
Expands scope of practice for PAs and NPs, can go into business for themselves, can write their own shit, no longer have to be under direct supervision of docs.
Study commissions?
Sets up lots of study commissions to develop a consensus for future change: behavioral care integration, single payer pharmacy plan (to drive down prices), allowable price variations (should state set a range of allowable prices), and do something about inaccurate coding.
How does ACA expand coverage?
Expand coverage by expanding MCAID program (voluntary) and creating state health insurance exchanges, and Expands MCARE Part D
ACA Coverage is provided by? (4)
Private employer based programs, state health exchanges, state MCAID, and federal MCARE
ACA Coverage is determined by? (3)
Income, age, employment status
Insurance status of small business owners? (4) Under ACA what would these business owners take advantage of?
Largely uninsured, private insurance, small group policy, or going through spouse. They would take advantage of state health exchanges.
ACA individual mandate?
Must have qualifying coverage, if you don’t you get taxed 2.5% of income
ACA employer mandate?
50+ employee business will get fined per employee if they don’t offer coverage. Feds will subsidize small businesses with low wages.
Why is MCAID expansion voluntary?
Cuz feds said they would cover 100% for first three years, then 90% for NEW PEOPLE. Current MCAID share is 50-70. SC called it BRIBERY that was coercing states, so they made it voluntary.
ACA MCAID reimbursement?
MCAID will pay docs at least the MCARE rates.
ACA changes to private insurance? (3)
No lifetime limits to coverage, and limits on deductibles, limits waiting periods for coverage to first 90 days (I won’t pay for cancer in first 90 days of coverage)
ACA limit on deductibles?
Just like MA law, limit deductibles to 2k for individual and 4k for family.
Where is a lot of these additional MCAID funds gonna come from?
Takes a shitload of money from MCARE»_space;> MCAID.
ACA Quality enhancement? (2)
We’re going to experiment with a whole bunch of ways to improve quality … we’re going to try to pay more for better care (quality incentives), as well as to bundle payments into hospital episode, pre AND post for EPISODE of care.
ACA workforce provisions? (2)
Increase residencies, reallocate slots to PRIMARY CARE. AND expand support for nurse training, especially in shortage areas.
ACA Tax changes? (6)
Tax if you don’t get coverage, use non-health money from HSA, increase MCARE wage tax “premiums” for incomes >200k, pharma pays money just cuz, durable medical equipment pays money just cuz, tanning booths pay money just cuz.
Projected economic effect of ACA?
Cost a trillion to implement, cover that cost with new taxes, if everything goes to plan we’ll reduce the federal deficit by $124b over 10 years.
