Section 8/Week 8 Flashcards
What were the 3 options given to states for the creation of new, statewide programs expanding health insurance coverage to uninsured children?
- Expand the existing Medicaid program to include more children
- Establish a program separate & distinct from Medicaid to extend coverage to those children not eligible for Medicaid
- Use a combination of both Medicaid expansion and new program combination
What problems did states face in enrolling children in S-CHIP?
- Administratively difficult to understand
- Poor outreach
- Medicaid/S-CHIP fraud
How does the ACA work with improving the S-CHIP program?
- extends S-CHIP authorization through 2019
- provides funding through 2015
- provides tax subsidies for families that aren’t included in S-CHIP before enrollment caps
Doesn’t really address aforementioned problems
Who is least likely to accept insurance from their employer and why?
Low minimum wage job earners.
-Health insurance takes too much out of their paycheck.
What are 3 approaches for addressing the uninsured?
- Individual Mandate
- Employer Mandate
- S-CHIP
What are 2 ways to classify new pharmaceutical products
- Drugs of an entirely new class of therapeutic agent
2. Drugs that fall within an established class of therapeutic agents
What are the 2 types of FDA review for new drugs
- Priority review-
2. Standard review-
What percent of new drug applications approved by the FDA are for new compounds that represent a significant improvement in therapy
LESS THAN 10%
-Most new drugs are chemical modifications of existing drugs
Why was direct to consumer advertising banned by the AMA?
The AMA felt that only doctors had sufficient knowledge to judge claims put forth by pharmaceutical advertising
Arguments for direct to consumer adverstising
Marketing marginal benefits to consumers who are insensitive to cost. Patients may not be educated well enough to evaluate claims put forth by the advertising.
What is the Medicare Part D doughnut hole
The lack of drug coverage for seniors who have spent between $750 and $3,600 out of pocket.
Why is there a doughnut hole?
Because the budget for Medicare part D was capped at $400 million dollars over 10 years. Policy makers wanted to ensure the seniors most in need were covered with a high benefit.
They used what was left over from the $400 million budget to cover as much drug spending at 75% as they could, but this amount only totaled to $2,250 total during drug costs per year.
ERISA
Employee Retirement Income Security Act-which forbids states (other than Hawaii) from establishing new employer mandates despite the success of the Hawaii program
Individual Mandate
requires all people to purchase health insurance or pay a penalty “tax”
Employer Mandate
requiring all employers to provide health insurance to their regular employees and their families
