The ACA, 2010 Flashcards
Major events leading to the Affordable Care Act (ACA), 2010: (Kominski, 2013)
Growth in managed care delivery system and “managed competition” since the 1970s (Alain Enthoven)
Promote price comparisons between Managed Care Organizations (MCOs)
Pooling small parties into Health Insurance Purchasing Cooperatives (HIPCs) & providing vouchers to low-income persons to buy HI
Failure of the Clinton Reform Act 1993/1994
(CHIP in 1997 and Medicare Modernization Act of 2003)
Significant healthcare reform in Massachusetts in 2006
Obama had a Democratic majority House and Senate
The ACA envisioned most people gaining coverage through private health insurance; Most people gained coverage through Medicaid. Why?
No more individual mandate with Tax Cuts & Jobs Act, 2017
Subsidies were limited between 2018-2020 for folks to buy private insurance from the government-run healthcare marketplace (aka exchanges)
Four different plans: platinum, gold, silver, bronze (the bronze only covered 60% of costs)
Employers with 50+ Full-time employees must cover 95%+ of workers. They got away by lowering the number of full-time employees
Consumer Protections: As of 2010, health insurance companies cannot deny insurance to people with pre-existing conditions and youth <26 covered through their parents’ insurance plans.
Under ACA, health insurance companies must offer at least these 10 essential benefits:
Maternity & Newborn Care
Hospitalization
Mental Health & Substance Use services
Rehabilitative and Habilitative services
Laboratory Services
Prescription Drugs
Ambulatory patient care (outpatient primary care)
Emergency Services
Pediatric Care (oral & vision, too)
Preventive and chronic disease management
Successes:
Consumer protections
Insurance companies cannot deny coverage to persons with pre-existing conditions
Insurance companies cannot terminate coverage to persons with high medical expenses
Insurance companies cannot discriminate on health status or gender.
Insurance had to provide a standard of benefits
Medicaid expansion reduced uninsured rates
+18-26 Adults can remain on parents’ insurance policy
Major Provisions - Access!
Non-profit hospitals need to conduct community health needs assessment (CHNAs) and develop financial assistance policies or pay a $50K tax.
Increased Federal Poverty Level (FPL) for Medicaid eligibility to at least 138% of FPL.
Medicaid coverage for childless adults 138% FPL ($17,774 annual income)
Adults (18-26 years) can continue as dependents on parents’ insurance.
People with pre-existing conditions will not be denied health insurance.
Health insurance companies cannot cancel health insurance plans, esp. for individually-insured.
No lifetime maximums of coverage
Annual Maximum out-of-pocket costs
Provides states with new options for offering home and community-based services through a Medicaid state plan (Older Adults)
Cultural challenges
Death panels & socialized medicine
Conflating Obamacare with ACA, 2010
Stigma with welfare
No specific population targeted (e.g., Medicare-elderly, CHIP-children, “identity and benefits obscured”)
Legislative challenges
Repeal and Replace 2017
Work requirements for Medicaid in some states
Tax Cuts and Jobs Act, 2017 eliminated individual tax penalty
Executive challenges
45 not funding HI subsidies
45 Department of Justice.
- supported states to reinstate discrimination to those with pre-existing conditions
SCOTUS challenges
NFIB vs. Sebelius, 2012
Burwell vs. Hobby Lobby, 2014
King vs. Burwell, 2015
TX vs. USA, 2021
