week 3

Question 1

what is “health care reform”

Answer 1

pt protection and affordable care act
signed into law march 23, 2010

Question 2

in general,
democrats and republicans support what

Answer 2

democrats support more governmental involvement in HC and more controls on markets

republicans believe in less governmental involvment and more market driven reforms

Question 3

what were some big issues when ACA was passed

Answer 3

• out of control costs
• high # of uninsured
• higher number of underinsured
• risking premiums/deductibles
• underwriting (pre existing condition exclusions and rescission)

Question 4

what are fundamental issues in the heathcare system

Answer 4

• access
• quality
• cost

Question 5

what does access mean

Answer 5

Question 6

what does quality mean

Answer 6

Question 7

what does cost mean

Answer 7

Question 8

what are the 5 fundamentals of ACA

Answer 8

1. shared responsibility paymetn (ind mandate)
2. medcaid expansion
3. insurance exchange and subsidies
4. 10 required essential benefits
5. revenue to pay for it

Question 9

individual mandate

Answer 9

Question 10

explain the death spiral

Answer 10

Question 11

explain the employer mandate

Answer 11

Question 12

what is the min coverage for the emplyer mandate

Answer 12

Question 13

what are some reasons why states did not chose to expand medicaid

Answer 13

Question 14

prior to the ACA, medicaid excluded who

Answer 14

Question 15

what are the choices for running health insurance/market?

Answer 15

• design/run your own with help of federal grants
• state and federal gvt work togetehr on designing and running exchange
• federal gvt runs it for you

Question 16

requirements for exchange design

Answer 16

• Standard language/information to allow comparison
• Comparison of plans based on price, benefits, and other features
• Tiered: lowest to highest as bronze, silver, gold, platinum
• Some plans are divided geographically (e.g. must live/work in Denver to purchase plan through Denver Health Insurance Plan)

Question 17

what does guaranteed issue eliminate and what does it limit

Answer 17

• pre existing condition
• rescission

allows for 3:1 rating variation based on
- age
- geographic area
- tobacco use

coverage limits:
- eliminates lifetime limts
- severly restricts annual limits
- in and out exchanges

Question 18

what are the 10 min required essential benefits

Answer 18

1. ambulatory (outpatient) care
2. emergency services
3. inpatient hospitlization
4. maternity and newborn care
5. mental health and substance use disorder service
6. RX drugs
7. rehab and habilitative services
8. lab services
9. preventative and wellness services; chronic disease tx
10. pediatric services (dental care and vision for kids)

Question 19

universally, what is thought to be the biggest issue

Answer 19

cost control

Question 20

what are known reaons for high costs (esp premiums) under ACA

Answer 20

• essential health benefits in exchange
• who buys in the exchange
• pre-existing conditions coverage
• no life time and very limited annual maximums
• no cost sharing for basic prevention

Question 21

whats the goal for medicare reforms

Answer 21

Goal: help to improve quality of care for seniors as hospitals would be more likely to find ways to help individuals stay well after a hospital discharge.

Question 22

how has access changed from the reforms

Answer 22

• increasing the number of PCP
• community health centers
• extension of coverage for young adults
• PCP/general surgeon payments (medicare payment bonus of 10% to PCP and general surgeons practicing in areas with sig shortage of physcians)
• medicaid reforms (increase payments to primary care drs- family physicians, internal med, peds)

Question 23

how has prevention changed with the refrom?

Answer 23

• free preventio benefits
• free prevention and wellness visits in medicine

chain resturants and vending machine co requires to disclose the nutritional content of each food

Question 24

healthcare before the ACA included what

Answer 24

• deductibles
• premiums
• cost sharing
• underinsured population
• uninsured population

Question 25

underinsurance

Answer 25

Question 26

republicans have focused on

Answer 26

Question 27

democrats have focused on

Answer 27

Question 28

medicare for all =

Answer 28

bernie sanders no premiums or deductibles cost savings largely would depend o how much providers would be paid currently private payers pay hospitals 100% more than medicare and physicans 43% more. (resistance from HC industry not to mention from insurance co) providors would still overwhelmingly be private so "socialized medicine" is a misnomer **called "SINGLE PAYER" and most similar to canadas system**

Question 29

what is a "public option health plan"

Answer 29

refers to a health plan created by the government to offer consumers a high value, affordable alternative to fully provate plans. traditionally, "public option" has referred to publicily funded plans that may or may not rely on provate entitites to provide some administrative functions more recently, the phase has been applied to privatelty funded plands established pursuant to a state law and subject to certain heightened requirments meant to improve value and advance state goals, like cost containment. washington nevada colorado fall in this latter category

Question 30

Bidencare

Answer 30

would have premiums and cost sharing was opposed by many in the HC industry and by insurers he proposed expanding number of individuas covered by insurance by: - lowering age of medicare to 60 - increasing premium subsidies on the ACA exchange

Question 31

price: cost: profit:

Answer 31

price: cost + profit; hospitals charged cost: hospitals spend profit: difference between the two

Question 32

what is behind making CO hospitals shoulder some of the burden of the public option

Answer 32

Question 33

public private partnerships

Answer 33

states contract with private companies to create new insurance options to be overseen by but NOT run by the governement has structural similarities to medicare part c

Question 34

colorado public option law

Answer 34

Question 35

colorado projects that the colorado option will ____

Answer 35

Question 36

inflation reduction act

Answer 36

Question 37

CMS inovation takeaways

Answer 37

- overreaching goal to having all traditional medicare beneficiaries and most medicaid beneficiiaries in an accountable care relationship by 2030 - health equity - stratgegy centers on total cost of care models and embraces adv primary care and affords very little attention to speciality episodic models

Question 38

progressive tax: regressive tax: flat (proportional) tax:

Answer 38

progressive tax: tax rate increases as income increases, increasing burden on higher wage earners (normal taxes) regressive tax: tax rate burdens lower wage earners more than higher wage earners (ex: ) flat (proportional) tax: burden is the same across all individuals

Question 39

political cost: economic cost: efficiency cost:

Answer 39

political cost: how hard would it be to get to make this happenin todays current poltical enviroment economic cost: the net impact of the system design in overall cost for healthcare efficiency cost: how complicated is the HC system in terms of paperwork, admin structure, regulatory review

Question 40

Answer 40

**preventative care = all 3 models** medical homes: chronic care conditions, careof minor acute episodes IF the person is already established within the medical home ACO: care of major acute; bundled payments: care of major acute;