Notes 7 Flashcards

1
Q

Older, richer, high insurance rates?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Academic centers?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MA 2012 REFORM? (6)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Set benchmark for total spending in MA?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Provide price transparency?

A

Gotta be able to provide price transparency to consumers (how much out of pocket/insurance? In all the hospitals?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Expand NP and PA scope of practice?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Study commissions?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does ACA expand coverage?

A

Expand coverage by expanding MCAID program (voluntary) and creating state health insurance exchanges, and Expands MCARE Part D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ACA Coverage is provided by? (4)

A

Private employer based programs, state health exchanges, state MCAID, and federal MCARE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ACA Coverage is determined by? (3)

A

Income, age, employment status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Insurance status of small business owners? (4) Under ACA what would these business owners take advantage of?

A

Largely uninsured, private insurance, small group policy, or going through spouse. They would take advantage of state health exchanges.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ACA individual mandate?

A

Must have qualifying coverage, if you don’t you get taxed 2.5% of income

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ACA employer mandate?

A

50+ employee business will get fined per employee if they don’t offer coverage. Feds will subsidize small businesses with low wages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is MCAID expansion voluntary?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ACA MCAID reimbursement?

A

MCAID will pay docs at least the MCARE rates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ACA changes to private insurance? (3)

A

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)

20
Q

ACA limit on deductibles?

A

Just like MA law, limit deductibles to 2k for individual and 4k for family.

21
Q

Where is a lot of these additional MCAID funds gonna come from?

A

Takes a shitload of money from MCARE&raquo_space;> MCAID.

22
Q

ACA Quality enhancement? (2)

A

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.

23
Q

ACA workforce provisions? (2)

A

Increase residencies, reallocate slots to PRIMARY CARE. AND expand support for nurse training, especially in shortage areas.

24
Q

ACA Tax changes? (6)

A

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.

25
Q

Projected economic effect of ACA?

A

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.