Affordable Care Act Flashcards
(22 cards)
Why did people not have insurance pre ACA?
insurance is not affordable, no need, lost job
Consequences of high rates of uninsurance
no usual source of care (preventative, as needed), postponement of care which becomes more complicated, don’t refill drugs
Affordable Care Act
passed in 2010, most of it applied in 2014, main goal was to expand health care coverage and slow down the rising cost of health care
Effects of the ACA
individual mandate to purchase insurance, end pre-exisiting prohibitions, extends coverage for young adults on parents insurance, covers preventative care and contraceptives with no cost sharing, creates marketplace for purchase of insurance, medicaid expansion
Individual mandate
required all citizens and legal residents to have health insurance or face a penalty (which no longer exists)
Why does the individual mandate exist?
the adverse selection problem
Marketplace for health insurance
government subsidies to those 400% or below of FPL, cost sharing (100-250%), incentives built in to encourage health insurance
3 legged stool
individual mandate, pre existing prohibition, and subsidies
Health insurance premium tax credits
designed to make premiums affordable for individuals and families with lower income, available until 400% FPL
Health insurance cost sharing reductions
only available to individ/families less than 250%, not available if you have insurance through a job
Employer requirements of ACA (large employers)
large employers with over 50 full time employees are required to offer a minimum level of health insurance or face a penalty
Employer requirements of ACA (small employers)
small employers are exempt but are eligible for health insurance tax credits if they provide health insurance
Tax credit
a reduction in the amount of taxes you owe
tax deduction
subtraction off your income when doing taxes
Challenges to ACA
Medicaid expansion left up to states, penalty for individual mandate struck down
Effects of ACA
number and percent of uninsured decreased, reduction in uninsurance across age, race, income, etc, improved access to care, financial security, health outcomes
The Beveridge Model
single payer national health service, health care is provided and financed by government through income taxes, care is free at point of service, similar to VA
The Bismarck Model
financed jointly by employers and employees through payroll deduction, multi-payer, most cover everyone and tight govt control limits prices, similar to ESI
The National Health Insurance Model
single payer program, private sector provides but payments made by government run insurance program that every citizen pays into, market power to negotiate lower prices, similar to Medicare
Out-of-pocket model
market driven healthcare, people who can afford medical care get it and otherwise you do not receive it, similar to the uninsured,
Ambulatory care
outpatient care
Ambulatory surgery center
go to a place for surgery and leave same day
