Exam #3: Political Activism Flashcards Preview

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Flashcards in Exam #3: Political Activism Deck (42):

Cost of Healthcare

National Health Expenditure
--2.8 trillion dollars in 2012
--17.2% of GDP


National Health Expenditures by Category (2011)

Hospital care: 31.5%
Nursing home facilities and continuing care retirement communities: 5.5%
Physician and clinical services: 20.0%
Prescription drugs: 9.7%


Who pays for healthcare?

Employee insurance


Private vs. Public

Households: 28%
Fed. Govn't: 26%
Private Businesses: 21%
State and Local: 18%
Private Revenues: 7%


Distribution of Costs

10% of population accounts for 63% of all healthcare spending

1% of population accounts for 21% of all healthcare spending

50% of population accounts for 3% of all healthcare spending

40% of Medicare Costs occur in last month of life


Federal Agencies: Department of Health and Human Services

Public Health Service
Center for Medicare and Medicaid services (formerly Health Care Financing Administration)
Administration for Children and Families
Administration of Aging
Office for Civil Rights


Agencies under Public Heath Service

Agency for Health Care Research and Quality
National Institutes of Heath (NIH)
Health Resources and Services Administration (HRSA)
Indian Health Services
Substance for Abuse and Mental Health Services
Agency for Toxic Substances and Disease Registry


Social Security

In 1935, Social Security Act

--Old Age and Survivor's Insurance
--Unemployment compensation
--Disability Insurance


When was Social Security formed?



Old Age and Survivor's Insurance

Provides monies to workers or family upon retirement, disability, or death
2 companies: Social Security and Disability

Federal Insurance Contributions Act (FICA)
--FICA rate (2014)
-->7.65% up to max of $117,000
-->self-employed 15.3%

In 2014, benefits sent to 55 million

Amount based on average earnings and length of employment
Retirement age: 62 with partial benefits
--trending to be 67 before you can receive full benefits
3% contributing to 1% receiving SS


In 2014, SS benefits were sent to how many million?

55 million


Disability Insurance

8 million receiving benefits
--around 70% of people are denied Disability Insurance (years of abuse of the program have led to strict Fed. regulations on who can receive it)

--covered by social security 5-10 years
--physical or mental disability
--unable to work

5 month waiting period
Paid to worker or dependents


Unemployment Insurance

Protect workers out of work through no fault of their own
Governed by states
--no work for > 1 week
--able to work and take job
--previous job ended through no fault

Do not have health insurance when collecting unemployment insurance


Supplemental Security Income (SSI)

Provides direct cash benefits to aged or disabled with decreased income
Amount based on need, not on contributions made throughout your lifetime

Somewhere between $400-$600/month
--however if that parson is receiving food stamps from SSI they need to subtract that amount
--so they're usually earning about $100-$200/month

Sent out to 5 million people per year



Established in 1965
Funds 20% of all health services
Provides health insurance to citizen or permanent residents over 65 who have worked at least 10 years (Part A)

Can purchase Supplemental Insurance (Part B) for additional cost


Medicare Part A

Hospital room fee is covered
Deductive is $1216 per benefit period (2014)
Will pay some nursing home costs
Hospice care is covered for 210 days
Home health services


When are most Americans automatically enrolled in Medicare Part A?

Once they turn 65


Medicare Part B

Purchased through a private entity
After $147 deductive, Part B pays 80% of all allowable expenses (2014)
--physician services
--durable medical equipment (braces, walkers, canes...)
--outpatient services
--prescription drugs not self-administered

Cost $104.90/month (2014)


Medicare Part C

Medicare Advantage Plans
--available only in select locations
--managed-care options run by private companies
--provide a few additional services
--high plan cost paid by all members, not just those in Medicare Part C

If you have Part A, you're also paying for people to receive the extra services through Part C but you yourself are not receiving those benefits


Medicare Part D

Prescription Drug Coverage
--complex regulations
--monthly fee purchased from private plans
--cost: $0-$50 per month with $310 deductible, patient pays 35% up to $2850. Then patient pays 47.5% (brand name) and 72% (generic) up to $4550 (gap, donut hole). After that, patient pays about 5% for drugs. (2014)

Going to be changing because of the Affordable Care Act



Pays or medical services for low income
Program designated by each state
Majority in managed care plans
Does not cover all poor
Major financial support for persons in nursing homes (up to 45% cost)


Medicare/Medicaid Legislation

Quality Improvement Organizations
The Health Care Quality Improvement Act


Medicare/Medicaid Legislation: Early 1980's

Drastic cuts to Medicare and Medicaid
Prospective payment system developed
Diagnostic Related Groups (DRG)


Medicare/Medicaid Legislation: Results of Prospective Payment System (PPS) - DRGs

Shorter length of stay
Increased patient acuity
Nursing home admissions increased x3
Increased demands on family, community, and home-care provider resources


Medicare/Medicaid Legislation: Past 10-20 years

Reimbursement for certified nurse-midwives, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists

Nursing home care standards
Child health


Home economic stats for 2009

46,000,000 uninsured Americans

86.7 million uninsured over past 2 years

Medical bills account for > 60% of bankruptcies

Uninsured have 40-50% higher risk of death

100,000 lives could be saved yearly with universal primary care

Family health insurance cost $13,376/year


Home Economic Stats for 2014

Approximately 30,000,000 uninsured Americans

Medical bills account for > 60% of all bankruptcies

Family health insurance cost $15,473/year


Concerns about Healthcare?

Is health care a right or a privilege?
If a right, whose jurisdiction?
Is equity of care an entitlement?
President Clinton - Health Security Act
Increasing trend to universal coverage with combination of public/private sectors


Heath Care Reform 2010

Provides coverage 32 million currently uninsured

Creates interstate health insurance exchanges

Closes Medicare part D donut hole

Expands Medicaid to 133% of poverty level ($29,327/family of four)

Insurance companies may no longer deny children coverage with preexisting conditions
--in 2014, insurance companies may no longer deny anyone coverage with preexisting conditions

Children stay on parent's plan until 26

In 2014, no lifetime limits

In 2014, everyone must purchase healthy insurance of face a $695 annual fine (low income exceptions)

Tax credits for small businesses

By 2018, all plans must cover preventative care


Paying for Healthcare Reform

In 2010, 10% tanning tax
In 2013, 3.8% investment income tax for families making > $250,000
In 2018, 40% excise tax on high-end health insurance plans > $27,500

Between 2011 and 2019
--drug companies will pay 16 billion
--insurance companies will pay 47 billion
--medical device manufacturers pay 2.9% excise tax on sale of wares

Medicare Part C reductions over 10 years
Home health care reductions over 10 years
Select cuts to hospitals by 2019


Nursing and Healthcare Costs

Difficult to determine actual cost of nursing care
About 20-28% of hospitalization costs are related to nursing care
Economic value of RN nursing care:
--decreased patient complications
--decrease length of stay
--decreased patent deaths


Managing Healthcare Costs

Be aware of costs
Provide evidence based care
Higher level degrees
Lifelong learning
Patient education


Political Professionalism in Nursing

Political activism is part of the role of a registered professional nurse
Know your legislators and how they vote on issues important to you
Contact legislators about issues
Participate in political campaigns


I don't know my legislators?

Call local board of Elections
local library


I don't know their voting record?



Legislator Influence

Interest groups
Political Action Committees (PACs)
Grassroots lobbying
--the best way to sway a legislator's vote


Writing to a Legislator

Address correctly
Identify self as nurse and constituent
Be brief and specific
Use reasoning, good sense, and facts
Include bill number, author, title, status
Use correct grammar and spelling


Political Professionalism in Nursing

Participate in organizations concerned with legislative issues
Give testimony at hearing
Participate on advisory committees
Originate and encourage specific legislation


Becoming Politically Savvy

Know your Nurse Practice Act
Join ANA
Read American Journal of Nursing
Awareness of speciality organizations legislative issues
Read newspapers or web


Nursing and Politics

Nurses becoming more politically involved

ANA and other organizations update nurses on important issues

Individual nurses are encouraged to become acquainted with legislators

Identify voting records especially health care policies and nursing issues


What are 3 parts of the Healthcare Reform 2010?

1. create interstate insurance exchanges
2. close Medicare Part D donut hole
3. expand Medicare to 133% of poverty level


How many Americans did not have health insurance in 2009?

46 million

In 2010, it increased to 52 million
In 2011, it decreased back to 46 million