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Health Care Delivery (Wk5)

How many uninsured people state and nationwide? Who is included in this statistic?

7 1/2 million in california and ~50 million nationwide. However, this includes illegal aliens, self-employers who choose not to ensure, and others who qualify for public health programs but do not (amont other groups)

Health Care Delivery (Wk5)

What are the risks for the uninsured population?

(1)Many private providers will not accept them (2)Difficult to find medical home or usual source of care (3)Some are considered uninsurable due to pre-existing conditions, but cannot qualify for Medicaid (4)Cannot afford full cost of visits.

This can lead to medical bankruptcies and foreclosures. There is some evidence that cost-shifting has resulted in the uninsured being billed for full charge, even higher than commercially insured patients. Delays in care lead to ER visits (EMTALA)

Health Care Delivery (Wk5)

What is EMTALA?

The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions.

Health Care Delivery (Wk5)

Being uninsured leads to increases in which behaviors for population?

(1) postpoining care due to cost (2)Not filling Rx or skipped doses (3)Do not get recommended treatment, followups etc

Health Care Delivery (Wk5)

Health Insurance Coverage Statistics: Where does it come from (%)?

Health Care Delivery (Wk5)

How does unemployment affect #s of uninsured and medicaid (nationally)?

1% increase leads to --> (1) 1.1 million more uninsured (2) 1 million increased medicaid enrollment. (3) $3.4 billion increased. medicaid spending for Fed and State gov.

1% increase in unemployment also correlates with 3-4% tax revenue decrease (so even less money for health spending)

Health Care Delivery (Wk5)

What is Medicaid?

Created as part of Social Security Act in 1965. Medicaid=Medi-cal, "welfare program" - Designed for needy people who are categorically eligible (need based). Medicaid is (1) State-Fed partnership State runs program within federal guidlines. (2)Regulated by CMS (Centers for medicare and medicaid services). (3) Medicaid is an entitlement program, its inclusion in the federal budget is guaranteed through mandatory spending

Health Care Delivery (Wk5)

what is Medicare?

“social insurance” Designed for people with disabilities or the elderly who meet specific requirements, lifetime benefit. Medicare requires you to have first been employed and paid dues for 40 quarters (10 years) before you are eligible. Together with medicaid it represents almost 1/2 of all health care expenditure!

Health Care Delivery (Wk5)

Focus issues of ACA?

Improve Access (1)Incentives to purchase insurance Increased regulation of insurance products (2)Added funding and training for primary care Reassignment of unused specialty residency slots (3)Expanded access to Medicaid 100% federal matching funds for state programs (2014-16) (4)Added funding for Community Health Centers (5)Additional services and delivery sites

Health Care Delivery (Wk5)

What is "Gauranteed Issue Coverage"?

Under ACA, all new health plans must be gauranteed issue (by 2014). This means no exclusions due to preexisting conditions. Also no Medical (individual) underwriting or rescissions

Health Care Delivery (Wk5)

What is the "individual mandate" clause in ACA and what are its implications?

Individuals are required to purchase health insurance by the federal government. Not purchasing=adverse effects (fines). Potential for "free-rider" phenomenon (bc of gauranteed issue people could wait until they were really sick to get insurace). Opponents to mandate question this laws constitutionality (requiring citizens to purchase something)

Health Care Delivery (Wk5)

What is a Health Insurance Exchange?

State-based marketplaces for uninsured individuals and small group (SHOP) purchasers. This is a big thrust of the ACA. No public option, but health insurers can compete in each state or regional market. Subisdies are available for individual purchasers on a sliding scale.

Health Care Delivery (Wk5)

How will medicaid expand as a result of ACA?

Still income based eligibility but now anyone under 138% of the federal poverty line and a legal citizen, or legal resident for the paste 5 years will be eligible. This will lead to SIGNIFICANT medicaid expansion in most states

Health Care Delivery (Wk5)

Implementation of the ACA depends on (2) things:

(1)State laws created in response to the ACA (2) Federal Agencies rulemaking processes

Health Care Delivery (Wk5)

State lawsuits over ACA: why?

Claiming that the federal government is overstepping their bounds throught the individual mandate (Interstate Commerce Clause in Constitution) . Insurance companies are for individual mandate. Almost have of states have sued over the issue. Court rulings have been split and the issue is sure to end up in the supreme court

Health Care Delivery (Wk5)

Unaddressed issues in ACA (2)

(1) undocumented workers (2) shortage of PCPs


Have you ever seen a picture of Helen Keller's parents?

neither has she...