Healthcare Reform with Special Reference to the Affordable Care Act (IRAT, exam 2) Flashcards
(79 cards)
1
Q
1946
A
First proclaimed in the WHO constitution: standard of health is a fundamental right of every human
2
Q
1948
A
Universal Declaration of Human Rights
3
Q
1966
A
International Covenant on Economic, Social & Cultural Rights (ICESCR)
4
Q
ICESCR is recognized globally as
A
the key instrument for the protection of the Right to Health
5
Q
ICESCR recognizes
A
the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
6
Q
how many parties does ICESCR have globally?
A
172
7
Q
The Right to Health has been incorporated…
A
in many other international & regional human rights treatises and many national constitutions
8
Q
1977
A
U.S. President Jimmy Carter signed the ICESCR resolution but the U.S. Congress has not yet officially ratified it
9
Q
is U.S. a party to ICESCR?
A
no!
the only industrialized member of the United Nations that has not done so
10
Q
right to health is
A
an inclusive right
11
Q
right to health includes
A
access to healthcare & attention to social and environmental factors (social determinants of health)
12
Q
examples of social determinants of health
A
Safe drinking water; adequate sanitation
Safe food plus adequate nutrition
Adequate housing
Healthy working & environmental conditions
Health-related education & information
Gender equity
13
Q
The Right to Health Provision Covers (7)
A
- Equal access to the highest level of health
- Right to disease prevention, treatment, and control
- Access to essential medicines
- Maternal, child, and reproductive health
- Equal, timely access to basic health services
- Health education and information
- Participation in health-related decision-making
14
Q
essential medicines
A
are those that satisfy the priority healthcare needs of the population
15
Q
priority is determined by
A
each country on the basis of current & future public health relevance
ie in relation to national disease prevalence
16
Q
is what we constitute as an “essential medicine” in Ghana may be regarded as such in the US?
A
no!
17
Q
The enjoyment of the highest attainable standard of health is
A
fundamental right of every human without any distinctions
18
Q
everyone has a right to
A
a standard of living adequate for the health and well-being, social services, circumstances beyond his control
19
Q
health and well-being include
A
food, clothing, housing and medical care
20
Q
does everyone have a right to circumstances beyond his control (lack of livelihood)?
A
yes
21
Q
Why is global health important for peace and security?
A
It relies on full cooperation of individuals and states
22
Q
Government responsibility for health
A
Providing adequate health and social measures
23
Q
U.S. Constitution on health care
A
It does not explicitly mention health or medical care and does not require governments to pay for medical expenses
24
Q
Right to Health vs. Right to Health Care
A
The Right to Health is distinct from the Right to Health Care
25
Healthcare as a fundamental right in the U.S
The Supreme Court has not elevated healthcare to a fundamental right
26
Government obligations for persons under control (e.g., prisoners)
Entitled to adequate food, clothing, shelter, and medical care under the Eighth Amendment
27
U.S. Constitutional framers' focus on government
They prioritized freedom from government over providing rights to services like healthcare
28
Proposals for healthcare rights in the U.S. Constitution
-F.D. Roosevelt’s “Second Bill of Rights” for adequate medical care
-Jessie Jackson Jr.’s amendment for the Right to Healthcare
29
since 1944
F.D. Roosevelt’s “Second Bill of Rights” for adequate medical care and achievement &enjoyment of good health
30
since Feb 2011
Jessie Jackson Jr.’s amendment for the Right to Healthcare
31
Article 1, Section 8, Clause 1 of the Constitution grants Congress
the “Taxing & Spending Power” to lay and collect taxes for the general welfare of the United States
32
Congressional power to regulate trade and commerce includes
regulating insurance companies and trade across state lines
33
Major characteristics of the U.S. healthcare system (a lot :/)
-Complex, fragmented, and multiple sub-systems with no central governing agency.
-Difficult for patients to navigate
-technology-driven.
-Defensive medicine due to lawsuit fears
-high costs.
-Access to routine care primarily for those with insurance
-focus on acute care over preventive care
-Financing: 55% private funds, 45% public funds
-includes 5,700 hospitals, 15,900 nursing homes, and 11,000 home health care agencies and hospices
-Over 14 million people are employed
-Approximately 1,000 health insurance companies offer multiple coverage plans, with Blue Cross/Blue Shield providing around 70 different plans
34
Characteristics of healthcare systems in other developed countries
Most have a unitary system with central government control, funded mostly by taxes, providing universal access to basic health services
35
Approximately 17.1% of nonelderly people were uninsured as of late 2013 due to (5)
-High costs
-Lack of employer coverage
-Job loss
-Being self-employed
-Ineligibility for public health insurance
36
reasons being uninsured (6)
-prefer to pay penalty
-don't know how to get it
-immigration status
-told they were ineligible
-not eligible at work/unemployed
-don't know/refused
37
The uninsured are less likely to have (2)
-Usual access to care
-Access to proven preventive services
have implications for the overall cost of care
38
The uninsured are more likely to (3)
-Use the emergency room for needed care
-Present late with medical conditions
-Go without needed health services
have implications for the overall cost of care
39
Survey results from the Kaiser Family Foundation (KFF)
highlight the healthcare-related challenges faced by Americans
40
People worried about... (medical stuff) (4)
unexpected medical bills
-health insurance deductible
-prescription drug costs
-monthly health insurance premium
41
it is difficult for insured people to afford (3)
- co-pays for doctor visits and drugs
-cost of insurance
-deductible paid before insurance kicked in
42
percent who say it is difficult to afford the cost of prescription medicine
24%
43
half of adults do not report putting off care due to costs: true or false?
false - they report it
44
some say their conditions got worse as a result of skipping care: true or false?
true
45
three in ten say they haven't taken their medicine as prescribed due to costs: true or false?
true
46
did not take as directed: 29% (3)
-not filled a prescription
-taken OTC drug instead
-cut pills in half or skipped doses
47
about one in six say they have not put off vaccines to pay medical bills: true or false?
false - they put off vaccines
48
2010
Affordable Care Act (ACA)
49
Goals of the Patient Protection and Affordable Care Act (ACA) (3)
-Expand health insurance coverage
-Improve the quality of care and contain costs
-Regulate the insurance industry for better patient protections against abuse and high costs
50
Key Features of the Affordable Care Act (ACA) (3)
- improving quality & lowering costs
- new consumer protections
- access to health care
51
improving quality & lowering costs include (4)
- free preventive care
- Rx discounts for seniors
- protect against care fraud
- small business tax credit
52
new consumer protections include (2)
- pre-existing conditions
-consumer assistance
53
access to health care includes (1)
- health insurance marketplace
54
Affordable Care Act (ACA) emphasizes (4)
- benefits for women
- young adult coverage
- strengthening medicare
- holding insurance companies accountable
55
The ACA expands coverage by (8)
-Medicaid expansion for low-income adults
-Young adults can stay on parents’ plans until 26
-State and federal health insurance marketplaces
-Temporary health plans for those with pre-existing conditions
-Subsidies for adults up to 400% of FPL
-Tax credits for small businesses
-Incentives for employer coverage for early retirees
-The Individual Mandate
56
The Individual Mandate under the ACA
starting 2014
individuals maintain minimal essential health insurance coverage or pay a shared responsibility payment to the federal government
57
Exemptions include (individual mandate requirement under the ACA) (5)
-American Indians
-People in extreme financial hardship
-Individuals with religious objections
-Incarcerated individuals
-Undocumented immigrants
58
Penalties assessed by the IRS were
2014: 1% of income or $95
2017: 2.5% of income or $695
59
elimination of the penalties assessed by the IRS lead to
increased insurance premiums due to fewer healthy individuals enrolling
from 2019
60
States that implemented their own Individual Mandate Penalty to stabilize insurance markets
Massachusetts
New Jersey
Vermont
District of Columbia
61
States besides Massachusetts, New Jersey, Vermont, District of Columbia have attempted but failed to establish their own Individual Mandate Penalty: true or false
true
62
ACA’s strategies for improving quality of care (2)
-Promotes care models like ACOs and Patient-Centered Medical Homes for chronic disease management
-Invests in Electronic Health Record systems for comprehensive patient information
63
ACA’s strategies for containing costs (2)
-Supports community initiatives and public health infrastructure to prevent disease
-Ensures access to preventive care services without out-of-pocket costs
64
ACA’s strategies for patient safety and reimbursement (2)
-Develops programs to enhance patient safety and reduce medical liability
-Reimburses providers with incentives based on performance metrics
65
ACA’s drug discount initiatives for Medicare: CMS negotiates discounts for Medicare enrollees in the doughnut hole:
-2015: 55% for brand names, 35% for generics
-2018: 65% for brand names, 56% for generics
-Closure of the doughnut hole for brand-name drugs in 2019, generics in 2020
66
ACA’s adjustments for Medicare Advantage Plans (2)
-Reduces excessive payments to Medicare Advantage Plans for cost-effectiveness
-Lowers Medicare expenditures by combating fraud and abuse
67
Limits on the portion of premiums health insurance companies can
allocate for administrative overhead, ensuring more funds go toward patient care
ACA’s strategies for protecting patients from health insurance abuses
68
ACA’s strategies for reviewing premiums
Supports states in reviewing health insurance premiums and preventing unreasonable increases
69
ACA’s Patient’s Bill of Rights
Issues a Patient’s Bill of Rights to protect patients from abuses by the health insurance industry
70
Before implementation of ACA (8)
-Annual and lifetime limits on coverage
-Excluded pre-existing conditions
-possible retroactive cancellations
-Higher uninsured rates among young adults
-Limited or no preventive service coverage
-Specialist access required primary care referrals
-Internal appeals for denied services
-reliance on insurers for information
71
After Implementation of ACA (8)
-Annual and lifetime limits eliminated
-No denials for children with pre-existing conditions; protections extended to all ages
-Coverage can only be canceled for fraud
-Dependents can stay on parents' plans until 26
-Preventive services covered without cost-sharing
-Direct access to pediatricians and OB-GYNs without referrals
-Internal and external appeals allowed for denied services
-www.Healthcare.gov for insurance information and options
72
Constitutionality of the ACA (5)
-26 states challenged the ACA's Individual Mandate and Medicaid expansion
-Mandate upheld as a tax; surcharge set to $0 in 2019
-States can opt to expand Medicaid without losing funding
-ACA includes consumer protections via the Patient’s Bill of Rights
-Some states maintain penalties for the uninsured
73
states that maintain penalties for the uninsured
Massachusetts
New Jersey
California
Rhode Island
74
Federal Tax Credits under ACA (4)
-ACA offers federal tax credits for insurance through state marketplaces.
-16 states have their own; 6.4 million use the federal marketplace.
-Supreme Court (2015) upheld credits nationwide, supporting ACA’s goals.
-Obama declared ACA a right for all Americans.
75
ACA Implementation Results (2014 & Beyond) (4)
-23M gained insurance
-8M covered through Medicaid expansion
-Seniors saved $10M on prescriptions
-Premium growth slowed but rose in 2019 after penalty repeal
76
23M gained insurance (ACA Implementation Result) (3)
-8M via exchanges
-7.8M on parents' plans
-5M direct purchases
77
Latest Developments in the ACA (4)
-IRS surcharge for Individual Mandate eliminated (Jan 2019).
-2018 lawsuit by 18 states (led by Texas) to strike down ACA.
-27 states (led by California) currently defending the ACA.
-Supreme Court decision pending.
78
Public Opinion Polls on the ACA (3)
-55% of Americans view the ACA positively; 38% negatively.
-Persistent partisan divide in opinions.
-Misinformation and lack of understanding of key provisions are issues.
79
Current Uninsured in the U.S. (5)
- 10.9% uninsured in 2019; 8.5% in 2018.
- Largest drop among low-income adults and Hispanics since 2013.
-48% of uninsured adults cite high costs; others lack employer coverage.
-Most uninsured are poor adults, especially in non-Medicaid expansion states.
-Undocumented immigrants are ineligible for marketplace or Medicaid coverage.
