hours 12-13 Flashcards Preview

MABS Health Policy > hours 12-13 > Flashcards

Flashcards in hours 12-13 Deck (30):

when did we see the introduction of healthcare insurance?

with the passage of the insurance law of 1883


whom did the idea of healthcare insurance begin with?

Otto Von Bismarck and his Junker Party which was comprised of conservative and elite members of society.


what was the priority of Bismarck?

to address the needs of the working class in order to help prevent them turning to the socialists


what was the sickness law of 1883?

13 weeks of coverage
1/3 paid by employer
2/3 paid by employee
legally fixed rates


why was theodore roosevelt significant?

he supported health insurance as he believed it necessary for a strong country; no real support in government for his proposals; administration followed by 20 years of no real interest in health insurance


what was the American Association of Labor Legislation (1905-1943)?

comprised of economists that proposed health insurance legislation for the working class making less than $1200 (about $30,000 today) per year; supported by the American Medical Association (nationally), but opposed by many state medical societies; Opposed by the American Federation of Labor (unions) who saw the program as putting the state in charge of people’s health
Opposed by private insurance companies who primarily provided burial insurance. The proposed bill included coverage for burials


eventually a turn of events happened globally that affected the way we saw health insurance, what was this event and why was it important?

Anything German was seen as inconsistent with American values including social insurance


in the 1920s and 30s, a committee of the cost of medical care was developed, what did the find?

research determined a need for more medical care; more resources to be committed to health; most members opposed compulsory insurance; AMA saw this as a radical move toward socialized medicine


what was the Wagner-Murray-Dingell Bill?

it called for compulsory national health insurance funded through payroll taxes, this entered into Congress for consideration 14 years in a row and this was what President Harry Truman supported but it never passed


what was introduced in 1965?

medicare and medicaid


what was the intent of medicare and medicaid?

introduced in 1958 to cover hospital costs and this was seen as a threat to the patient physician relationship


what were the compromises made by the passage of medicaid and medicare?

hospitals paid cost plus and physicians paid usual and customary charges


why was Hilary Care in the early 1990s a failure?

Ms. Clinton was inexperienced, the plan was not clear top down driven, Harry and Louise


who was Harry and Louise?

supported by advertising campaign put on by the insurance companies because the Hilary care plan was not working and they help kill the bill and now support health care reform


in the implementation of health reform by Donald Berwick, MD, how many phases are there? name them, which is the one we are focusing on?

2 phases
Phase 1: coverage agenda
Phase 2: system improvement agenda


what is the goal of phase 1?

to provide the coverage people want and need and problems will not be solved because they are not sustainable


what is the goal of phase 2?

to make the security achieved in phase 1 sustainable with focus on the triple aim which is:
better care
better health
better cost
so, if we don't improve we can't afford it


What were the five coverage expansion strategies?

1) insurance coverage must be provided to certain classes of individuals not able to afford coverage (two parts)
2) individuals must have coverage (individual mandate or pay a fine)
3) employers with more than 50 employees must provide affordable coverage (full time)
4) health benefit exchanges/marketplace
5)medicaid expansion


what were the two parts of the first implementation strategy that covered classes of individuals not able to afford coverage?

1) adult dependent coverage to age 26
2) pre existing conditions


what happened to the second bullet of the five coverage expansion strategy about the individual mandate?

it was modified, penalty was repealed but still required people to have coverage


in the employer mandate penalty what was the effect of having one employee subsidized?

the employer saves money


What were the four types of plans covered in strategy?

Bronze (60%), Silver (70%), Gold (80%), Platinum (90%) difference being percent of costs covered by plan


what are catastrophic plans?

if you are older than 26 and need insurance, then you would go to a local health insurance company for coverage, however, lowered premiums would come at higher deductibles. Individual must be under 30 years of age. Other hardship exemptions


what was the effect of the expansion of medicaid in 2014?

it was ruled unconstitutional and was not further implemented


what was the effect of medicaid enrollment results?

Medicaid enrollment increased by 28% to 73,733,050 by May 2018 compared to 56,533,472,091 pre-ACA.
Uncompensated care cost at hospitals has decreased by approximately $6.2 billion between 2013 and 2015
HCA saw a 58% reduction in uncompensated care in states that expanded Medicaid


what was the argument against the expansion of medicaid?

Medicaid is a far from perfect system and states need to be able to modify the system prior to implementation
Added expense to states beginning in 2016 and beyond may threaten other essential programs
How is the Federal government going to pay for it?


what were the arguments for expansion of medicaid?

-If not expanded tax dollars will go to other states
-Positive financial impact as dollars are spent
-Job creation
-Loss of funding to hospitals that serve a large number of non-paying/poor paying patients
-Support needed by rural hospitals
-Improved health for those currently uninsured


what were some changes to private insurance?

no lifetime or annual limits except for services provided beyond essential health services


what were the changes in private health insurance that protected consumers in individual and group plans?

Bans practice of retroactively cancelling health coverage except for fraud.
Health plans must establish an appeals process for coverage determination.


MLR (minimum loss ratio)

insurance companies have to use 80-85% to pay for health services of beneficiaries, the rest can be used by the company as they wish.