Lec 13 - Health Care Reform Basics

Question 1

The 2010 Health Care Reform includes:

Answer 1

The patient protection and ACA

The reconciliation act of 2010

Question 2

The 2010 health care reform: Coverage: 32 million Americans presently ____________ for 95% coverage

Answer 2

Uninsured

Question 3

2010 Health Care Reform: Cost: 940 billion dollars over _______ years

Answer 3

10

Question 4

What 4 things led to the new law?

Answer 4

Cost of insurance - access
Cost of health care
Access - preexisting conditions
Lifetime limit on benefit

Question 5

Overall approach to increasing coverage:
\_\_\_\_\_\_\_\_\_ mandate
\_\_\_\_\_\_\_\_\_ requirements
Expansion of \_\_\_\_\_\_\_\_\_\_\_ programs
Premium and \_\_\_\_\_\_\_\_\_\_\_\_\_ subsidies to individuals
Premium subsidies to \_\_\_\_\_\_\_\_\_\_
Cost sharing \_\_\_\_\_\_\_\_\_\_ for payers ***

Answer 5

Individual
Employer
Public
Cost-sharing
Employers
Reductions

Question 6

What were 3 concerns about the new law?

Answer 6

Complexity
Cost
Mandate

Question 7

What are the 3 overarching goals of health care reform?

Answer 7

Access to insurance

Improved coverage/benefits

Improved quality and cost reduction

Question 8

Estimated Effect of HCR in 2019? What will stay the same?

Answer 8

Medicare

Employer Sponsored

Question 9

Estimated Effect of HCR in 2019? What will increase?

Answer 9

Medicaid/SCHIP

Individual coverage

Question 10

Estimated Effect of HCR in 2019? What will go down?

Answer 10

Uninsured

Question 11

Essential Health Benefits: Packing of benefits that assure certain health plans offered in the state ______ ______ ________ provide a _______ of coverage, benefits, and services to their ___________

Answer 11

Health Insurance Exchanges

Baseline

Enrollees

Question 12

T/F: Is this an essential health benefit?:

Ambulatory patient services?

Answer 12

T

Question 13

T/F: Is this an essential health benefit?: Emergency services?

Answer 13

Yes

Question 14

T/F: Is this an essential health benefit?: Hospitalization

Answer 14

Yes

Question 15

T/F: Is this an essential health benefit?: Maternity and toddler care?

Answer 15

F; maternity and newborn

Question 16

T/F: Is this an essential health benefit?: Mental health and substance use disorder services, including behavioral health treatment

Answer 16

True

Question 17

T/F: Is this an essential health benefit?: Over the counter drugs

Answer 17

F, prescription

Question 18

T/F: Is this an essential health benefit?: Rehabilitative and habilitative services and devices

Answer 18

T

Question 19

T/F: Is this an essential health benefit?: Lab services

Answer 19

Yes

Question 20

T/F: Is this an essential health benefit?: Preventive and wellness services and chronic disease management

Answer 20

T

Question 21

T/F: Is this an essential health benefit?: Pediatric services, including oral and auditory care?

Answer 21

F, oral and vision

Question 22

Health insurance marketplaces: Provide competitive marketplaces for individuals and small employees to directly compare available private health insurance options on the basis of ______, ________, _________ and other factors

Answer 22

Price
Quality
Services

Question 23

Health Insurance Marketplaces: What is the primary purpose?

Answer 23

To ENHANCE competition in the health insurance market
Improve CHOICE of affordable health insurance
Give small business the same purchasing clout as large business

Question 24

2012 Supreme Court Decision National Federation of Independent Business v. Sibelius: Court agreed to consider the constitutionality of two major provisions of the ACA: what were they? (List)

Answer 24

The individual mandate

The Medicaid expansion

Question 25

Was the individual mandate upheld?

Answer 25

YES

Question 26

The Medicaid expansion - unconstitutionally coercive of states, because states did not have adequate notice to voluntarily __________; affected a state’s existing federal Medicaid funds for ____________

Answer 26

Consent Non-compliance

Question 27

2012 Supreme Court Decision ....: A majority found that this issue was appropriately remedied by circumscribe great the Secretary’s enforcement authority, thus leaving the _________ expansion intact in the ____

Answer 27

Medicaid ACA

Question 28

Update on Individual Mandate: Requires most people to maintain a minimum level of ______ ______ ______ for themselves and their tax dependents in each months beginning in 2014.

Answer 28

Health insurance coverage

Question 29

Update individual mandate: Can be satisfied by obtaining coverage through: ______ _______ Insurance An individual insurance plan offered through health insurance ____________. A ___________ health plan ________ sponsored coverage such as Medicare or Medicaid, or similar federally recognized coverage

Answer 29

Employer sponsored Exchanges Grandfathered Government

Question 30

Update individual mandate: To increase access to affordable health insurance, the ACA provides for the creation of health insurance exchanges that will offer __________ health plans, as well as advance payment of ________ tax credits to people with ________ incomes

Answer 30

Qualified Premium Qualifying

Question 31

Update individual mandate: if individual mandate not met = _________ responsibility payment (financial ____)

Answer 31

Shared | Penalty

Question 32

Medicaid expansion: To fund the expansion of Medicaid coverage, federal government will cover ____% of the states’ costs of the coverage expansion in 2014-2016, gradually decreasing to ____% in 2020 and thereafter

Answer 32

100 | 90

Question 33

Medicaid expansion: Benefit package for the newly eligible Medicaid population must include the ____ _____ __________ of _______ _______ ______

Answer 33

ACA ten categories Essential health benefits

Question 34

Medicaid expansion: Effect of the Supreme Court’s decision: Medicaid expansion _________ for states. If states do not comply with the Medicaid expansion, only ACA Medicaid expansion funds may be ________, not all or a part of a non-compliant state’s federal funds for the rest of the Medicaid program.

Answer 34

Optional Withheld

Question 35

How many states have adopted Medicaid expansion?

Answer 35

33

Question 36

NJ Medicaid expansion: The _____ _____ ______ offering health coverage in NJ beginning in 2014

Answer 36

Federally-facilitated marketplace (FFM)

Question 37

NJ Medicaid Expansion: NJ expanded Medicaid coverage to _____ ______ adults effective 1/1/14

Answer 37

Low income

Question 38

Current status of 2010 Law: ________ continues Individual mandate ________ by Supreme Court in July 2012 Medicaid participation determined by _______ Shift in political balance of power in _________ (Republican majorities in ______ and ____________) 2016 Presidential election 2017 Congressional action

Answer 38

``` Implementation Upheld States Congress House and senate ```