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Flashcards in Notes 5 Deck (25)
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A is HOSPITAL insurance plan (through soc security taxes of employers and employees), and B is a PHYSICIAN SERVICE plan (through federal taxes and monthly premiums from the beneficiaries)



Rx coverage, paid by federal taxes and monthly premiums



Run by the states, funded by federal ADN state taxes, pays for care of certain low-income groups


Who's eligible for MCARE A?

As long as you reach 65 and are eligible for social security, nothing else matters ... you're eligible. If you're not eligible for s.s., you can enroll by paying a monthly premium.


How are you eligible for social security?

If that person has paid into the s.s. system for 10 years, he and spouse are eligible


How is MCARE A financed? How will this change with ACA?

Through S.S.. The ACA increases SS payments for higher income taxpayers starting 2013.


Who's eligible for MCARE B?

People who are eligible for MCARE A who pay the monthly B premium. Some low incomes dun gotta pay, higher incomes pay more.


How is MCARE B financed?

1) General federal revenues from income/federal taxes 2) B monthly premium


Who's eligible for MCAID? (4)

1) Low income families with children 2) Elderly, disabled, blind who receive cash assistance under federal SSI program 3) Children < 6 and pregnant ladies < 133% FPL, and 4) school aged children whose income is < FPL


What's the SSI program?

Supplemental Security Income program


What's the MMA, what 2 changes did it make?

MCARE Modernization Act of 2003 - made 2 major changes, added MCARE C (expanded role of private health plans) and MCARE D (establishment of Rx drug benefit)


Explain MCARE C.

Under MCARE Advantage, person can enroll in a private health plan that contracts with MCARE, and MCARE subsidizes the premium for private health plan (usually HMO) instead of paying people directly under A and B. Basically MCARE-subsidized private insurance.


Limitations to MCARE C?

Sacrifice degree of freedom of choice of MD and hospital in return for lower out-of-pocket payments, only allowed to receive care from providers connected that plan.


How is ACA gonna change MCARE C?

It's gonna reduce payments to MCARE Advantage plans, cuz it turns out its kind of a dud which is costing the fed govt more than traditional A & B plans


3 reasons why MCARE D is criticized?

1) Major gaps in coverage 2) Coverage has been farmed out to private insurance rather than administered by MACRE 3) Govt is not allowed to negotiate with pharmaceuticals for lower drug prices


How is access to care measured?

Access to health care is most simply measured by the number of times a person uses health care services. Commonly used data are numbers of physician visits, hospital days, and preventive services received.


Is sales tax regressive, progressive, or proportional? What about MCARE payroll tax?

Sales tax is REGRESSIVE. Even though the sales tax percentage is the same for everyone, those who are low income spend a larger amount of their income than the wealthy, in turn causing them to see more of the sales tax. Therefore this affects lower income individuals more than high income individuals. MCARE payroll tax is PROPORTIONAL: Percentage is the same for everyone and is based on your earnings.


How would it be possible to see if you're actually performing MCARE fraud?

Emphasis from beginning of MCARE program and private insurers is on efficiently paying bills as presented. Process contracts to lowest bidder. Process claims quickly/cheaply, not to look at the claims to see if they're actually valid. There was a dis-incentive to see if that shit was invalid cuz it would slow down processing times.


MCAID Waiver?

Scheme by states to convince the feds that by sending more money to their MCAID programs, they can magically make the changes they want to make in MCAID come out revenue neutral for feds. Have been used as a way to test new ideas


What was the pressure point to get shit done in mass?

1) Advocates and policy makers were like, we gotta make this priority 2) MCAID WAIVER which allowed Mass to make people above national average FPL to be MCAID enrolled was ready to expire. Fed Govt was like, we dun wanna give any more money to Mass for uncompensated something about it or we'll pull some funding 3) Mitt Romney


3 main pillars

Individual mandate, give incentives to employers to provide insurance, state needs to play a role in case you couldn't afford insurance


Individual mandate?

500k uninsured people in Mass - For people who could afford health insurance on their own, they had to or else they paid a penalty.


Connector Authority?

State health insurance exchange - governed by a board which helped people to get insurance - can shop online, if you're between jobs there can be an option


Mass outcomes?

Preventative care, access went up.


How to reduce costs associated with Mass reform? (6)

1) Improve primary care (cuz now, sick people use up most resources and aren't getting the right kind of care) 2) Increase transparency (get all players to talk about what's driving their costs up, UNDER OATH) 3) EHEALTH 4) Alternative to fee-for-service 5) Transparency for PATIENTS, providers mandated to let patient know how much shit will cost. 6) Give a shitload of money to public health