Notes 6 Flashcards
Older, richer, high insurance rates?
On average, MA residents are both older and richer than US population, means higher rates of health care utilization, AND High rates of insurance coverage with low out-of-pocket costs = higher spending….BUT this doesn’t account for difference between MA and US.
Academic centers?
MA residents get more of their care at academic medical centers than US, more specialists per capita than anywhere else in US…means higher costs.
MA 2012 REFORM? (6)
1) Set benchmark for total spending in MA 2) Gotta register to be a provider 3) Provide price transparency 4) Expand NP and PA scope of practice 5) Give tax credits to small business 6) Study commissions
Set benchmark for total spending in MA?
we don’t wanna spend more on health care any more than gross state product as a whole, eventually we want more SLOWLY). A commission will monitor compliance with this target (if provider is out of compliance, they gotta file correction plans to explain how they’re gonna come back into compliance.
Provide price transparency?
Gotta be able to provide price transparency to consumers (how much out of pocket/insurance? In all the hospitals?)
Expand NP and PA scope of practice?
Expands scope of practice for PAs and NPs, can go into business for themselves, can write their own shit, no longer have to be under direct supervision of docs.
Study commissions?
Sets up lots of study commissions to develop a consensus for future change: behavioral care integration, single payer pharmacy plan (to drive down prices), allowable price variations (should state set a range of allowable prices), and do something about inaccurate coding.
How does ACA expand coverage?
Expand coverage by expanding MCAID program (voluntary) and creating state health insurance exchanges, and Expands MCARE Part D
ACA Coverage is provided by? (4)
Private employer based programs, state health exchanges, state MCAID, and federal MCARE
ACA Coverage is determined by? (3)
Income, age, employment status
Insurance status of small business owners? (4) Under ACA what would these business owners take advantage of?
Largely uninsured, private insurance, small group policy, or going through spouse. They would take advantage of state health exchanges.
ACA individual mandate?
Must have qualifying coverage, if you don’t you get taxed 2.5% of income
ACA employer mandate?
50+ employee business will get fined per employee if they don’t offer coverage. Feds will subsidize small businesses with low wages.
Why is MCAID expansion voluntary?
Cuz feds said they would cover 100% for first three years, then 90% for NEW PEOPLE. Current MCAID share is 50-70. SC called it BRIBERY that was coercing states, so they made it voluntary.
ACA MCAID reimbursement?
MCAID will pay docs at least the MCARE rates.
