Update on Healthcare Financing and Coverage Flashcards
(50 cards)
Describe the history of healthcare financing, insurance, government healthcare funding in the US.
Before insurance - patients expected to pay all health care costs out of their own pockets.
costs were low in the past compared to today bc US health expenditure as a % of GNP was way less (5%)
1920s
some hospitals offered services on a pre-paid plan
1929
the first employer-sponsored plan was created by teachers in Dallas, TX
1935
Social Security Act – no health coverage
WWII
employer-sponsored plans as a benefit dramatically
expanded as a direct result of wage controls
1946
Hill Burton Act – hospital construction
1948
President Truman proposes national health insurance
1954
tax deduction for employers in the Revenue Act
Entire health insurance system was built on the
employer sponsored model
– A system for the retired (Medicare) 1965
– A system for the poor (Medicaid) 1965
– A system for the self-employed who had to buy insurance on their own through exchanges (ACA) 2010
Describe the role of the ACA and the American Rescue Plan in expanding healthcare coverage to the uninsured in the US.
goals of the affordable care act:
* Improve Accessibility to Coverage
* Decrease number of uninsured
* Improved efficiency of providing care
* Improve Quality of Care
* Decrease Cost of Care
taxpayers did not like the ACA
30 day readmission penalties
- Historically 20% of Medicare patients are readmitted within 30 days
- Review of the data indicates 75% of readmission are preventable
- Savings to Medicare could be $12 billion/year
- ACA penalizes hospitals for excessive readmission
rates (3% in 2016) - Current diagnosis tracked: AMI, CHF, Pneumonia,
Knee/Hip Replacement, and COPD
History of medicare
- Lyndon B. Johnson, president from 1963-1968, made passage of Medicare his top legislative priority
- House vote: 307-116; Senate vote: 70-24
– Medicare was also a priority of JFK but lost by 4 votes in 1962. - President Harry Truman and his wife Bess were presented with the first two Medicare cards.
- Medicare and Medicaid were enacted as Title 18 and Title 19 of the Social Security Act.
– Signed into law on July 30, 1965
History of medicaid
– Begins January 1, 1966
– Health insurance for the poor and medically indigent of all ages.
* Inpatient; Outpatient;
* Not required - last state to implement – AZ in 1982
– Federal-State partnership program.
* Matching funds based on state per capita income - 50-83% (now up to 90%)
* Federal standards for services
* Managed by state govt
* Wide variation in the quality and range of services in various states.
developed into important aspect of nation’s social welfare program
Medicaid milestones
– 2014:
*ACA goes into affect expanding Medicaid eligibility for states that choose to opt in.
*Allows people with income up to 138% of FPL to qualify. ($17,775; $36,570 –family of 4)
*In 2022, > 50% of the nation’s uninsured live in states that have opted out of the expanded program.
*ACA and beyond: Healthcare and especially Medicaid has become somewhat of a political football.
Medicaid is comparable to ______ for access to care
private insurance
Medicaid per enrollee spending is significantly greater for
the elderly and individuals with disabilities compared to children and adults
Describe who is eligibility for Medicare enrollment.
Medicare: begins july 1, 1966
Health insurance for the elderly (≥65yo)
* Disabled
* People of all ages with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease); 19 million initially enrolled, no dental or eye benefits, no drug benefit for outpatients
Describe who is eligibility for Medicaid enrollment.
- Low-income families who meet certain state requirements. < 138% of FPL in IN
- Infants born to Medicaid-eligible pregnant women.
- Children <6 yo and pregnant women with incomes < 138% of FPL (varies by State - <158% in IN)
- Pregnant mothers are covered 12 months
after the pregnancy ends. - Certain Medicare beneficiaries.
Hoosier healthwise
children and pregnant women
Hoosier care connect
> 65 not eligible for medicare; blind; disabled
Traditional medicaid
> 65 eligible for medicare; LTC; home or community based waiver services
Healthy indiana plan
low income adults 19-64 with income < 138% FPL
National enrollment for Medicaid
- Mandatory Services: LTC, Hospital, Physician, Home Health, Prenatal care, Family
planning services - Optional Services: Pharmacy, Dental, ICF for mentally retarded; Mental health rehab
- Enrollment: ~85 million covered by Medicaid + CHIP; Assist 60% of all nursing home residents; Assist 40% of all childbirths (38% in Indiana)
National eligibility Medicaid
- 1/3 of all children are insured through
Medicaid. - 60% of low-income children insured through Medicaid
- While children are eligible for dental coverage, few dentists participate.
- ACA: Provides eligibility for most low-income adults
<65 with incomes <138% of FPL; Fed Gov pays 100% of expansion cost 2014-16, then declines to 90% in 2020?
