PUBH 6012 COMPREHENSIVE EXAMS QUESTIONS
AND ANSWERS SET A+
✔✔What are the ACA's minimum value and affordability standards for large employer
plans? - ✔✔Minimum value: plan must pay at least 60% of the total cost of medical
services for a standard population AND include substantial coverage of physician and
inpatient hospital services
Affordability: employee-only coverage costs no more than 9.12% (2023) of household
income. If affordable AND meets minimum value, the employee isn't eligible for a
premium tax credit on the marketplace
✔✔What preventive services are covered with NO cost sharing under the ACA? -
✔✔Includes screenings for cancer, mental health, STDs, vaccinations, and the full
range of FDA-approved contraceptives for women (not abortions or vasectomies)
Religious employers exempt from birth control requirement, some are suing to avoid
covering PrEP
✔✔What are the 4 metal tiers in the ACA marketplace plans, and what are their
actuarial values? - ✔✔Based on how much the plan pays vs. the individual:
- Bronze (60/40)
- Silver (70/30)
- Gold (80/20)
- Platinum (90/10)
✔✔Who is eligible for premium tax credits (subsidies) on the marketplace? - ✔✔-
Income between 100-400% FPL
- 100-133% FPL: those NOT eligible for Medicaid
- 133-400% FPL: available on sliding scale
- Over 400% FPL or below 100% FPL: no subsidy
- Tax credit amount depends on plan cost and how much the premium exceeds a set %
of income
, - Can be applied to any metal level plan
✔✔Who qualified for cost-sharing reduction (CSR) subsidies, and what's the catch? -
✔✔Available to those with an income below 250% FPL, to reduce out-of-pocket costs
(deductibles, co-pays, coinsurance)
Catch: must select a SILVER plan for CSR to be applied. CSRs are in addition to
premium tax credits
✔✔What is the benchmark plan used to determine subsidy amounts? - ✔✔The second-
lowest cost silver premium for a 40-year-old
This is separate from the essential health benefits benchmark
✔✔What is the coverage gap, and why does it exist? - ✔✔The Coverage Gap exists in
states that did NOT expand Medicaid
Congress drafted the ACA to cover everyone up to 133% FPL via Medicaid, then
subsidies for 100%-400% FPL. But after NFIB v. Sebelius, Medicaid expansion became
OPTIONAL
In non-expansion states, people too poor to qualify for subsidies (below 100% FPL) but
who don't fit pre-ACA Medicaid categories fall into the gap - no Medicaid, no
marketplace subsidies
✔✔What did NFIB v. Sebelius (2012) decide about the individual mandate? - ✔✔The
Supreme Court upheld the individual mandate as a legitimate cause of Congress' taxing
power
However, the Court rejected the argument that the Commerce Clause justified it -
Congress cannot compel people to participate in commerical activiry under that clause
(ony regulate existing activity)
✔✔What did NFIB v. Sebelius decide about Medicaid expansion? - ✔✔The Court held
that the federal government cannot require states to expand Medicaid to 133% FPL as
a condition of continued Medicaid participation. The incentive (losing all Medicaid
funding) was so great that it was unconstitutionally coercive - a violation of states' rights
This created two Medicaid structures in the US: expansion (income-based) and non-
expansion (categorical, pre-ACA rules)
✔✔What were the primary federal powers at issue in the ACA constitutional
challenges? - ✔✔Three primary federal powers:
1. Tax
2. Spend
AND ANSWERS SET A+
✔✔What are the ACA's minimum value and affordability standards for large employer
plans? - ✔✔Minimum value: plan must pay at least 60% of the total cost of medical
services for a standard population AND include substantial coverage of physician and
inpatient hospital services
Affordability: employee-only coverage costs no more than 9.12% (2023) of household
income. If affordable AND meets minimum value, the employee isn't eligible for a
premium tax credit on the marketplace
✔✔What preventive services are covered with NO cost sharing under the ACA? -
✔✔Includes screenings for cancer, mental health, STDs, vaccinations, and the full
range of FDA-approved contraceptives for women (not abortions or vasectomies)
Religious employers exempt from birth control requirement, some are suing to avoid
covering PrEP
✔✔What are the 4 metal tiers in the ACA marketplace plans, and what are their
actuarial values? - ✔✔Based on how much the plan pays vs. the individual:
- Bronze (60/40)
- Silver (70/30)
- Gold (80/20)
- Platinum (90/10)
✔✔Who is eligible for premium tax credits (subsidies) on the marketplace? - ✔✔-
Income between 100-400% FPL
- 100-133% FPL: those NOT eligible for Medicaid
- 133-400% FPL: available on sliding scale
- Over 400% FPL or below 100% FPL: no subsidy
- Tax credit amount depends on plan cost and how much the premium exceeds a set %
of income
, - Can be applied to any metal level plan
✔✔Who qualified for cost-sharing reduction (CSR) subsidies, and what's the catch? -
✔✔Available to those with an income below 250% FPL, to reduce out-of-pocket costs
(deductibles, co-pays, coinsurance)
Catch: must select a SILVER plan for CSR to be applied. CSRs are in addition to
premium tax credits
✔✔What is the benchmark plan used to determine subsidy amounts? - ✔✔The second-
lowest cost silver premium for a 40-year-old
This is separate from the essential health benefits benchmark
✔✔What is the coverage gap, and why does it exist? - ✔✔The Coverage Gap exists in
states that did NOT expand Medicaid
Congress drafted the ACA to cover everyone up to 133% FPL via Medicaid, then
subsidies for 100%-400% FPL. But after NFIB v. Sebelius, Medicaid expansion became
OPTIONAL
In non-expansion states, people too poor to qualify for subsidies (below 100% FPL) but
who don't fit pre-ACA Medicaid categories fall into the gap - no Medicaid, no
marketplace subsidies
✔✔What did NFIB v. Sebelius (2012) decide about the individual mandate? - ✔✔The
Supreme Court upheld the individual mandate as a legitimate cause of Congress' taxing
power
However, the Court rejected the argument that the Commerce Clause justified it -
Congress cannot compel people to participate in commerical activiry under that clause
(ony regulate existing activity)
✔✔What did NFIB v. Sebelius decide about Medicaid expansion? - ✔✔The Court held
that the federal government cannot require states to expand Medicaid to 133% FPL as
a condition of continued Medicaid participation. The incentive (losing all Medicaid
funding) was so great that it was unconstitutionally coercive - a violation of states' rights
This created two Medicaid structures in the US: expansion (income-based) and non-
expansion (categorical, pre-ACA rules)
✔✔What were the primary federal powers at issue in the ACA constitutional
challenges? - ✔✔Three primary federal powers:
1. Tax
2. Spend
