HCMG 1010; MIDTERM 1 EXAM
PREP QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) A
GRADE
401K automatic enrollment effect - correct answer- -
studied showed that automatic enrollment dramatically
increased employee enrollment in 401k participation
ACA based on Massachusetts health care reform - correct
answer- - background: uninsured ppl generate lots of
expensive uncompensated ER/hospital care
- make everyone insured, will save that $$$ and use those
savings to help make insurance more affordable
- passed in 2006 by Gov. Romney (R)
- mandated residents to get min. level of insurance coverage
- provided free and subsidized health insurance for residents
earning less than 150% and 300% of FPL respectively
- mandated employers with >10 full-time employees to provide
insurance
- Result: covered 2/3 of uninsured residents, reached 98%
insured in MA
,ACA Hate - correct answer- - conservatives and
libertarians object to fed government getting involved in HC
system
- individual mandate with tax penalty = MOST UNPOPULAR PART
- some are worse off:
1) healthy with non-group coverage pre-ACA saw premiums
increase
2) coverage gap from states not expanding Medicaid
- many on left do not think ACA goes far enough
- lack of knowledge: many of ACA's individual pieces very
popular, why it has endured
ACA: changes to private insurance coverage (leg 2) - correct
answer- - can stay under parents until age 26
- free preventative services
- no lifetime/annual limits to care provision
- caps to OOP expenses
- caps to medical loss ratios
- insurance required to cover a standard set of services (10
essential benefits: preventive, wellness, + disease management,
,ER care, ambulance, hospitalization, PEDs, maternity/newborns,
drugs, lab services, mental health, rehabilitation)
- created exchanges: makes it easy to buy and compare
insurance plans, also increases competition
- plans labeled by actuarial value for ease of comparison on the
exchange
- individual mandate with tax penalties if you do not have
insurance
- large employers (>50 FTEs) must offer coverage
ACA: financial assistance part 1: Medicaid expansion (part 1 of
leg 3) - correct answer- - biggest expansion of public
insurance since 1905
- expansion initially 100% federally financed, 90% in the long run
- medicaid eligibility limited to specific low income groups
(elderly and persons with disabilities, children, pregnant women)
- extended to low-income and childless adults under <138% of
FPL in 2014
ACA: financial assistance part 2: subsidies on the exchange -
correct answer- - qualify for premium tax credits if:
1) household income 100-400% of FPL
2) no access to affordable HC, even Medicare, Medicaid, CHIP
, 3) Have US citizenship or proof of legal residency
- qualify for cost sharing reduction if:
- eligible to receive premium tax credit and household income
100%-250% FPL
- have to purchase silver plan
ACA: Non-group Health Insurance Market Reforms (leg 1) -
correct answer- - health insurance market places
established in each state
- community-rated premiums: limits any variation in premiums
to variations based on age, tobacco use, family size, and
geography (premiums cannot be based on health status)
- 3:1 age bands on rates
- 1.5:1 bands for tobacco users
- guaranteed availability of coverage: insurers required to offer
coverage to and accept any individual who applies for coverage
(limited enrollment periods allowed)
- cannot be denied coverage for pre-existing conditions
- gauranteed renewability of coverage
ACA: Supreme Court gets involved - correct answer- -
individual mandate to buy health insurance unheld (5 to 4) as
constitutional excise of Congress's taxing power
PREP QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) A
GRADE
401K automatic enrollment effect - correct answer- -
studied showed that automatic enrollment dramatically
increased employee enrollment in 401k participation
ACA based on Massachusetts health care reform - correct
answer- - background: uninsured ppl generate lots of
expensive uncompensated ER/hospital care
- make everyone insured, will save that $$$ and use those
savings to help make insurance more affordable
- passed in 2006 by Gov. Romney (R)
- mandated residents to get min. level of insurance coverage
- provided free and subsidized health insurance for residents
earning less than 150% and 300% of FPL respectively
- mandated employers with >10 full-time employees to provide
insurance
- Result: covered 2/3 of uninsured residents, reached 98%
insured in MA
,ACA Hate - correct answer- - conservatives and
libertarians object to fed government getting involved in HC
system
- individual mandate with tax penalty = MOST UNPOPULAR PART
- some are worse off:
1) healthy with non-group coverage pre-ACA saw premiums
increase
2) coverage gap from states not expanding Medicaid
- many on left do not think ACA goes far enough
- lack of knowledge: many of ACA's individual pieces very
popular, why it has endured
ACA: changes to private insurance coverage (leg 2) - correct
answer- - can stay under parents until age 26
- free preventative services
- no lifetime/annual limits to care provision
- caps to OOP expenses
- caps to medical loss ratios
- insurance required to cover a standard set of services (10
essential benefits: preventive, wellness, + disease management,
,ER care, ambulance, hospitalization, PEDs, maternity/newborns,
drugs, lab services, mental health, rehabilitation)
- created exchanges: makes it easy to buy and compare
insurance plans, also increases competition
- plans labeled by actuarial value for ease of comparison on the
exchange
- individual mandate with tax penalties if you do not have
insurance
- large employers (>50 FTEs) must offer coverage
ACA: financial assistance part 1: Medicaid expansion (part 1 of
leg 3) - correct answer- - biggest expansion of public
insurance since 1905
- expansion initially 100% federally financed, 90% in the long run
- medicaid eligibility limited to specific low income groups
(elderly and persons with disabilities, children, pregnant women)
- extended to low-income and childless adults under <138% of
FPL in 2014
ACA: financial assistance part 2: subsidies on the exchange -
correct answer- - qualify for premium tax credits if:
1) household income 100-400% of FPL
2) no access to affordable HC, even Medicare, Medicaid, CHIP
, 3) Have US citizenship or proof of legal residency
- qualify for cost sharing reduction if:
- eligible to receive premium tax credit and household income
100%-250% FPL
- have to purchase silver plan
ACA: Non-group Health Insurance Market Reforms (leg 1) -
correct answer- - health insurance market places
established in each state
- community-rated premiums: limits any variation in premiums
to variations based on age, tobacco use, family size, and
geography (premiums cannot be based on health status)
- 3:1 age bands on rates
- 1.5:1 bands for tobacco users
- guaranteed availability of coverage: insurers required to offer
coverage to and accept any individual who applies for coverage
(limited enrollment periods allowed)
- cannot be denied coverage for pre-existing conditions
- gauranteed renewability of coverage
ACA: Supreme Court gets involved - correct answer- -
individual mandate to buy health insurance unheld (5 to 4) as
constitutional excise of Congress's taxing power
