MHA 707 Exam D Study Guide – Complete With Solutions
What groups of Americans were largely uninsured when the ACA was being
considered? ✔ Ans - -Unemployed, -Employed with no ESI (employer-sponsored ins)
-Young employees
-Those who didn't take ESI
-Those who chose not to be insured
Why didn't the ACA go to a single-payer or an NHI format? What was the Public potion? ✔ Ans - Each had its own stakeholder with invested interest in continuing their role in the HC system. Allow many to purchase medicaid with means tested premium employers shift twd medicaid b/c it was cheaper than having private ins
What were the hoped advantages of achieving expanded coverage under the ACA? ✔ Ans - Reduce increased care, expand rationing of care, costly exacerbation of health conditions, uncompensated care for providers (academic providers)
What features of the ACA were designed to increase coverage? What are pre-existing conditions and guaranteed issue? How were they Impacted by ACA? ✔ Ans - •Mandated that private health insurance plans meet minimum standards
•Cannot discriminate against people with preexisting conditions (guaranteed issue)
•Cannot impose lifetime and annual limits on coverage
Must extend dependent coverage to age 26
What are pre-existing conditions and guaranteed issue? ✔ Ans - Made changing employer/insurance practical and more fair
Helped many who could not get insurance because of early life events
Removed disincentives to practice "less-healthy" lifestyles
stop smoking, lose weight, etc. Allowed people to "game the system" - buy insurance only when a health problem arises and be uninsured (not pay premiums) otherwise.
What are Health insurance exchanges? ✔ Ans - State-based health insurance exchange for individuals and small businesses to compare plans, apply for financial assistance, purchase coverage
What is SHOP? ✔ Ans - Small Business Health Options Program Helped firms with 50 or less employees to have insurance to cover them.
What was the individual mandate and its design? What happened to it? ✔ Ans - Mandated that most citizens and legal residents have health insurance. distributes health care costs over people in poor health and good health (community rating)
How did ACA aim to reduce health care cost? ✔ Ans - -Medicare fraud, excessive payment for prescription drugs, shift cost to the state (stronger federal partnership in Medicaid), series of HC reforms would save $349 billion by 2021 and $480 billion by 2023, $1 Trillion in the following decade
What was the Center for Medicaid and Medicare Innovation? ✔ Ans - •Established to develop cost savings through health services research that evaluates the effectiveness and efficiency of health care treatments (Like NICE in United Kingdom)
•Testing various payment and service delivery models to achieve better care for patients, better health for communities, and lower costs
What are the source of funds for the ACA? ✔ Ans - Prevention and public
health fund
Cuts in government spending (Dr. and hospital) and new revenues (tax penalties)
What is Medicaid expansion? ✔ Ans - Expansion supports local economics, level of financial protection, drops uninsurance rate cost of expansion is minimal, decreases cost-shifting issues, delay to dr. dr doesn't have to accept Medicaid
What groups of Americans were largely uninsured when the ACA was being
considered? ✔ Ans - -Unemployed, -Employed with no ESI (employer-sponsored ins)
-Young employees
-Those who didn't take ESI
-Those who chose not to be insured
Why didn't the ACA go to a single-payer or an NHI format? What was the Public potion? ✔ Ans - Each had its own stakeholder with invested interest in continuing their role in the HC system. Allow many to purchase medicaid with means tested premium employers shift twd medicaid b/c it was cheaper than having private ins
What were the hoped advantages of achieving expanded coverage under the ACA? ✔ Ans - Reduce increased care, expand rationing of care, costly exacerbation of health conditions, uncompensated care for providers (academic providers)
What features of the ACA were designed to increase coverage? What are pre-existing conditions and guaranteed issue? How were they Impacted by ACA? ✔ Ans - •Mandated that private health insurance plans meet minimum standards
•Cannot discriminate against people with preexisting conditions (guaranteed issue)
•Cannot impose lifetime and annual limits on coverage
Must extend dependent coverage to age 26
What are pre-existing conditions and guaranteed issue? ✔ Ans - Made changing employer/insurance practical and more fair
Helped many who could not get insurance because of early life events
Removed disincentives to practice "less-healthy" lifestyles
stop smoking, lose weight, etc. Allowed people to "game the system" - buy insurance only when a health problem arises and be uninsured (not pay premiums) otherwise.
What are Health insurance exchanges? ✔ Ans - State-based health insurance exchange for individuals and small businesses to compare plans, apply for financial assistance, purchase coverage
What is SHOP? ✔ Ans - Small Business Health Options Program Helped firms with 50 or less employees to have insurance to cover them.
What was the individual mandate and its design? What happened to it? ✔ Ans - Mandated that most citizens and legal residents have health insurance. distributes health care costs over people in poor health and good health (community rating)
How did ACA aim to reduce health care cost? ✔ Ans - -Medicare fraud, excessive payment for prescription drugs, shift cost to the state (stronger federal partnership in Medicaid), series of HC reforms would save $349 billion by 2021 and $480 billion by 2023, $1 Trillion in the following decade
What was the Center for Medicaid and Medicare Innovation? ✔ Ans - •Established to develop cost savings through health services research that evaluates the effectiveness and efficiency of health care treatments (Like NICE in United Kingdom)
•Testing various payment and service delivery models to achieve better care for patients, better health for communities, and lower costs
What are the source of funds for the ACA? ✔ Ans - Prevention and public
health fund
Cuts in government spending (Dr. and hospital) and new revenues (tax penalties)
What is Medicaid expansion? ✔ Ans - Expansion supports local economics, level of financial protection, drops uninsurance rate cost of expansion is minimal, decreases cost-shifting issues, delay to dr. dr doesn't have to accept Medicaid
