PUBHLTH 122 Lecture 14: 2/24/17 Lecture Notes

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lilaccricket217

9 Mar 2017

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Death spiral: unless there are some mechanisms to address it, we end up with a spiral where the market disappears and no one stays in it: excluding prior conditions is one way to deal with it. This could keep the premium lower for everyone else. This was the case for many years until health reforms: another way is to set premiums based on communities. Whether you are sick or healthy, premiums are reasonable because there is a mix of many different people: high risk pool: people with prior conditions are pulled out of the risk pool to keep the premiums low. This is something that has been talked a lot about in changing in the past 10 years. Employer based insurance (2015: annual premiums: (ex of how much insurance may cost, single ,251 workers share 1,071 (workers share is part of your benefits. The employer pays some of the health insurance and you pay some.

Related Questions

The poverty threshold for a household with one person in 2010 was:

	A.	about $25,600.
	B.	about $21,100.
	C.	about $11,300.
	D.	about $38,000.

Compared to a generation ago, public aid programs that are likely to benefit families have received:

	A.	less funding.
	B.	about the same level of funding.
	C.	no funding.
	D.	more funding.

There is considerable ________ among the quintiles of the distribution of income, with many families moving from ________ and others moving from ________ quintiles.

	A.	immobility; lower to lower; higher to higher
	B.	immobility; lower to higher; higher to lower
	C.	stability; lower to higher; higher to higher
	D.	mobility; higher to lower; lower to higher

The ________ is widely used to measure income inequality.

	A.	median household income
	B.	ability-to-pay principle
	C.	poverty rate
	D.	Gini coefficient

Medicaid is funded by:

	A.	private charities.
	B.	federal and state governments.
	C.	state governments only.
	D.	the federal government only.

Private health insurance is funded by:

	A.	members of a large pool of individuals, each paying a fixed premium to a private company that agrees to pay most of the medical expenses of the members.
	B.	tax contributions to Medicare.
	C.	the government.
	D.	people who are extremely ill who pay very high premiums.

n the United States, the government pays _______ of all medical costs.

	A.	between 70% and 80%
	B.	approximately 50%
	C.	100%
	D.	less than 20%

Which of the following programs represents in-kind transfers?

	A.	Medicaid
	B.	Temporary Assistance for Needy Families
	C.	the Earned Income Tax Credit
	D.	Social Security

Children raised in poverty have a greater likelihood of living in poverty as adults than do those raised in nonpoor families, because low income is highly correlated with higher:

	A.	high school dropout rates.
	B.	high school dropout rates, risk of mental problems and behavioral disorders, and with higher rates of illness and hospitalization.
	C.	risk of mental problems and behavioral disorders.
	D.	rates of illness and hospitalization.

byzantiumclam639

The Amos Drug Company has developed a new drug that will prevent osteoporosis, one of the most dangerous conditions affecting older people, especially older women. In osteoporosis, calcium is leached out of the bones, which then become brittle and break easily. Osteoporosis can also cause serious compression fractures of the vertebrae and neck, as well as cause a great deal of pain as the condition progresses.

The drug has cost millions to develop, test, and put on the market. It has no side effects, but it does have to be taken every day from puberty on. If this regimen is followed, the person will never develop osteoporosis. The drug is especially effective for those who are genetically predisposed to the condition.

This drug has an enormous potential market. Prior to its release, the only way someone could prevent osteoporosis was to take calcium supplements or increase the calcium in their diet; but this didn't guarantee that a problem would not occur much later in life. With the new drug, if someone takes one pill every day, there is no chance of developing osteoporosis.

Amos Drug Company is contemplating an interesting marketing plan. If all people over age 25 were required to take the drug, many people could be saved from a painful and crippling disease. So the company's president, Doug Marshall, has asked legislators in his state to consider passing a law requiring the drug for everyone.

There is some precedent for a state stepping in to better the health of its constituents. In many states, genetic testing for certain conditions is required at birth; in others, the state often intervenes to force certain patients to have a procedure (such as a cesarean section or blood transfusion).

If the drug became required by the state, the company would not only recoup all the money it had spent on research and development but make a huge profit and at the same time help many people.

Questions

What would be Mr. Marshall's argument to the representatives of the state legislature?

Should people be required to take care of their health?

What should be the part of the government in our health care decisions?

How might insurance companies react to the law?

If the law were passed, how would the courts deal with someone who refused to follow the law?

two more pages of elaboration to how Trumpcare and Obamacarerelates to health care finance. 30 resources

Obamacare, also known as the Affordable Care Act (ACA), waspassed in 2010 as a health care insurance plan for all Americans.The law made many changes to the existing minimum coverage ininsurance, and increase the federal subsidies for the middle-incomehouseholds of the country. Trumpcare, also known as the AmericanHealth Care Act (AHCA), is a replacement health insurance plandesigned to partly repeal the existing ACA. The new healthcarebill, is one step closer to repealing . The nonpartisanCongressional Budget Office (CBO) has an estimate with ACA as thelaw of the land, the uninsured Americans would be 28 million willremain stable for the next decade. The analysis of an earlierversion of the bill, there is an estimate of 54 million could beuninsured by 2026 in case of implementation of the AHCA. The ACAhave provision to impose penalty on consumers who can afford to buyhealth insurance but do not do so, known as the individual mandatepayment. itâs paid when you file your federal tax return. Thispenalty can be either 2.5% of income up to the totalyearly premium or $695 per person up to $2,085, whichever ishigher. AHCA eliminates the individual mandate and offers anincentive to consumers who maintain insurance coverage: insurancecompanies can charge a 30% penalty who buy health insurance afterhad a gap in required coverage exceeding 63 days. The 30% penaltywould apply for 12 months. The ACA requires that all major healthpolicies sold to consumers offer coverage for 10 categories ofessential health benefits: Outpatient services, Emergency services, Maternity and newborn care, Hospitalization. Prescriptionmedication , Mental health and substance abuse services, Laboratoryservices. Pediatric services, Rehabilitation services, includingvision and oral. Preventative, wellness, and chronic diseasemanagement services. The AHCA eliminates these protections bygiving a waiver to define what they consider essential healthbenefits. States could allow insurance companies to sell plans thatdo not cover prescription drugs or maternity care. The ACA and AHCAhave the same rules for newborns. A baby can be added to familyexisting health insurance plan or can buy a new plan to give coverthe baby. AHCA is making major changes in the health insurance byreducing the requirements and making change in the structure oftotal offered government subsidies. On the analysis, the CBO hasreported the current changes would make health insurance moreaffordable for few customers. Obamacare: The ACA increased Medicaretaxes for the households having incomes above $250,000. Thelegislation gave some tax credits to middle-income earners to helpthem pay out-of-pocket health expenses. The AHCA repeals taxes ofprevious insurance plan. It was mandatory for the companiesemploying more than 50 employees to offer health insurance or pay apenalty. Trumpcare: The mandatory insurance of employees andpenalty has been repealed under Senate plan. Insurance fordependents under 26 (Obamacare) : It requires insurer that thechildren under the age of 26 are allowed to be covered under theparent's policy. Trumpcare: Well this requirement is not repealedby trump care. Trumpcare: Pre-existing condition coverage(Obamacare):The insurer is prohibited fromdenying coverage or charging more to individuals whohave pre-existing medical conditions. Trumpcare: Gives states theability to opt-out of requirements that insurers charge the samepremiums for healthy and sick customers. Women care (Obamacare): Itis mandatory for the insurance companies to provide core servicesincluding maternity care and contraceptives and the insurancecompanies are prohibited from charging women more than men for thesame health plan. Planned Parenthood receives federal funding forfamily planning and other medical services used by Medicaidrecipients. Abortion cannot be funded with federal dollars.Trumpcare: Insurance companies prohibited from charging women morefor health insurance, but states could apply for waivers that allowthem to drop coverage for maternity care and contraceptives. Thebill also bans women from using government money to buy plans thatcovers abortion and ends non-abortion Medicaid reimbursement toPlanned Parenthood, a non-profit group that provides abortionservices in some of its clinics, for one year. Older Americans(Obamacare):The insurer are not allowed to charge the olderAmericans more than three times the cost for younger Americans.Trumpcare: States can receive waivers to allow them to charge olderAmericans more. Insurance marketplaces (Obamacare) : The Obamacaremarketplaces, such as HealthCare.gov, enable people who don't gethealth benefits at work to compare plans, just as they mightcompare hotel rooms or airline tickets online. All plans on themarketplaces must offer a basic set of benefits, such as hospitalcare, mental health services and prescription drugs. Trumpcare:Under both the House and Senate bills, it is unclear how themarketplaces would work because insurers might potentially offerhealth plans that do not offer the same set of benefits.

PUBHLTH 122 Lecture 14: 2/24/17 Lecture Notes

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