PHTH 1260 Study Guide - Final Guide: Patient Protection And Affordable Care Act, Private Good, Community Rating

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greenduck662

30 Apr 2019

School

Northeastern University

Department

Public Health

Course

PHTH 1260

Professor

Ranjini Ghosh

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Document Summary

There are many important aspects of the aca. The most important would include the individual mandate, employer mandate, medicaid expansion, and state exchanges. The individual mandate simply meant that the aca made it illegal for uninsured people to not be covered. That meant, if you were one of the many uninsured people in the u. s. you had to get your insurance through an employer, or through state exchanges. Employer mandate meant that any business with over. 50 employees had to provide health insurance to full time employees. The health insurance companies did appreciate these two aspects of the aca, because it meant more customers and therefore more money for them. Exchanges are an online database that allows citizens to research and get a health insurance plan that works for them. Without these exchanges (or the obamacare website), many uninsured people would stay uninsured. Another important aspect of the aca is medicaid expansion.

Related Questions

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.

Case Study: Price Discrimination in Practice

What do American Airlines, Walgreens, Staples, Stanford University, AT&T, the Mayo Clinic, and Safeway have in com-mon? They all price discriminate (Valentino-Devries, Singer-Vine, and Soltani 2012). They charge different customers different amounts for the same product.Pharmaceutical discounts are the clearest examples of healthcare price discrimination because the products are identical. Only the prices differ. A cash customer (e.g., someone without insurance coverage) would pay the highest price, the list price. Most customers pay much less than list price. Insurers negotiate discounts with manufacturers and pharmacies. These discounts are typically about 30 percent (Herper 2012). Some hospitals and HMOs have their own pharmacies and can negotiate even better deals with manufacturers. These organizations sometimes pay as little as 40 per-cent of list price. Most discounts come in the form of rebates, meaning that a purchaser pays the list price up front but gets a payment from the seller later. This process makes resale more difficult and limits price transparency (Morgan, Daw, and Thomson 2013). The federal government has multiple discount programs. The larg-est is the Medicaid rebate program, which requires manufacturers to pay a rebate that varies by the type of drug. Prices, formularies, and copayments vary from state to state, so whether the Medicaid rebate program covers the most effective medications or gets the best prices is not clear (Millar et al. 2011). Many federally funded clinics and hospitals are eligible for the Medicaid discount. However, these agencies can often negotiate better deals because they can buy wholesale and because they can choose drugs for their formularies. Tribal and territorial governments can use the prices on the Federal Supply Schedule, which federal agencies use to buy common supplies and services. The Department of Defense, the Department of Veterans Affairs (VA), the Public Health Service, and the Coast Guard may get prices that are slightly lower than the Federal Supply Schedule because of a provision called the federal ceiling price . This provision caps the price using a formula based on private-sector transactions. Finally, these agencies can try to negotiate prices below the federal ceiling price. The VA, which uses a national formulary, has used its bar-gaining power to get substantially better prices. Frakt, Pizer, and Feld-man (2012) report that the VAâs prices are 37 to 44 percent lower than Medicare prices.

Discussion questions:

â¢ Why do drug firms give discounts voluntarily?

â¢ Do other healthcare providers routinely give discounts to some customers?

â¢ Why do the uninsured typically pay the highest prices?

â¢ Why would a hospital usually get a better price for a drug than an insurance company?

â¢ Why does the VA get such low prices?

â¢ Suppose a law was enacted that required drug manufacturers to give state Medicaid agencies the same price they negotiated with the VA. How would Medicaid and VA prices change?

â¢ Should Medicare adopt the VA formulary?

1. With regard to health care spending patterns, we can say that

A. Everybody demands the same basic level of health care

B. Health care spending varies dramatically according to governments willingness to pay for such services

C. Men demand much more medical care than women

D. The elderly need much less health care than adults do

E. Only a few people (less than 5 percent) consume more than half of all health care expenditures

2. Which of the following is the best example of a renewable resource?

A. Crude petroleum

B. The ozone layer in the atmosphere

C. Library book

D. Minerals