Chapter 5 Health Care Reform - VOCABULARY Flashcards

Vocabulary flashcards covering key terms and concepts related to the Affordable Care Act and health care reform.

Affordable Care Act (ACA)

The 2010 U.S. health reform law designed to expand insurance coverage, slow cost growth, and improve health care quality and efficiency.

Health Insurance Marketplace (Marketplace) / Health Exchange

Online marketplace to compare and purchase ACA-compliant insurance; may be state-based or federally run.

HealthCare.gov

The federal website for applying for health insurance and learning about ACA options.

Medicaid expansion

Expansion of Medicaid eligibility to nonpregnant adults under 65 with incomes up to 138% of the federal poverty level (FPL); not all states chose to expand.

Federal Poverty Level (FPL)

A measure of income used to determine eligibility for ACA subsidies and Medicaid.

138% of FPL

Income threshold for Medicaid expansion under the ACA.

State-Based Marketplace (SBM)

A state-run health insurance marketplace offering ACA options.

Federally Facilitated Marketplace (FFM)

Marketplace run by the federal government in states that did not establish an SBM.

FFM-P (Marketplace partnership)

Marketplace operated in partnership between state and federal government.

Navigators

Individuals/organizations funded by the ACA to help people enroll in a Qualified Health Plan in the Marketplace.

Qualified Health Plan (QHP)

An ACA-compliant health insurance plan offered in the Marketplace that covers essential benefits.

Premium subsidies / Advance Premium Tax Credit (APTC)

Financial assistance to lower monthly premiums for incomes between 100% and 400% of the FPL.

Cost Sharing Reductions (CSR)

Subsidies lowering out-of-pocket costs for people with incomes between 100% and 250% of the FPL.

Preexisting conditions protection

ACA provision prohibiting denial of coverage or higher rates due to preexisting conditions.

Young adults up to age 26 on parents’ policy

Policy allowing young adults to remain on their parents’ health insurance until age 26.

Essential Health Benefits (EHB)

A standard set of health services required in all Qualified Health Plans.

Primary care workforce expansion

ACA initiatives to increase the number of primary care clinicians (physicians, NPs, PAs) through scholarships and loan repayment.

Federally Qualified Health Centers (FQHCs)

Community health centers expanded under the ACA to improve access to primary care.

Accountable Care Organization (ACO)

Medicare payment reform where providers are rewarded for lowering costs while maintaining quality.

Center for Medicare and Medicaid Innovation (CMMI)

CMS center that tests new payment and service delivery models.

Hospital Readmission Reduction Program (HRRP)

Program penalizing hospitals for higher readmission rates to improve care quality and efficiency.

Individual mandate elimination

The ACA requirement to maintain minimum essential coverage was effectively repealed/eliminated by the 2017 Tax Cuts and Jobs Act.

NFIB v. Sebelius (2012)

Supreme Court decision upholding the ACA's constitutionality while allowing states to opt out of Medicaid expansion.

King v. Burwell (2015)

Supreme Court decision upholding premium subsidies for policies purchased in the Federal Marketplace.

Burwell v. Hobby Lobby Stores (2014)

Supreme Court decision allowing certain employers with religious objections to opt out of contraception coverage.

Little Sisters of the Poor v. Pennsylvania (2020)

Supreme Court ruling permitting exemptions from contraception coverage for religiously affiliated entities.

Short-Term, Limited-Duration Insurance (STLDI)

Temporary health plans that are not ACA-compliant and have limited duration.

Contraceptive coverage requirement

ACA provision requiring many plans to cover women’s preventive services, including contraception.

Contraceptive coverage exemptions (2020 ruling)

Supreme Court ruling allowing broader exemptions from contraceptive coverage for certain employers.

Uninsured rate under the ACA

The share of Americans without health insurance fell significantly after 2010, reaching about 8.5% by 2018 (and 5.5% for children under 19).

Coverage gap in non-expansion states

In states that did not expand Medicaid, some individuals earn too much for Medicaid but too little to qualify for Marketplace subsidies.