Health Care Policy and the Affordable Care Act 093025

These flashcards cover key concepts related to health care policy and the Affordable Care Act, focusing on access, costs, Medicaid expansion, and insurance requirements.

What does access in health care refer to?

The ability to obtain personal health services that are needed, affordable, convenient, acceptable, and effective.

What are the three goals used to evaluate the health care delivery system?

Increase access, reduce costs, and improve quality.

What does the macro-level cost of health care refer to?

The proportion of the total healthcare expenditures that make up the gross domestic product.

What is the individual mandate in the context of the Affordable Care Act?

A requirement that every individual must have health insurance or face a penalty.

What was a major issue pre-Affordable Care Act regarding insurance coverage?

48 million people were uninsured.

What does Medicaid expansion involve?

Expansion of Medicaid eligibility to adults with incomes up to 138% of the FPL.

What are Health Insurance Exchanges?

Websites for consumers to shop and apply for health insurance.

What is one requirement of plans offered through Health Insurance Exchanges?

Guaranteed issue and renewability.

How does the ACA aim to address pre-existing conditions?

No exclusions for pre-existing conditions in health coverage.

What is a Premium Tax Credit?

A subsidy that reduces enrollees’ monthly payments for insurance plans purchased through the Marketplace.

What income range qualifies for Premium Tax Credits under the ACA?

Household income between 100% and 400% of the Federal Poverty Level (FPL).

What is the purpose of cost-sharing subsidies?

To reduce enrollees’ out-of-pocket costs when they use health care services.

What is the Medical Loss Ratio (MLR) required by the ACA?

A minimum of 80% of premiums must be spent on health care services.

What is included in the essential health benefits mandated by the ACA?

Coverage for 10 essential health benefits including preventive services and chronic disease management.

What year did the individual mandate take effect?

January 1, 2014.

What change occurred to the individual mandate in 2017?

It was repealed under the Trump administration.

What demographics experienced the highest uninsured rates according to the 2008 survey?

Those aged 18-24 years experienced the highest uninsured rate of 28.9%.

What does the term 'Employer Mandate' refer to under the ACA?

Large employers may face penalties if they do not provide affordable coverage to full-time employees.

How many states had adopted Medicaid expansion as of September 2025?

41 states, including DC.

What happens to the coverage gap in non-expansion states?

Approximately 2.8 million adults aged 19-64 are in the coverage gap.