Affordable Care Act (ACA)

to ensure that all people obtain the health services they need without suffering financial hardship when paying for them

goal of universal coverage

physical accessibility

financial affordability

acceptability

3 main components

physical accessibility

patients can access care within a reasonable distance and reasonable amount of time (iron triangle-access)

financial affordability

patients can obtain care where the payment does not cause undue financial hardship (iron triangle-cost)

acceptability

patients are willing to seek services because of sufficient quality and trust in the system (iron triangle-quality)

universal coverage

USA is the only developed country without...

insurance is not affordable

primary reason why people are uninsured

low-income families with at least one worker

most insured are in BLANK

to fix people being uninsured due to pricing

-increase insurance coverage of US population

primary goal of ACA

-expansion of Medicaid eligibility to 138% FPL

-creation fo insurance marketplaces, with those people falling between 100-400% FPL qualifying for subsidies

2 mechanisms for ACA to increase insurance coverage

subsidies

tax credits or discounts

Medicare/Medicaid in 1965

ACA is the most significant overhaul of healthcare policy since introduction of....

the 2008 Presidential election

ACA was. a major topic during

pay a tax penalty

ACA added a requirement that Americans had to obtain health insurance or

exist anymore

individual mandate does not really BLANK

religious

those not lawfully present

incarcerations

members of Native American tribes

hardship waivers

short coverage gaps

exemptions to the individual mandate

expand state Medicaid programs

ACA allocated funds to BLANK

all individuals up to 138% FPL

Medicaid coverage mainly focused on pregnant women and children but it is now expanded to...

each state

medicaid was not mandatory and was up to...

41 states (including DC)

how many states have expanded their medicaid?

significant gaps in coverage

states that did not expand their medicaid...

health outcomes

economic outcomes

racial/ethnic disparities

medicaid expansions have significantly improved a variety of...

insurance marketplace

a website created by ACA for patients to shop for insurance, compare plans, and identify if they qualify for tax credits to help lower costs

only private insurance, not government programs like Medicaid/Medicare/CHIP

insurance marketplace is only for what kind of insurances?

insurance marketplace

several states run their own..

all US residents without coverage elsewhere

insurance marketplace is available to...

age

geography

tobacco use

individual vs. family

plan category

5 different variables that premium costs must consider

catastrophic

bronze

silver

gold

platinum

different categories for plans on insurance marketplace

catastrophic (HDHP)

health plan pays <60%

*only available if younger than 30 years old or hardship exemption

bronze

health plan pays 60% and patient pays 40%

silver

health plan pays 70% and patient pays 30%

gold

health plan pays 80% and patient pays 20%

platinum

health plan pays 90% and patient pays 10%

tax credits

ACA created BLANK for individuals between 100-400% FPL

close the coverage gap

tax credits were deigned to...

-medicaid up to 138% FPL

-tax credits on the marketplace for 100-400% FPL

In states that expanded Medicaid, people qaulify for either:

either as lower premiums for each month or as a tax return at end of the year

how can patients receive tax credits?

remain on their parents' coverage up until age 26

ACA mandated that insurance must allow dependents to....

18

what age would people lose coverage?

limited

options for healthcare coverage for young adults not in full-time employment was BLANK

control costs

reduce adverse selection

by getting more young and healthy patients covered by insurance helps to...

popular

dependent son insurance is very BLANK

deny an individual insurance coverage or determine premium costs

ACA made it illegal to BLANK or BLANK based on pre-existing conditions

popular

pre-existing conditions mandate was very BLANK

medical underwriting

insurance companies used to evaluate potential customers for pre-existing conditions via BLANK

higher premiums based on health status

waiting periods before coverage kicked in

complete denial of coverage

result of insurances looking at pre-existing conditions

equity and morality through the denial fo coverage to needy people

critics opposed the use of pre-existing conditions due to concerns with...

preventative health services with no copay or coinsurance

ACA mandated that insurance policies must cover...

healthier population over time

less long-term complications of chronic disease

better access to preventative care leads to BLANK and BLANK

adults

women

children

preventative services covered include but are not limited to:

contraceptives/counseling with no copay or coinsurance

ACA mandated that insurance policies must cover...

erratic

previously, contraceptive coverage was BLANK based on insurance policy

reduce costs

improves health

provides people with better control over family and economic planning

access to contraceptives ultimately...

-barrier methods (diaphragms and sponges)

-hormonal methods (birth control pills and vaginal rings)

-implanted devices (intrauterine devices (IUD))

-emergency contraception (Plan B and ella)

-tubal ligations

-instruction in fertility awareness-based methods

-patient education and counseling

methods of contraception that are fully covered include:

-vasectomies

-drugs to induce abortions (abortifacients) and surgical abortions

methods with NO mandated coverage include:

women's stuff was always undercovered while vasectomies stuff was usually covered so this balances it out

why are most contraceptive methods specific to women?

limits

the ACA eliminated placing annual/lifetime BLANKS on insurance policies for essential health benefits

annual

total amount spent in one year

lifetime

total amount spent during plan enrollment

dollar limits

policies used to specify BLANK up to which they would provide coverage

pay higher premiums

to increase limits, patients had to BLANK

essential health benefits

the ACA now has mandated basic services which must be covered without limits in coverage

ambulatory patient services (outpatient care)

emergency services, hospitalizations (such as surgery)

pregnancy, maternity, and newborn care

mental health and substance use disorders

prescription drugs

rehabilitative and habilitative services and devices

laboratory services

preventive and wellness services and chronic disease management

pediatric services

examples of essential health benefits

incrementally

the ACA BLANK the Medicare part D donut hole

accountable for quality of care

ACA created programs to make hospitals more BLANK by leveraging Medicare payments

public

hospital performance is required to be made BLANK

readmissions reduction program

aims to reduce readmissions for specified conditions (AMI, HF, CABG, COPD, pneumonia, hip/knee replacements)

hospital-acquired condition reduction program

aims to reduce preventable conditions form occurring (infections, falls, pressure ulcers, hematomas)

Accountable care organizations (ACO) payment models

ACA incentivized opportunities for insurers and providers to use BLANK

groups of doctors, hospitals, and other health care providers, who provide coordinated high-quality care

who may use ACO payment models

pay for performance

another name for ACO payment models

significant cost savings primarily driven by decreases in inpatient utilization

benefits of using ACO

national federation of Independent Business vs Sebelius (2012)

argued that the ACA was violating the "necessary and proper clause" in the constitution and that the federal government can't compel states to do certain things

-can the law require citizens to purchase health insurance?

mandate upheld as a taxation power of the federal government

outcome of national federation of Independent Business vs Sebelius (2012)

burwell vs hobby lobby (2014)

for-porfit corporations with religious owners argued the conceptive mandate asking for exemptions like religious institutions

-can the law require all employers to cover contraceptives?

corporations have the choice of whether to include contraceptives in their insurance based on religion

outcome of burwell vs hobby lobby

King vs Burwell (2015)

ACA mandated creation of "state-based insurance exchanges" but many states opted to use a coordinated federal exchange instead

-are state and federal insurance exchanges the same?

subsidies regardless fo federal vs state exchange

outcome of king vs burwell