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Policy economics
1.
2. Public Health Insurance
Medicare
Health insurance for aged and disabled
Medicaid
Health insurance for economically disadvantaged
Indian Health Insurance
Veterans Administration Health Systems
3. Medicare Parts
A: pays for inpatient hospitalizations, hospice, home
health, and skilled nursing
B: pays for doctor appointments, outpatient patient services
C: Medicare Advantage Program
Expands beneficiaries options for participation in private sector
health care plans
D: helps pay for prescription drugs
8. Infrastructure
Nursing Homes
Majority are for-profit
Population
2.9% of over-65 individuals
10.7% of over-85 individuals
Women 67% of residents
15% under 65 years old
9. Private Health Insurance
Obtained as benefit of employment
Provided as group insurance
Managed care
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
10. Managed Care
HMO
Fee-for-service
reimbursement
Primary care provider
gatekeeper of care
Must get referrals for
specialty care
Access to providers and
hospitals in-network
PPO
Flexibility when choosing
doctor or hospitals
No referrals required
Higher premiums and
deductibles
11. Affordable Care Act (ACA)
Competitive health insurance marketplace
Provides access to group insurance
Comparison of plans
Financial assistance
End discrimination
Insurance companies can’t deny care based on health status,
gender, wages or preexisting conditions
Require coverage for preventative care and vaccines
12. ACA
Requires a minimum essential coverage
Requires inviduals and dependents to obtain health insurance
Non-compliant individuals face a tax penalty
Expands Medicaid and CHIP
Eliminates lifetime and annual limits on benefits
Extends dependent coverage to age 26 under parent’s plan
15. Safety Net Providers
Serve uninsured, underinsured low income Medicaid
recipients
Shortage of primary care providers
Due to low repayments thus lower salaries
Due to ACA, funding for these facilities may be
adversely affected
This will negatively effect the population served
16. References
Andrulis, D. & Siddiqui, N. (2011) Health reform holds both risks and rewards for safety net
providers and racially and ethnically diverse patients. Health Affairs: 30 (10) 1830-1836.
doi:10.1377/hlthaff.20112011.0661
Kaiser Family Foundation. Key facts about the uninsured population. KFF.org. Retrieved
from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy and politics in
nursing and health care (7th ed). St. Louis, MO: Elsevier Inc.
ObamaCare Facts. (2016). Affordable care act summary. Retrieved from
http://obamacarefacts.com/affordablecareact-summary/
Editor's Notes
This program was created as a portion of the 1965 Social Security Act (Mason, Gardner, Outlaw, & O’ Grady, 2016). Each part (A,B,C,D) pays for a different portion of medical care. Medicare is funded by nation’s revenue from taxes.
Medicaid is funded by state and federal government through taxes. With the Affordable Care Act the eligibility for Medicaid became broader, making more individuals eligible. By 2021, 77.9 million people are expected to be enrolled in Medicaid (Mason et al., 2016).
Created in 1997 funded by state and federal government funds (Mason et al., 2016).
Academic hospitals in comparison with community hospitals are teaching facilities. Academic health centers often provide services that other facilities do not. Academic health centers provide new interdisciplinary research models in knowledge management and information technology (Mason et al., 2016).
Many nursing homes eligible for both Medicaid and Medicare funding (Mason et al., 2016).
Private insurers regulated by states. Insurance companies operate like a business according to free market ideals (Mason et al., 2016). Managed care is a system used to contain the costs of health care.
The main objective of this law is to increase access to health insurance to more people. As well as try to contain health care costs (Mason et al., 2016). The ACA is expected to provide health insurance for an additional 36 million Americans (Mason et al., 2016). The marketplace can be accessed at healthcare.gov. All participants of the exchanges pay into it. Costs are contained by the plans having to compete for business (ObamaCare Facts, 2016). Some aspects of the act went into effect immediately in 2010 when it was signed, full implementation of the act is expected by 2023 (Mason et al., 2016).
The tax penalty in 2014 as $95 or 1% of income, increasing in subsequent years (Mason et al., 2016). Coverage can be obtained through employer-provided health insurance, state health exchanges, government programs as long as the insurance meets minimum essential coverage standards (Mason et al., 2016). Employers with more than 50 employees are mandated to provide minimum essential coverage. While employers with more than 200 employers must automatically enroll new employees in group insurance.
Despite the passage of the Affordable Care Act, many Americans remain without insurance. The reason cited is costs of insurance still remains too high. 28.5 million Americans remain uninsured (Kaiser Family Foundation, 2016).
This group of individuals are less healthy, more likely to forgo needed medical care, less likely to receive regular care, and are more likely to receive care in the emergency department than those with health insurance (Andrulis & Siddiqui, 2011). The Medicaid disproportionate share hospital program is being reduced by 18 million dollars through the ACA over a period of seven years (Andrulis & Siddiqui, 2011). This program subsidizes hospital, largely safety net hospitals for for unreimbursed care. Health care reform should reduce the need for these subsidies, but this is yet to be seen with many people still uninsured. For clinics that treat only patients with no health insurance, they may be harming the population they serve because they do not have the revenue to support infrastructure innovations such as electronic health records which help to coordinate care among multiple providers. Also with a decrease in federal funding, the quality of care and number of primary care providers will be compromised. This could result in subpar care. Without revenue these facilities may end up needing to close, completely closing off access to uninsured individuals.
