Chapter 5: Healthcare Reform

• President Obama signed health care reform legislation into law in March 2010.
• A decade after the ACA was passed, what percent of Democrats had a favorable opinion of the ACA?

  86%
• A decade after the ACA was passed, what percent of Republicans had an unfavorable opinion of the ACA?

  70%
• With the election of a Republican president in 2016, the law was threatened with being overturned
• The US Supreme Court held initial hearings on the fate of the ACA on?

  November 10, 2020 and June 17, 2021.
• What was the average cost of health care per person in the US in 1970?

  $355
• What was the average cost of healthcare per person in the US in 2010?

  $8,402
• What was the average cost of healthcare per person in 2018?

  $11,172
• After implementation of the ACA, the primary source of health insurance continued to be the employer for 55% of Americans
• What can small businesses use to offer insurance to their employees?

  SHOP
• The most important parts of the ACA started?

  January 1, 2014 (When health insurance coverage became effective for those purchasing insurance through the marketplace)
• Obtaining Health Insurance Coverage after the ACA through an Employer

  Most large companies offer health benefits, the same as before ACA. For new small business markets, SHOP offers insurance for businesses with up to 100 employees
• Obtaining Health Insurance Coverage after the ACA through direct enrollment


  Consumers buy coverage directly from private insurers with new consumer protections
• Obtaining Health Insurance Coverage after the ACA through your parents

  Young adults can remain on their parents' health plan until 26
• Obtaining Health Insurance Coverage after the ACA through the Marketplace

  Consumers shop for private plans with different cost sharing through a State-Based Marketplace or the Federally Facilitated Marketplace. Based on income, consumers can also apply for Medicaid or CHIP
• Obtaining Health Insurance Coverage after the ACA through Medicaid

  Medicaid coverage expanded in 38 states and D.C.
• Navigators work for Health Exchanges to?

  assist consumers in selecting and enrolling in health plans
• With the ACA, employers with 50 or more employers were required to provide health insurance for employees
• What fine was triggered if a full-time employee was receiving a Marketplace premium subsidy and why?

  The Employer Shared Responsibility Payment (ESRP) was triggered because the employer is required to provide health insurance for employees
• The IRS allows premium subsidies to be purchased through any Marketplace: SBM, FFM, or FFM-P
• The majority of newly insured were?

  Latinos as well as low and middle-income adults who lived in states that expanded Medicaid
• As of August 2020, Medicaid expansion has been adopted in 38 states and Washington DC, with expansion yet to be implemented in two of the 12 states and 12 states that were not expected to expand Medicaid
• An estimated 2 million people were not able to obtain government-sponsored health care in states that didn't expand Medicaid because of income guidelines for both Medicaid and premium subsidies for those purchasing health insurance through Health Exchanges
• In what year were all parts of the ACA completed?

  2018
• 2010: Adult children under 26 years of age are covered by parents' health insurance policy
• 2010: Pre-existing conditions could no longer be used to exclude applicants from obtaining health insurance (for example those with type 1 diabetes are able to obtain health insurance when changing jobs and insurance policies)
• 2010: Clinical preventive services were required by all health insurance policies (ex: contraceptives, immunizations, and cancer screenings)
• 2010: Scholarship and loan repayment program for student training: Physicians, nurses, and physician assistants
• 2010: Federally qualified health centers were expanded
• 2011: Limits on non medical spending by private health insurance plans to 15% of the cost of health insurance premiums
• 2011: The Center for Medicare and Medical Innovation was established to develop and evaluate new payment and delivery service models
• 2011: Pharmaceutical fees levied on drug manufacturers
• 2012: HRRP lowered Medicare payments to hospitals failing to meet the standard for readmission for three diagnoses: heart attack, stroke, and pneumonia
• 2012: Accountable Care Organizations: Incentives for healthcare providers (hospitals, clinics, physicians) to coordinate care to reduce costs and improve quality of care
• 2013: Electronic health records are required by private health insurers
• 2013: Payment reform: Pilot programs that bundle services (ex: surgery plus home care after surgery)
• 2014: Health Exchange established by individual states and the federal government for individuals with incomes between 100% and 400% of the FPL
• 2014: Medicaid expansion for individuals with incomes at 138% of the FPL living in states that chose to expand Medicaid
• 2014: Essential health benefits required by all health insurance policies sold through Health Exchanges
• 2014: Shared responsibility for coverage: Individuals must have health insurance or pay a penalty; employers with at least 100 employers must offer health insurance to employees