What is the Affordable Care Act (ACA)?
a law consisting of two pieces of legislation that are collectively referred to as "Healthcare Reform" or
... [Show More] "Obamacare"
What are the individual laws that make up the ACA?
1. The Patient Protection and Affordable Care Act (PPACA), enacted on March 23, 2010
2. The Health Care and Education Reconciliation Act (HCERA), enacted on March 30, 2010
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What is the main objective of the ACA?
to expand health insurance coverage to an estimated 32 million uninsured Americans and strengthen existing coverage
What does the ACA do?
- increase benefits and lower costs for consumers
- provide new funding for public health and prevention
- bolster health care and public health workforce and infrastructure
- foster innovation and quality in our system
What points encompass the Patient's Bill of Rights?
- Coverage
- Costs
- Care
What are the main ideals of Coverage?
- ends preexisting condition exclusions for children
- keeps young adults covered
- ends arbitrary withdrawals of insurance coverage
- guarantees the patient's right to appeal
What are the main ideals of Costs?
- ends lifetime limits on Coverage
- reviews premium increases
- helps patients get the most from their premium dollars
What are the main ideals of Care?
- covers preventive care at no cost to patients
- protects the patient's choice of doctors
- removes insurance company barriers to emergency services
What are the 10 essential health benefits?
1. Ambulatory Patient Services
2. Emergency Services
3. Hospitalization
4. Maternity and Newborn Care
5. Mental Health and Substance Use Disorder Services
6. Prescription Drugs
7. Rehabilitative and Habilitative Services
8. Laboratory Services
9. Preventive and Wellness Services and Chronic Disease Management
10. Pediatric Services
As of April, 2014, how many individuals were eligible to enroll in a Marketplace Plan in the U.S.? Florida?
U.S. = 13,547,592
Florida = 1,603,575
As of April, 2014, how many individuals had selected a Marketplace Plan in the U.S.? Florida?
U.S. = 8,019,763
Florida = 983,775
As of April, 2014, how many individuals could potentially enroll in Marketplace Coverage in the U.S.? Florida?
U.S. = 28,605,000
Florida = 2,545,000
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As of April, 2014, how many uninsured individuals were eligible for Medicaid under the ACA in the U.S.? Florida?
U.S. = 8,748,000 adults & 5,220,000 children
Florida = 94,000 adults & 362,000 children
As of April, 2014, how many adults were in a Coverage Gap in the U.S.? Florida?
U.S. = 4,831,580
Florida = 763,890
According to the ACA in 2010, insurance companies will no longer be able to do what?
- deny coverage to children with pre-existing illnesses
- rescind coverage due to an error on a customer's application
- impose lifetime dollar limits on essential benefits
- impose annual dollar limits on insurance coverage
What benefits were allowed to consumers by the ACA in 2010?
- consumers had the right to appeal insurance company decisions
- uninsured Americans with preexisting conditions could access insurance coverage
- the establishment of consumer assistance programs
In 2010, what was provided to seniors in the Medicare prescription drug "Donut Hole"?
a $250 rebate check
In 2010, what were tax credits provided to?
small business health insurance
In 2010, what were new plans required to cover?
free preventive care
In 2010, the ACA also began focusing efforts on what?
cracking down on healthcare fraud
In 2010, what were the main guarantees of the ACA?
- extending coverage for young adults until age 26
- expanding coverage for early retirees
- rebuilding of the primary care workforce
- insurance companies are held accountable for rate hikers
- Medicaid expansion for states
- increased payments for rural healthcare providers
- strengthening of community health centers
What benefits were guaranteed for senior citizens by the ACA in 2011?
- 50% off for Medicare Part D brand name drugs
- free preventive care
- community care transitions program for high Medicare beneficiaries
What was established by the ACA in 2011?
the Center for Medicare & Medicaid Innovation and the Community First Choice Option
What does the Community First Choice Option allow?
states to offer home and community-based services to disabled individuals
In 2011, in what ways were prices reduced for consumers?
- health care premiums were reduced
- overpayments to big insurance companies were stopped
Health Care Premiums were reduced in 2011, but in what way?
at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on healthcare quality improvement
How was Medicare Advantage strengthened in 2011?
enrollees were able to receive all guaranteed Medicare benefits while also having bonus payments for high quality care provided for
In what way were payments linked to quality outcomes by the ACA in 2012?
financial incentives were provided to hospitals to improve the quality of care provided to Medicaid patients
How were care organizations for physicians made accountable in 2012?
- they were able to better coordinate and improve patient care and quality
- help prevent disease and illness
- reduce unnecessary hospital admissions
In 2012, how did the ACA improve the understanding of health disparities?
by collecting and reporting racial, ethnic, and language data
What new ACA policies came into effect in January of 2013?
- new funding to state Medicaid programs covering preventive services
- establishment of a national pilot program to improve coordination and quality of patient care (runs on a flat fee)
- increased Medicaid payments for primary care doctors
When did open enrollment in the health insurance marketplace begin?
October 1, 2013
What ACA policies were changed in January of 2014?
- discrimination due to preexisting conditions or gender were prohibited
- annual limits on insurance coverage were eliminated
- individuals participating in clinical trials are ensured
- healthcare was made more affordable for middle class
How was healthcare made more affordable for those in the middle class?
tax credits became available for people with an income between 100% and 400% of the poverty line who were not eligible for other afforable coverage
What was established in 2014?
the Health Insurance Marketplace
What option did a patient have if their employer did not offer them with insurance?
they could buy it directly from the Health Insurance Marketplace
What was increased in 2014?
- the small business tax credit
- access to Medicaid
How was access to Medicaid increased?
people earning less than 133% of the poverty level (about $14,000 for an individual and $29,000 for a family) were eligible to enroll in Medicaid
What was the goal of the ACA in 2014?
to promote individual responsibility
What will become effective in January of 2015?
physicians will be paid based on value rather than volume based on a new provision
How will the new provision for physician payment work?
physicians who provide higher quality care will receive higher payments than those who provide lower quality care
When did the ACA require most individuals to have health insurance or health coverage by?
January 1, 2014
How can health insurance by obtained?
Through an employer or individual health plan
How can health coverage be obtained?
Through programs such as:
- Medicare, Medicaid, Florida Healthy Kids
- Tri-Care, federal employee health benefit plans
- Veteran's Health Care, Indian Health Services (IHS)
What were some exceptions to the ACA's healthcare reform deadline?
- individuals at or below 100% of the federal property level and eligible for Medicaid Expansion
- individuals for whom coverage would be unaffordable
- under a hardship which prevents the consumer from obtaining health coverage
- undocumented immigrants
- individuals that are members of the healthcare sharing ministries as well as the Amish, Mennonite, and Indian tribe communities
What was the consequence for people who did not meet the health coverage deadline and were not exempt from the federal requirement?
they were subject to a Shared Responsibility Payment collected by the Internal Revenue Service (IRS)
When would individuals who did not meet the deadline NOT have to make a payment?
- when the coverage was unaffordable for them
- when they spent less than three consecutive months without coverage
- when they qualified for an exemption
What was the total annual tax penalty for the eligible who did not meet the deadline?
the greater amount of either a flat dollar amount or a percentage of taxable income
- $95 per person or 1% taxable income for 2014
- $326 per person or 2% taxable income for 2015
- $695 per person or 2.5% taxable income for 2016
What happens to the tax penalty after 2016?
it will increase annually based on a cost of living adjustment
How does the ACA affect women and families?
by protecting them from the worst insurance company abuses, making healthcare more affordable, and giving people better access to care (through preventive benefits and coverage for preexisting conditions)
How does the ACA affect young adults?
by expanding affordable options for health insurance and giving hardworking families security (through coverage) and important new benefits (through preventive services)
How does the ACA affect seniors?
will help save them money ensure that people with Medicare can see a doctor that they know and trust
What will the ACA do for seniors?
- provide cheaper prescription drugs
- end limits on care
- provide free preventive services
- better coordinate care
- fight fraud
- protect medicate benefits
How does the ACA affect employers?
makes it easier for businesses to find better coverage options while also building on the employer-based insurance market that is already in place, giving the consumer and business owner more control while making healthcare coverage more afforable
How does the ACA affect healthcare providers?
by holding health insurance companies accountable, protecting providers and patients, while also guaranteeing choice and control (through the provision of opportunities and incentives to coordinate care and by strengthening the workforce)
How does the ACA hold health insurance companies accountable?
by reducing the burden of uncompensated care on physicians and hospitals by making access to care easier and more affordable
How does the ACA affect people with disabilities?
by ending insurance company abuses and discrimination against preexisting conditions, expanding affordable coverage, and through the creation of new long-term and community-based care options
Why do we need the Affordable Care Act?
to help minimize the high uninsured rate, unsustainable spending, poor health outcomes, lack of preventative emphasis, and health disparities
According to the Congressional Budget Office, how many Americans were uninsured in 2012?
about 55 million under the age of 65
(1 in 5 people)
Why do the uninsured usually face higher treatment costs?
they are less likely to receive preventive care and less likely to seek care when they are sick or injured, resulting in higher overall costs
In 2012, how much of the U.S. gross domestic product (GDP) was represented by healthcare?
16.9%
How much is the GDP expected to reach by 2020?
20%
What was life expectancy in the U.S. in 2011?
78.7 years
Where does the U.S. rank among Organization for Economic Cooperation and Development (OECD) countries?
27th [Show Less]