Questions and Answer
CollegeStudent R
M5HCReformMedMedcarRecoveredoct120134.pptHealth Care Reform, Medicaid and Medicare
Why Needed, Barriers, and the Affordable Care Act of 2010
Why Reform Needed?
- U.S. Spends 17.6% of Gross Domestic Product (GDP), more than any other developed nation, to get poorer outcomes (infant mortality, life expectancy) than countries that spend less
- Thousands have limited access to care
- Thousands have no insurance to finance care
Barriers to reform
- No clear goals, philosophy, or consensus on what or how
- Less support in U.S. for single payer like other nations
- No constitutional mandate
- Federal/state constitutional roles limit actions
- Politics and interest groups
- Path dependency
Previous Efforts
- Truman in 50’s after WWII
- Nixon liked HMO idea as profit making
- LBJ did Medicaid and Medicare 1965
- Clinton, never got started stopped by pharmacies, insurers, and other interest groups (90’s)
Previous Efforts (Con’d)
- Reagan fought against any government involvement in healthcare viewing it to be “socialized medicine”
- Some administrations viewed healthcare as a market commodity to be left to each individual and not needing government involvement
Why did President Obama succeed with ACA?
- Democrats had control of House of Representatives, Senate, and White House
- Managed the threat of interest groups
- Pragmatism of the President
- Proposed national ACA was like one that had bi-partisan support successfully implemented in Massachusetts in 1996 signed by Mitt Romney as Governor, who became 2012 Republican Presidential & against the ACA
Features of ACA of 2010
- Have insurance or pay tax or fine. Federal government can tax, but not mandate insurance. Repealed in Republican tax law Jan 2019.
- State exchanges allow affordable insurance
- Employers mandated to offer insurance
- Private market insurance provisions
- Pre-existing conditions & Lifetime limits banned
- Dependent care to age 26 added
ACA
Insurers must spend 80%/90% income from premiums on care or must give rebate to insured
- Taxes on tanning beds, some equipment
- Insurance plans must cover minimum prevention measures and assessments at no cost to consumer
- Hospital reimbursement rates reduced if patient return rates are high
ACA
- Quality and Prevention incentives
- Practitioners reimbursed to give end of life consultations (not death panels as critics claimed)
- Sharing of best practices among practitioners (not rationing as critics claimed)
- See videos at Kaiser Family Foundation website ( overall and on health exchanges)
Political, Legal, or Health Issue?
- Republican controlled House of Representatives voted to repeal ACA 60+ times, stopped by Senate Democrats
- Some Republican controlled states still refuse to expand Medicaid in their states even when100% financed by federal government (TN is one).
- Many Republican controlled states still allow federal government to run health exchanges in their state, not running their own.
Future of ACA
- Republican critics of ACA worried public would learn to like ACA if it actually experienced its benefits. Republicans under Trump controlling government were unable to repeal in 2017 seems to support that.
- ACA proponents seem determined to keep it intact, willing to improve, not delete it
- Deemed constitutional by Supreme Court, but challenges continue.
Legal Challenges to ACA
- Hobby Lobby, et al
- Sued to get exemption from financially supporting contraception as a for-profit employer
- Not for profit 501 (C) (3) corporations already exempt from contraception provision before Hobby Lobby filed
- Does federal government have a compelling interest to mandate corporation to provide insurance over corporate religious objections?
Challenges to ACA
- Hobby Lobby, et al determined by Supreme Court to be exempt as for profit employer from participating in providing or financing employees insurance that includes contraceptives.
Legal Challenges to ACA
- Does the ACA only mentioning state run exchanges can subsidize insurance mean that federally run health insurance exchanges cannot offer subsidies?
- Court concluded an entire reading of the language and intent of the ACA is to promote insurance coverage, so subsidies were intended to be offered in both state and federal health insurance exchanges.
Trump Administration Erosion of ACA
- 90% reduction ACA enrollment notice money
- Removed financial incentives to insurance companies to accept higher risk insured in exchanges
- Removed subsistence to individuals not eligible for Medicaid, in exchanges earning $10-40 K
Legal Challenges to ACA
- In 2019 Republicans eliminated tax on those not having insurance, making the rather than a constitutional federal tax.
- In 2020 Republican states (led by Texas) sued arguing the total ACA is now unconstitutional if mandate without a tax is unconstitutional.
- Case is being argued at lower level courts, but likely to come before Supreme Court 2021
ACA future
- Was functioning prior to Trump Administration, despite political rhetoric
- Critics unable to repeal, so effort now is openly try to undermine ACA
- Despite rhetoric to replace, no evidence from critics of a replacement
- Just using administrative rule changes and removing a tax, health system in U.S. goes back to pre-2010 pre ACA status
- Next administration can promote ACA or not.
Future of ACA
- Using administrative rules to limit enrollment and eliminate subsidies to providers and enrollees, the Trump administration has openly engaged in trying to sabotage the ACA.
- Some states have supported that effort.
- Others seeing benefits of ACA have resisted efforts to undermine the law, continuing to use and support the law still in place.
- Updated 7/10/20
