In the constant effort to improve the course and its tools,

Heathersimf

PPT-Slides-CH10-4th.pdf

Home >Science homework help >In the constant effort to improve the course and its tools,

Chapter 10

Health Reform in the United

States

Chapter Overview

• Discusses the history of health reform in the United States and details the key provisions of the Affordable Care Act (ACA)

• Focuses on: – Previous attempts at national health reform – Why health reform is difficult to achieve – The passage and provisions of the ACA

Health Reform

• There have been numerous health reform attempts in the United States. – Prior to 2010, all attempts at national health reform

to create universal or near-universal coverage have failed

– Some successes at the state level

Health Reform—Difficulty of Reform in the United States

• Individualistic culture • Dislike of big government • Lack of consensus • Federal system rules and structure make it

difficult to achieve major reform • States generally home to social welfare issues • Powerful interest groups against national health

reform • Path dependency

Health Reform—Key Failed Attempts at National Health Reform

• 1912 Progressive Party candidate Teddy Roosevelt supported social insurance platform that included health insurance

• 1915 American Association for Labor Legislation proposal for working-class health insurance

• President Truman supported national health reform upon taking office, won re-election on national health insurance platform in 1948

• President Nixon: initial health reform proposal in 1969 and revised proposal in 1972

• President Clinton Health Security Act in 1993

The Affordable Care Act (1 of 3)

• Why did the ACA pass when so many prior attempts had failed? – Commitment and leadership – Learned lessons from past failures – Political pragmatism

The Affordable Care Act (2 of 3)

• Individual mandate—most people have to purchase health insurance or pay a penalty starting in 2014 – Exemptions for certain populations and based on

affordability – Penalty for individual mandate repealed in 2017 Tax

Cut and Jobs Act • Controversy

– Too much government interference in private lives? – Constitutional?

The Affordable Care Act (3 of 3)

• State Health Insurance Exchanges – American Health Benefit Exchanges for

individuals – Small Business Health Options program for small

businesses • Effectively ended in 2018; may be revised

– Must offer essential health benefits (abortion compromise)

– Four cost levels for plans based on actuarial value

ACA: Premium and Cost Sharing Subsidies

• Premium tax credits available for individuals who purchase insurance in an exchange and have income between 133% and 400% of poverty

• Cost-sharing subsidies available for individuals who purchase insurance in an exchange and have income up to 250% of poverty

• To qualify, must be a U.S. citizen or legal resident, not eligible for any type of public insurance, and not have access to employer-sponsored insurance

ACA: Employer Mandate

• In 2014, employers with 50 or more employees must provide affordable health insurance or pay a penalty. – Insurance is affordable if it has an actuarial value

of at least 60% or is not more than 9.5% of an employee’s income.

– Penalty is per employee after first 30 employees.

The Affordable Care Act (ACA) (1 of 2)

• Private insurance market changes – No preexisting condition exclusion – Dependent coverage to age 26 – Preventive services without cost sharing – Prohibitions against lifetime and annual coverage

limits – No rescission without fraud – New appeals process – Premium rate reviews

The Affordable Care Act (ACA) (2 of 2)

• Private insurance market changes (cont.) – Guaranteed issue and renewability – Rate variation limits – Essential health benefits – Wellness plans

• Some plans may be grandfathered in and not subject to all of these changes

ACA: Financing Health Reform (1 of 2)

• Changes to Medicare provider reimbursement • Changes to Medicare Advantage

reimbursement • Medicare Part A increases for high earners • Changes in Medicare Part D subsidies • Changes in Medicare employer subsidy

ACA: Financing Health Reform (2 of 2)

• Changes in disproportionate share payments • Increase Medicaid prescription drug rebate

paid by manufacturers • Income tax code changes • Health industry fees • Tax on high-cost health insurance plans

Slide Number 1
Chapter Overview
Health Reform
Health Reform—Difficulty of Reform in the United States
Health Reform—Key Failed Attempts at National Health Reform
The Affordable Care Act�(1 of 3)
The Affordable Care Act�(2 of 3)
The Affordable Care Act�(3 of 3)
ACA: Premium and Cost Sharing Subsidies
ACA: Employer Mandate
The Affordable Care Act (ACA)�(1 of 2)
The Affordable Care Act (ACA)�(2 of 2)
ACA: Financing Health Reform�(1 of 2)
ACA: Financing Health Reform�(2 of 2)