Health Care Policies: Week 5 Patient Protection and Affordable Care Act: Description and Policy Analysis: Chapters 9 & 10 Objective: What is Policy Analysis? Policy recommendations, or simply writt
Chapter 9: Health Reform in the United States Chapter Overview • Chapter 9 discusses the history of health reform in the United States and details the key provisions of the Affordable Care Act (ACA) • Chapter 9 focuses on:
– Previous attempts at national health reform – Why health reform is difficulty to achieve – The passage and provisions of the Affordable Care Act Health Reform • There have been numerous health reform attempts in the U.S.
– Prior to 2010, all attempts at national health reform to crate universal or near -universal coverage have failed – Some successes at the state level Health Reform – Difficulty of Reform in the U.S. • 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 (ACA) • Why did the Affordable Care Act pass when so many prior attempts had failed?
– Commitment and leadership – Learned lessons from past failures – Political pragmatism The Affordable Care Act (ACA) • Individual Mandate: most people have to purchase health insurance or pay a penalty starting in 2014 – Exemptions for certain populations and based on affordability • Controversy – Too much government interference in private lives? – Constitutional? The Affordable Care Act (ACA) • State Health Insurance Exchanges – American Health Benefit Exchanges for individuals – Small Business Health Options program for small businesses – Must offer essential health benefits (Abortion compromise) – Four cost levels for plans based on actuarial value The Affordable Care Act (ACA): Premium and Cost Sharing Subsidies • Premium tax credits available for individuals who purchase insurance in an exchange and have income between 133% – 400% of poverty • Cost sharing subsidies available for individuals who purchase insurance in an exchange and have income up to 250% of poverty • To quality, must be a US citizen or legal resident, not eligible for any type of public insurance, and not have access to employer -sponsored insurance The Affordable Care Act (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) • Private Insurance Market Changes – No pre -existing 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) • 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 The Affordable Care Act (ACA): Financing health reform • 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 The Affordable Care Act (ACA): Financing health reform • 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
