PPPM460 Lecture Notes Week1.pdf
PPPM460 Lecture Notes Week1.pdf PPPM 460
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This 3 page Class Notes was uploaded by Kaitlyn Endo on Friday September 25, 2015. The Class Notes belongs to PPPM 460 at University of Oregon taught by Nicole Ngo in Spring 2015. Since its upload, it has received 27 views.
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Date Created: 09/25/15
PPPM 460 Week 1 Monday s lecture continued History of EmployerSponsored Health Insurance Event 1 President FDR decided not to pursue universal health care coverage Event 2 Federal rules in the 19405 and 19505 0 Expand workers bene ts 0 Contributions by employers toward health insurance was not taxable By 2004 the tax bene t for employees was 1885 billion annuaHy 19401950 Enrollment in private health plans increased from 206 to 1423 million 1948 Pres Truman advocated for national health insurance but a strong insurance industry was already too developed strong lobby on behalf of medical Implications The private sector vs government quotCan employers alter hiring policies to cut health costsquot 0 Health care costs increasing 15 per year since 2002 0 Of 29 million customers 7 account for 63 of the company s medical costs 0 Try to alter health behaviors but becoming more punitive Wednesday Medicaid Medicaid established in 1965 0 Part of the Social Security Act Medical assistance for the o Poorest families with dependent children 0 Poor elderly dual eligible 0 Blind and disabled individuals gt62 million Americans more than 1 in 3 children CHIP 18 of population But Medicaid leaves out many of the poor 0 Exclude quotchildless adultsquot 0 Limited eligibility for parents 1 increase in the unemployment rate Medicaid enrollment grows by 1milion Changed with the ACA l Medicaid expansion address gaps in private health insurance 0 June 2012 when ACA went to court quotone individual mandatequot crucial for ACA to survive and Medicaid expansion How is Medicaid nanced o Federalstate partnership Each state designs and operates its own program within braod federal guidelines 0 Account for economic and demographic changes 0 Address emergent needs eg providing immediate short term bene ts for 0 Medicaid is the largest source of federal revenue owing in states Fed Medicaid dollars accounted for 44 of all federal grants to states in 2011 States spent 167 of their general funds on Medicaid 2nOI largest item in budgets Medicaid is a major engine in state economies Main source of nancing for safetynet providers 0 fed state partnership l fed govt matches above 50 depending on state Who does Medicaid cover 0 Sates must cover federal core groups of lowincome individuals and have broad exibility to expand coverage Pregnant women children parents elderly individuals and individuals with disabilities People within some of the federal poverty level FPL o FPL for family of 4 in 2014 was 23850 0 Standards depend on state but tend to be pretty strict 0 Many eligible people are not enrolled 85 of children 63 of adults overall 0 Why Some lowincome families are unaware more effective outreach in needed Documentation and other administrative requirements 0 Premiums and cost sharing State s choice to charge premiums and cost sharing out of pocket requirements Medicaid and ACA 0 Under the ACA the federal match rate for newly eligible adults is 100 in the rst 3 years and equal or more than 90 thereafter With respect to expansion it wouldn t have cost too much for states it would have fallen on fed govt for newly included individuals 00000 If any states implemented the Medicaid expansion the federal government would nance 93 of the total increase in Medicaid spending between 20132022 Burden on fed govt again for funds for newly eligible individuals Highest cost 5 of Enrollees account of over half of Medicaid spending A number of states challenged the constitutionality of the ACA in National Federal of Independent Business v Seblius Original Medicaid expansion all states expand Medicaid to includes individuals who make less than or equal to 138 of the FPL June 2012 limited the enforceability of Medicaid New State Spending under ACA76 billion New Fed Spending under ACA 952 billion Total new Medicaid spending under ACA 1029 billion In comparison to old Medicaid not that bad Number of uninsured in states that included expansion uninsured decreased 0 What s the bene t Why expand O O O Incremental change in Medicaid spending due to expansion how much states would have to pay 8238 Change in state spending on uncompensated care due to expansion since a lot of uninsured go to hospital 18310 they d save money Net change in state spending due to expansion 10072 they d save money 0 What states expanded O 0 Ex Oregon Washington California Arizona Nevada Colorado etc Trend democratic states seem to have expanded more than republican states 0 Medicaid and Oregon 0 O 0 Cover Oregon failed state insurance marketplacel Healthcaregov Expanded Medicaid Yes Medicaid and CHP Oregon Health Plan OHP and Healthy Kids
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