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PPPM460 Lecture Notes Week2.pdf

by: Kaitlyn Endo

PPPM460 Lecture Notes Week2.pdf PPPM 460

Marketplace > University of Oregon > PPPM 460 > PPPM460 Lecture Notes Week2 pdf
Kaitlyn Endo
GPA 3.43
Health Policy
Nicole Ngo

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PPPM 460 Lecture Notes Week2
Health Policy
Nicole Ngo
Class Notes
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This 8 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 Lecture Notes Week 2 Monday Review Federal poverty level 0 1 person 11490 0 4 people 23550 PreACA Employment based coverage dominated in 19505 but who bene ts high income workers or the spouses of high income workers who get insurance by employer l fed govt tried to x that by implementing Medicaid Medicaid was implemented to cover gaps in employment based coveragebut who bene tsgt a lot of children are covered under CHIP and Pregnant women are covered if under FPLbut gaps are working parents who make too much money and those without jobs and especially those adults without children Medicaid Gap ln states that do not expand Medicaid there will be large gaps in coverage leaving millions of low income adults with no affordable oonns To qualify for premium tax credits subsidized health insurance you had to make100400 of FPL This leaves gap tho people who make too little for subsidized health insurance and those who make too much above 48 of FPL Gap Distribution of Adults in the Coverage Gap by State and Region 0 Distribution by State Texas 25 FL 17 NC 9 0 Work status of Adults in the Coverage Gap Majority are working poor Push to expand Medicaid to cover the gap 0 24 of 29 states expanding Medicaid as in the law BUT some states get waivers allow more exibility Arkansas Iowa Michigan Penn and Indiana 0 States own terms states can decide how Medicaid works in their own statedeas were made with fed govt in order for them to expandsince originally they states didn t want to turning point in quotbattlequot of Obamacare 0 Good or bad quotmore than that the staunchly conservative Pence may have taken a big step toward fundamentally reshaping one of the country s biggest safety net programsso much so that many liberals who generally cheer any expansion of coverage are feeling deeply ambivalent about this developmentquot 0 Medicaid expansion in Indiana 0 Cover 3500000 people BUT gt FPL monthly premium2 of income ltFPL no premium but no dental or vision without premium copayments creates waiting period due to admin issues rsts if miss monthly premiums and gt FPL no coverage for 6 months 0 Payment for ER visit if made previous needless visit to ER Medicare Elderly have the highest heathcare expenditures Medicare st step to universal heathcare Before Medicare 505 of seniors didn t have health insurance Signed into law with social secturity act in 1965 by President Johnson 0 Need health insurance as part of secure retirement 0 Intention bring the elderly to the same standard of treatment as everyone else 0 What is Medicare 0 Medicare is a social insurance program that provides heath and nancial security for 55 million people Individuals 65 and older 46 million Younger people with permanent disabilities 9 million 0 14 of federal budget 0 important part of reducing health care spending 0 4 parts of Medicare covering different bene ts 0 Part A Hospital insurance HI Program 55 million in patient hospital services as long as you pay your taxes you re automatically enrolled in part A no premium in part A 0 Part B supplementary medical insurance SMI program 51 million out patient medical care nursing facilities home health cares and preventative services and doctor visits this is used more than Part A as long as you pay your taxes then you re covered for part b There s a monthly premium in part B 0 Part C Medicare Advantage program 16 million Medicare advantage program 16milion people Provides Part A and Part B bene ts but different rules Fee for service versus Manage care Bene t is that some plans include dental and vision which isn t covered by traditional Medicare 0 Part D Outpatient prescription drug bene t 42 million Medicare and ACA o Expands prescription drug and prevention bene ts 0 Introduces programs to improve the quality and delivery of care Social disparities among those served by Medicare 0 25 income below 14400 0 50 income below 23500 Changing demographicsbaby boomers 0 Born post WWII between 1946 and 1964 0 Between 2010 and 20155 gt80 years of age 11 million l 31 million gt90 2 million l 8 million How much do they pay Gaps in Medicare coverage 0 Doesn t cover long term services dental care or vision 0 High deductibles and cost sharing 0 Pay premiums for parts bd 0 Traditional Medicare no limit on out of pocket spending Who pays 0 Medicare bene ciaries avg total out of pocket spending on services and premiums by self reported health status and age 201 Out of pocket expenditures increases over time Premiums stays relatively the same Services increases Deductibles and premiums look at chart in lecture slides Medicare Part D o Started in 2006 0 Purchase separately or medicare advantage part c 0 Standard bene t Deductible 320 25 coinsurance up to 2960 Drug bene t 0 Deductible350 0 Then your insurance kicks in but you need to pay 25 of drugs 0 Doughnut hole Initial coverage limited 2960 total drug cost Generic drugs enrollee pays 65 and plan pays 35 o Catastrophic Coverage Limit 7062 in estimated total drug costs Then enrollee pays 45 and plan pays 5 o How does Medicare pay providers 0 63 of bene t spending hospitals physicians nurshing homes hospice 0 each paid separately based on payment rates speci c to a provider 0 FFS incentives doctors to do more Determine base rate for a service make adjustments based on severity of case policies and geographic market area differences Probemsgt fee for service probs To improve quality of care ACA tie larger share of traditional Medicare payments to provider performance on quality and spending 0 2014 Medicare data released for rst time traditional Medicare aka not part c o quotSliver of Medicare Doctors Get Big Share of Payouts quot 0 Medicare paid doctors 64 billion in 2012 Most of it was for expenses Of ce overhead 43 Dr compensation 41 Mapracice premiums 3 Drugs other costs 13 o The highest paid 2 percent of doctors received almost one fourth of Medicare payments Wednesday How much does Medicare cost Expensive to sustain 14 of federal spending 35 trillion Medicare bene t payments 597 billion what goes to doctors 0 Medicare advantage 0 Hospital inpatient services 0 Distribution of Traditional Medicare Bene ciaries and Medicare Spending l similar to Medicaid population small portion consume a lot of Medicare expenditures 0 Medicare Spending and Percent of Fed Outlays net amount and GDP supposed to go from about 3 of our GDP to 20 of our GDP l going to cost a lot more in the future 0 Why Live ong better technology Insurance companies Growth of Medicare population 0 Sources of Medicare Revenue 0 General Revenue 0 Payroll taxes Medicare tax 0 Bene ciary premiums o Is it sustainable 0 Funding for Part A will be depleted in 2030 0 Based on assets and income 0 Important factors Economic growth payroll tax contribution s Health care spending Demographic trends 0 Part B and D don t have the same challenges Funded by premiums and general revenues and not as much on payroll taxes like how Part A does 0 Delivery system reform 0 Goal decrease spending and improve patient care 0 ACA launch Medicare wide programs and pilot projects t 0 test new payment models Financial incentives to encourage collaboration and care coordination Reduce unnecessary service use Reward providers for higher quality patient care Evaluations ongoing and results are mixed 0 Accountable Care Organizations Group of providers physicans hospitals responsible for Medicare bene ciaries so instead of focusing on patient center caremaking sure that all aspects of an individuals health care are communicating and coordinating hopefully will decrease waste Share nancial savings if meet spending and quality target 0 Bundle payments Reimburse for all services provided to a patient for a de ned treatment 0 ex knee replacement single payment for surgeon anesthesiologist hospital physical therapy instead of paying everyone separately share in savings but also losses if spending gt payment 0 Hospital readmission reduction initiatives Penalized hospitals that have higher rates of Medicare readmissions Medicare and the ACA 0 Expected to reduce growth in Medicare spending Net reduction of 428 billion savings of 533 billion and new spending of 105 billion 0 Medicare Medicaid Eligibility 65 and youth with permanent disabilities Poor families below poverty level 138 Poor elderly dual eligibility blind and disabled individuals Administration Federal government Implemented by state nanced by federalstate partnership How much is covered 100 medical coverage vision dental and pharmaceutical drugs oonnal Depends on each state but essential medical services to all dental and vision are optional Cost sharing All parts have some kind of deductible or coinsurance Varies by state Affordable Care Act Presentation 0 Provide affordable quality health care for all Americans and reduce the growth in health care spending and for other purposes 0 What is the ACA individual mandate and why is it important 0 ACA was created to increase the quality and affordability of healthcare 0 Individual mandate is a requirement by the federal govt that most Americans get health insurance by 2014 unless thy qualify for exemptions or pay a tax 0 Paid by individuals 0 all ages 0 The objective being to make everyone participate in the insurance market 0 How much is the penalty and how is it paid 0 Collected thru income tax returns at the end of the year by the IRS 0 Money used to subsidize health insurance for low income people and settle unpaid hospital bills Subsidies and Special enrollment period 0 Subsidies Offered to provide making between 100400 of the FPL Insurance must be purchased through the federal or state marketplace For 2014 coverage the open enrollment period was Oct 1st 2013March 31st 2014 0 Have to enroll by this date or else have to pay for extension proof of exemption or just pay for penalty How to avoid the penalty 0 Obtain the minimum essential coverage Available through most insurance plans Must be obtain during that plan s open enrollment period If missing the deadlines 0 Wait until next opening period usually following year Qualify for an special extension period a life event that you re not able to register at that time but extension usually only last for about 60 days after 0 Get an exemption o 90 of 30 million uninsured people will not be required to pay taxes 0 some last for months and others last for the full calendar year ex bankruptcy eviction natural disasters Outcomes and limits of the provision 0 Increased number of insured people especially among health people 0 However the IRS does not have any way to check whether you are really insured if you say so when you le taxes 0 Failing to pay the penalty is not a crime Health Insurance Marketplaces Presentation In general each state shall not later than 1114 establish an American Health Bene t Exchange referred to in this title as an Exchange What are health Insurance marketplaces o Commonly referred to as exchanges Marketplaces use zip code level geographic data and ask ve questions 0 Smoke Parent Pregnant Have health coverage Covered Services 0 Dr visits Prescription drugs Hospitalization Maternity and newborn care Preventative care OOOO 0 Additional bene ts 0 Birth control 0 Breastfeeding bene ts 0 Dental 0 Vision


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