The Influence of

Healthcare Policy on

Healthcare and Economics

Touro University By Jessica Phelps

Public Health InsuranceMedicare

Health insurance for aged and disabledMedicaid

Health insurance for economically disadvantagedIndian Health InsuranceVeterans Administration Health Systems

Medicare PartsA: pays for inpatient hospitalizations, hospice, home health, and skilled nursingB: pays for doctor appointments, outpatient patient servicesC: Medicare Advantage Program

Expands beneficiaries options for participation in private sector health care plans

D: helps pay for prescription drugs

MedicaidInsurance for low-income people

Eligibility determined by income

At 138% of federal poverty level

ChipInsurance coverage for uninsured children not eligible for Medicaid

InfrastructureHospitals

Non-profit communityFor-profit communityState & local government community hospitalsFederal government Psychiatric hospitalsLong-term careInstitutional hospitals

Infrastructure Nursing Homes

Majority are for-profitPopulation

2.9% of over-65 individuals10.7% of over-85 individualsWomen 67% of residents15% under 65 years old

Private Health InsuranceObtained as benefit of employment

Provided as group insuranceManaged care

Health Maintenance Organizations (HMO)Preferred Provider Organizations (PPO)

Managed CareHMO

Fee-for-service reimbursementPrimary care provider gatekeeper of care

Must get referrals for specialty care

Access to providers and hospitals in-network

PPOFlexibility when choosing doctor or hospitalsNo referrals requiredHigher premiums and deductibles

Affordable Care Act (ACA)Competitive health insurance marketplace

Provides access to group insuranceComparison of plansFinancial assistance

End discriminationInsurance companies can’t deny care based on health status, gender, wages or preexisting conditions

Require coverage for preventative care and vaccines

ACARequires a minimum essential coverage

Requires inviduals and dependents to obtain health insuranceNon-compliant individuals face a tax penalty

Expands Medicaid and CHIPEliminates lifetime and annual limits on benefitsExtends dependent coverage to age 26 under parent’s plan

The Uninsured

Safety Net ProvidersServe uninsured, underinsured low income Medicaid recipientsShortage of primary care providers

Due to low repayments thus lower salariesDue to ACA, funding for these facilities may be adversely affected

This will negatively effect the population served

ReferencesAndrulis, D. & Siddiqui, N. (2011) Health reform holds both risks and rewards for safety net providers and racially and ethnically diverse patients. Health Affairs: 30 (10) 1830-1836. doi:10.1377/hlthaff.20112011.0661 Kaiser Family Foundation. Key facts about the uninsured population. KFF.org. Retrieved from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy and politics in nursing and health care (7th ed). St. Louis, MO: Elsevier Inc.ObamaCare Facts. (2016). Affordable care act summary. Retrieved from http://obamacarefacts.com/affordablecareact-summary/