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The Influence of Healthcare Policy on Healthcare and Economics

The Influence of Healthcare Policy on Healthcare and Economics Touro University By Jessica Phelps

Public Health InsuranceMedicareHealth insurance for aged and disabledMedicaidHealth 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 ProgramExpands beneficiaries options for participation in private sector health care plansD: helps pay for prescription drugs

This program was created as a portion of the 1965 Social Security Act (Mason, Gardner, Outlaw, & O Grady, 2016). Each part (A,B,C,D) pays for a different portion of medical care. Medicare is funded by nations revenue from taxes. 3

MedicaidInsurance for low-income peopleEligibility determined by incomeAt 138% of federal poverty level

Medicaid is funded by state and federal government through taxes. With the Affordable Care Act the eligibility for Medicaid became broader, making more individuals eligible. By 2021, 77.9 million people are expected to be enrolled in Medicaid (Mason et al., 2016). 5

ChipInsurance coverage for uninsured children not eligible for Medicaid

Created in 1997 funded by state and federal government funds (Mason et al., 2016). 6

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

Academic hospitals in comparison with community hospitals are teaching facilities. Academic health centers often provide services that other facilities do not. Academic health centers provide new interdisciplinary research models in knowledge management and information technology (Mason et al., 2016). 7

Infrastructure Nursing HomesMajority are for-profitPopulation2.9% of over-65 individuals10.7% of over-85 individualsWomen 67% of residents15% under 65 years old

Many nursing homes eligible for both Medicaid and Medicare funding (Mason et al., 2016). 8

Private Health InsuranceObtained as benefit of employmentProvided as group insuranceManaged careHealth Maintenance Organizations (HMO)Preferred Provider Organizations (PPO)

Private insurers regulated by states. Insurance companies operate like a business according to free market ideals (Mason et al., 2016). Managed care is a system used to contain the costs of health care. 9

Managed CareHMOFee-for-service reimbursementPrimary care provider gatekeeper of careMust get referrals for specialty careAccess to providers and hospitals in-networkPPOFlexibility when choosing doctor or hospitalsNo referrals requiredHigher premiums and deductibles

Affordable Care Act (ACA)Competitive health insurance marketplaceProvides access to group insuranceComparison of plansFinancial assistanceEnd discriminationInsurance companies cant deny care based on health status, gender, wages or preexisting conditionsRequire coverage for preventative care and vaccines

The main objective of this law is to increase access to health insurance to more people. As well as try to contain health care costs (Mason et al., 2016). The ACA is expected to provide health insurance for an additional 36 million Americans (Mason et al., 2016). The marketplace can be accessed at healthcare.gov. All participants of the exchanges pay into it. Costs are contained by the plans having to compete for business (ObamaCare Facts, 2016). Some aspects of the act went into effect immediately in 2010 when it was signed, full implementation of the act is expected by 2023 (Mason et al., 2016). 11

ACARequires a minimum essential coverage Requires inviduals and dependents to obtain health insuranceNon-compliant individuals face a tax penaltyExpands Medicaid and CHIPEliminates lifetime and annual limits on benefitsExtends dependent coverage to age 26 under parents plan

The tax penalty in 2014 as $95 or 1% of income, increasing in subsequent years (Mason et al., 2016). Coverage can be obtained through employer-provided health insurance, state health exchanges, government programs as long as the insurance meets minimum essential coverage standards (Mason et al., 2016). Employers with more than 50 employees are mandated to provide minimum essential coverage. While employers with more than 200 employers must automatically enroll new employees in group insurance. 12

The Uninsured

Despite the passage of the Affordable Care Act, many Americans remain without insurance. The reason cited is costs of insurance still remains too high. 28.5 million Americans remain uninsured (Kaiser Family Foundation, 2016). 13

Safety Net ProvidersServe uninsured, underinsured low income Medicaid recipientsShortage of primary care providersDue to low repayments thus lower salariesDue to ACA, funding for these facilities may be adversely affectedThis will negatively effect the population served

This group of individuals are less healthy, more likely to forgo needed medical care, less likely to receive regular care, and are more likely to receive care in the emergency department than those with health insurance (Andrulis & Siddiqui, 2011). The Medicaid disproportionate share hospital program is being reduced by 18 million dollars through the ACA over a period of seven years (Andrulis & Siddiqui, 2011). This program subsidizes hospital, largely safety net hospitals for for unreimbursed care. Health care reform should reduce the need for these subsidies, but this is yet to be seen with many people still uninsured. For clinics that treat only patients with no health insurance, they may be harming the population they serve because they do not have the revenue to support infrastructure innovations such as electronic health records which help to coordinate care among multiple providers. Also with a decrease in federal funding, the quality of care and number of primary care providers will be compromised. This could result in subpar care. Without revenue these facilities may end up needing to close, completely closing off access to uninsured individuals.


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., & OGrady, 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/