656 Group Work
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School
Arizona State University *
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Course
656
Subject
Health Science
Date
Feb 20, 2024
Type
Pages
5
Uploaded by SuperHumanScorpion6616
5. What models are being discussed regarding re-visioning health care insurance? What are the merits of
running a "traditional" health care system (i.e. Obama Care) vs. the models that trend in the opposite
direction? (4/14)
The threat to the United States' Academic Health Centers (AHCs) has been reported for the past
decade, signified most importantly by the decrease in the perceived value of patient care
delivered and a significant reduction in direct payments to physicians in AHCs. These reductions
have required AHCs to become more efficient and increased pressures to become more
productive in both patient care and research“The U.S. healthcare system continues to evolve in
response to these challenges and the additional pressures of increasing costs and the increasing
numbers of uninsured. Ten trends for the next decade are evident: 1) more patients, 2) more
technology, 3) more information, 4) the patient as the ultimate consumer, 5) development of a
different delivery model, 6) innovation driven by competition, 7) increasing costs, 8) increasing
numbers of uninsured, 9) less pay for providers, and 10) the continued need for a new healthcare
system. In response to these trends, AHCs will have to continue to improve efficiency by
increasing cooperation between researchers, clinicians, and educators while demonstrating how
they are “different” and “better” than the competition.”
References
Garson, A., Jr, & Levin, S. A. (2001). Ten 10-year trends for the future of healthcare: implications for
academic health centers.
The Ochsner journal
,
3
(1), 10–15.
Since the ACA was passed in 2010, Congress has not passed further legislation to insure more
people or make private plans more affordable or cost-protective.
The Affordable Care Act expanded access to affordable health insurance to millions of
lower-middle class Americans and
made it possible for anyone with health problems to buy
health insurance by banning insurers from denying people coverage or charging them more
because of preexisting conditions. The number of uninsured people in the United States has
fallen by nearly half since the ACA was signed into law, dropping from 48.6 million people in
2010 to 29.7 million in 2018. There was also a decline in the share of people who reported
financial problems associated with medical bills or who had problems getting health care
because of cost.
Continued issues: millions of people are still uninsured, millions of people with insurance have
plans that are leaving them underinsured, and health care costs are growing faster than median
income in most states.
Other research has demonstrated that people who don’t have adequate health insurance all their
lives have fundamentally different life experiences and less economic opportunity than those
who are adequately insured. This includes lower educational attainment, lifetime earnings, and
life expectancy.
Lowering premiums, limiting out-of-pocket cost exposure, and lowering the overall rate of health
care cost growth are achievable goals. Some ideas — like enhancing the ACA’s subsidies —
won’t completely solve the U.S.’s significant affordability problem, but will provide a step
toward providing targeted relief to several million people.
1.
Adding public plan features to private insurance.
These bills include provisions to
enhance the premium and cost-sharing subsidies for marketplace plans, fixing the
so-called family coverage glitch in employer plans, adding reinsurance, and addressing
the Medicaid coverage gap for low-income people in nonexpansion states.
2.
A choice of public plans alongside private plans.
In addition to enhancing ACA
subsidies and providing reinsurance, the bills in this category also give consumers a
choice of a public plan, based on either Medicare or Medicaid, for employers and people
in the ACA marketplaces. The bills use the leverage of the federal government’s buying
power in setting premiums for the public plan, establishing provider payment rates, and
negotiating prescription drug prices. Some bills also improve benefits for people
currently enrolled in Medicare.
3.
Making public plans the primary source of coverage in the U.S.
Bills in this category
are single-payer or Medicare-for-All bills in which all residents are eligible for a public
plan that resembles the current Medicare program, but is not the same program we have
today. The bills limit or end premiums and cost-sharing and end most current forms of
insurance coverage, including most private coverage, with the exception of HR 7337,
which retains employer coverage as an option. Benefits are comprehensive and include
services not currently covered by Medicare such as dental, vision, and long-term care.
The approach brings substantial federal leverage to bear in setting premiums and
lowering provider and prescription drug prices.
While these bills would create different degrees of change, all have the potential to make the
following general changes in the U.S health care system:
Improve the affordability, benefit coverage, and cost protection of insurance for many or
all U.S. residents
Lower the rate of cost growth in hospital and physician services, prescription drugs, and
health plan and provider administration
Reduce the number of uninsured people, in some bills to near zero
Reduce the number of underinsured people, in some bills to near zero.
Collins, S. (2019). Testimony: Status of U.S. health insurance coverage. Retrieved 2021, from
https://www.commonwealthfund.org/publications/2019/apr/testimony-health-insurance-re
cent-congressional-reform-bills
Intro- Nancy
USA and Canada Countries are
highly advanced industrialized countries.
-
What are some types of models of healthcare? (other countries). USA, Canada,
-
Traditional type (Obama care) / current system - brief overview
-
Health care in the United States is financed by a combination of public and
private insurance, employers, and individuals who pay out of pocket.
-
Health Care delivery system in the United States: Public insurance systems are
Medicare, Medicaid, the Veterans Health Administration.
-
The United States requires that individuals found their own health insurance or
get health insurance through employment.
-
Before the ACA, Medicaid covered people who were categorically eligible for
benefits on the basis of income and other requirements determined at the state
level. Eligibility categories include low-income children and their families,
low-income people who are 65 and older, and low-income adults and children
who have disabilities. Some states voluntarily extended Medicaid to other
eligibility categories, such as people who have high medical expenses and the
long-term unemployed.
-
ACA controversie:
Canada Health System:
-
Canada has a national health insurance program NHI (a government run health
insurance system covering the entire population for a well defined medical
benefits package). Health insurance coverage is universal. General taxes finance
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NHI through a single payer system (only one third-party payer is responsible for
paying health care providers for medical services).
-
With minor exceptions, health coverage is available to all residents with no out of
pocket charges. Most physicians are paid on a fee for service basis and enjoy a
great deal of practice autonomy
-
Coverage is publicly-funded, meaning that the funds come from federal and
provincial taxes
-
Question: what has been your experience regarding the health care system?
Pros vs cons of current U.S. system- Samuel
An article from 2019 showed that 27.5 million Americans or 8.5% of the US population does not have
health insurance.
-
What pro or con have you experienced?
Proposed plans- Katelynde
-
Current bills/legislation
-
Thoughts on these? What do you like/dislike?
Conclusion- Samantha
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AHCCCS
-
Arizona Health Care Cost Containment System
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Medicaid system since 1982
-
Can pay for both physical and behavioral health services
o
Aurora- many people on it
o
If no insurance we can help them apply
-
Serves 2 million Arizonians
-
Who can qualify
o
Different parameters based on age
●
1-19 child age
●
19-64 adult age
●
65 + senior
o
Adult
●
US citizen or qualified immigrant
●
Has Social security number
●
Is under income limit (monthly)
○
1: $1,428- 5: $3,441
○
Number different depending on group
-
Behavioral health services covered
o
Mental health counseling
o
Psychiatric or psychologist services
o
Opioid use disorder and treatment
-
In the news
o
Transgender teen sues for no coverage of gender confirmation surgery
-
Future health concerns for those who cannot get surgery
o
AHCCCS does not cover single-tablet regimen for HIV treatment
-
Can lead to problems when people are not able to keep up with more complicated
forms of treatment
-
Societal implications
-
Share link:
https://www.azahcccs.gov/Members/Downloads/AccessingBHSystem.pdf
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Have you worked with clients on AHCCCS or trying to qualify?
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What complications have you seen with AHCCCS care?