Page 1 of 53 Success! 1 MHA 707 EXAM D ACTUAL EXAM COMPLETE 250 QUESTIONS AND DETAILED SOLUTIONS LATEST 2024 -2025 UPDATE JUST RE LEASED MHA 707 EXAM D EXAM 1 What groups of Americans were largely uninsured when the ACA was being considered? -Unemployed, -Employed with no ESI (employer -sponsored ins) -Young employees -Those who didn't take ESI -Those who chose not to be insured Why didn't the ACA go to a single -payer or an NHI format? What was the Public potion? Each had its own stakeholder with invested interest in continuing their role in the HC system. Allow many to purchase medicaid with means tested premium employers shift twd medicaid b/c it was cheaper tha n having private ins What were the hoped advantages of achieving expanded coverage under the ACA? Reduce increased care, expand rationing of care, costly exacerbation of health conditions, uncompensated care for providers (academic providers) What features of the ACA were designed to increase coverage? What are pre -existing conditions and guaranteed issue? How were they Impacted by ACA? •Mandated that private health insurance plans meet minimum standards •Cannot discriminate against people with preexisting conditions ( guaranteed issue ) •Cannot impose lifetime and annual limits on coverage Page 2 of 53 Success! 2 Must extend dependent coverage to age 26 What are pre -existing conditions and guaranteed issue? Made changing employer/insurance practical and more fair Helped many who cou ld not get insurance because of early life events Removed disincentives to practice “less -healthy” lifestyles stop smoking, lose weight, etc. Allowed people to “game the system” – buy insurance only when a health problem arises and be uninsured (not pay pr emiums) otherwise. What are Health insurance exchanges? State -based health insurance exchange for individuals and small businesses to compare plans, apply for financial assistance, purchase coverage What is SHOP? Small Business Health Options Program Helped firms with 50 or less employees to have insurance to cover them. What was the individual mandate and its design? What happened to it? Mandated that most citizens and legal residents have health insurance. distr ibutes health care costs over people in poor health and good health ( community rating ) How did ACA aim to reduce health care cost? -Medicare fraud, excessive payment for prescription drugs, shift cost to the state (stronger federal partnership in Medicaid) , series of HC reforms would save $349 billion by 2021 and $480 billion by 2023, $1 Trillion in the following decade Page 3 of 53 Success! 3 What was the Center for Medicaid and Medicare Innovation? •Established to develop cost savings through health services research that evalua tes the effectiveness and efficiency of health care treatments (Like NICE in United Kingdom) •Testing various payment and service delivery models to achieve better care for patients, better health for communities, and lower costs What are the source of fun ds for the ACA? Prevention and public health fund Cuts in government spending (Dr. and hospital) and new revenues (tax penalties) What is Medicaid expansion? Expansion supports local economics, level of financial protection, drops uninsurance rate cost of expansion is minimal, decreases cost -shifting issues, delay to dr. dr doesn't have to accept Medicaid Expansion would stp benefits of private ins What were the major achievements of the ACA? •Specific ACA policies benefited many people •Mandated coverage for preexisting conditions •Mandated minimum benefit plans [stop "street insurance"] •Subsidies for low - and moderate -income individuals •Guaranteed issue policy helped people in transition —people who leave a job, are laid off, start a business or retire e arly Death Spiral a snowball effect refers to a condition of the insurance markets, where premiums are rapidly increasing because low -risk individuals are continuously priced out of the market Page 4 of 53 Success! 4 ACA effects on Uncompensated Care? Pros and Cons Burdens fell s harply, 2.3% of operating cost Savings access all hospitals in Medicaid Medicaid expansion ($6 B) Overall effect on HC cost by ACA? Revenue decreased after ACA (private care, government care, pay more) providers didn't want the ACA (40% private, 60% govt, 0% uncompensated care) What was Repeal and Replace Efforts by republican -Trump Admin Republicans had voted to repeal and replace ACA 2016 - there was no republican support What are predictive analytics and big data and their effects on the system? •looking at a patient's past patterns in behavior and use of services, coupled with current health needs to predict the future use of resources -Big data used to make forecasts about a broad range of health issues (population level) What is personalized medicine? Avoiding side effects or ineffective treatment, picking better medicine for an individual Ex: certain BP meds work better in African -Americans than other racial groups What is the triple aim? •Improve the patient experience •Improve the health of populations •Reduce the per capita costs of health care
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