Deck 30: The Affordable Care Act and Public Health

Question 1

The Affordable Care Act (ACA) is the central part of a very broad drive for change in the U.S. health system. That drive is centered on the so-called triple aim, defined by the federal Centers for Medicare and Medicaid Services. What are the components of the triple aim and what will it take to achieve those goals?

Answer 1

The triple aim is defined as:
-Better care for patients
-Better health for our communities
-Lower costs
Achieving the triple aim will require a strong partnership between the health care delivery system and the public health community and a strong partnership between the health community and non-health sectors.

Question 2

One of the ACA programs is Medicaid "health homes," which is a new state Medicaid option that allows eligible individuals to seek care through a PCMH-like model. To qualify for health home services, eligible Medicaid enrollees must meet one of three requirements. What are those three requirements and what is Medicaid's role if those requirements are met?

Answer 2

The three requirements are that the individual must have:
a. A serious and persistent mental illness
b. Two chronic conditions (qualifying chronic conditions are specified by the law)
c. One chronic condition and be at risk of developing a second
Under the law, a Medicaid health home is responsible for providing or coordinating all patient care.

Question 3

ACA includes specific coverage requirements for clinical preventive services and applies the requirements of Section 2713 to different insurance types. Discuss the different insurance types and the differences of each.

Answer 3

-Private employer-based plAnswer: Most employer-based plans must cover all Section 2713 services with no cost-sharing imposed on the enrollee (no deductible, co-payments, or coinsurance).
-Individual and small-group plAnswer: Most individual plans, whether or not purchased through an Exchange, must cover all Section 2713 services with no cost-sharing.
-Medicaid:
-The "expansion" population: In states expanding Medicaid, the newly eligible population is entitled to all Section 2713 services without cost-sharing.
-The "traditional" population: In all states, people in traditional eligibility categories are not automatically entitled to any of the Section 2713 services, and even if these preventive services are covered, beneficiaries may be responsible for co-payments or other forms of cost-sharing.
-Medicare: The Medicare program does not have to cover Section 2713 services. However, if Medicare does cover a USPSTF-recommended service, ACA requires that it do so with no cost-sharing imposed on the beneficiary.