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Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."
Mark Barr McClellan is the director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy at Duke University. Formerly, he was a senior fellow and director of the Health Care Innovation and Value Initiative at the Engelberg Center for Health Care Reform at The Brookings Institution, in Washington, D.C. McClellan served as commissioner of the United States Food and Drug Administration under President George W. Bush from 2002 through 2004, and subsequently as administrator of the Centers for Medicare and Medicaid Services from 2004 through 2006.
In the United States, a high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven healthcare. Being covered by an HDHP is also a requirement for having a health savings account. Some HDHP plans also offer additional "wellness" benefits, provided before a deductible is paid. High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses. Adoption rates of HDHPs have been growing since their inception in 2004, not only with increasing employer options, but also increasing government options. As of 2016, HDHPs represented 29% of the total covered workers in the United States; however, the impact of such benefit design is not widely understood.
Jonathan Holmes Gruber is an American professor of economics at the Massachusetts Institute of Technology, where he has taught since 1992. He is also the director of the Health Care Program at the National Bureau of Economic Research, where he is a research associate. An associate editor of both the Journal of Public Economics and the Journal of Health Economics, Gruber has been heavily involved in crafting public health policy.
Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
Health insurance coverage in the United States is provided by several public and private sources. During 2019, the U.S. population overall was approximately 330 million, with 59 million people 65 years of age and over covered by the federal Medicare program. The 273 million non-institutionalized persons under age 65 either obtained their coverage from employer-based or non-employer based sources, or were uninsured. During the year 2019, 89% of the non-institutionalized population had health insurance coverage. Separately, approximately 12 million military personnel received coverage through the Veteran's Administration and Military Health System.
Healthy San Francisco is a health access program launched in 2007 to subsidize medical care for uninsured residents of San Francisco, California. The program's stated objective is to bring universal health care to the city. Healthy San Francisco is not a true insurance program, as it does not cover services such as dental and vision care, and only covers services received in the city and county of San Francisco. The program itself acknowledges its limitations, and has stated that "insurance is always a better choice." Healthy San Francisco represents the first time a local government has attempted to provide health insurance for all of its constituents. The program is open to low-income city residents over the age of 18 who do not qualify for other public coverage, and who have had no insurance for at least 90 days. Eligibility is not conditional on citizenship, immigration, employment or health status. The program covers a range of services, but only pays providers within San Francisco. By July 2010, almost 90% of the uninsured adults in San Francisco — over 50,000 people — had enrolled in Healthy San Francisco.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health insurance went into effect. Before 2014, some insurance policies would not cover expenses due to pre-existing conditions. These exclusions by the insurance industry were meant to cope with adverse selection by potential customers. Such exclusions have been prohibited since January 1, 2014, by the Patient Protection and Affordable Care Act.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act, and colloquially known as Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965.
Health care in the United States is provided by many distinct organizations, made up of insurance companies, healthcare providers, hospital systems, and independent providers. Health care facilities are largely owned and operated by private sector businesses. 58% of community hospitals in the United States are non-profit, 21% are government-owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent $9,403 on health care per capita, and 17.9% on health care as percentage of its GDP in 2014. Healthcare coverage is provided through a combination of private health insurance and public health coverage. The United States does not have a universal healthcare program, unlike most other developed countries.
The United Hospital Fund of New York (UHF) is a nonprofit organization that focuses on improving health care in New York. It conducts health policy research and supports numerous health care initiatives through fundraising, grantmaking, and collaboration with other health care organizations. Since August 2017, the organization is led by Anthony Shih.
The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. CMS provides healthcare coverage to more than 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
Amy Nadya Finkelstein is a professor of economics at the Massachusetts Institute of Technology (MIT), the co-director and research associate of the Public Economics Program at the National Bureau of Economic Research, and the co-Scientific Director of J-PAL North America. She was awarded the 2012 John Bates Clark Medal for her contributions to economics. She was elected to the National Academy of Sciences and won a MacArthur "Genius" fellowship in 2018.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
The Affordable Care Act (ACA) is divided into 10 titles and contains provisions that became effective immediately, 90 days after enactment, and six months after enactment, as well as provisions phased in through to 2020. Below are some of the key provisions of the ACA. For simplicity, the amendments in the Health Care and Education Reconciliation Act of 2010 are integrated into this timeline.
A safety net hospital is a type of medical center in the United States that by legal obligation or mission provides healthcare for individuals regardless of their insurance status or ability to pay. This legal mandate forces safety net hospitals (SNHs) to serve all populations. Such hospitals typically serve a proportionately higher number of uninsured, Medicaid, Medicare, Children's Health Insurance Program (CHiP), low-income, and other vulnerable individuals than their "non-safety net hospital" counterpart. Safety net hospitals are not defined by their ownership terms; they can be either publicly or privately owned. The missions of safety net hospitals are rather, to focus and emphasize their devotion to providing the best possible care for those who are barred from health care due to the various possible adverse circumstances. These circumstances mostly revolve around problems with financial payments, insurance plans, or health conditions. As per America's Health Care Safety Net: Intact but Endangered, safety net hospitals are known for maintaining an open-door policy for their services.
Value-Based Insurance Design is a demand-side approach to health policy reform. V-BID generally refers to health insurers’ efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services – those that have the greatest potential to positively impact enrollee health. V-BID also discourages the use of low-value clinical services – when benefits do not justify the cost. V-BID aims to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices. V-BID health insurance plans are designed with the tenets of "clinical nuance" in mind. These tenets recognize that medical services differ in the amount of health produced, and the clinical benefit derived from a specific service depends on the consumer using it, as well as when and where the service is provided.
The Oncology Care Model (OCM) is an episode-based payment system developed by the Center for Medicare and Medicaid Innovation. The multipayer model is designed for discrete instances of care, especially those involving chemotherapy, which triggers the six-month episode. The program combines fee-for-service (FFS) payments for established services, monthly payments for additional care under a structured guideline, and performance-based payments weighed against quality metrics and benchmarks.
The Patient Protection and Affordable Care Act, often shortened to the Affordable Care Act (ACA) or nicknamed Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the passage of Medicare and Medicaid in 1965. Once the law was signed, provisions began taking effect, in a process that continued for years. Some provisions never took effect, while others were deferred for various periods.
References
- ↑ "Kosali Simon Indiana page" . Retrieved 26 March 2017.
- ↑ Hinnefeld, Steve. "For Wells Professor, a busy life is a fulfilling life". News at IU. Retrieved 2018-11-01.
- ↑ "Kosali I. Simon". www.nber.org. Retrieved 2018-11-01.
- ↑ Journal of Health Economics - Editorial Board . Retrieved 6 October 2018.
- ↑ "Experts Weigh HIP 2.0's Fate Under Proposed GOP ACA Replacement". News - Indiana Public Media. Retrieved 2018-11-01.
- ↑ Semuels, Alana (2016-12-21). "Indiana's Medicaid Experiment May Reveal Obamacare's Future". The Atlantic. Retrieved 2018-11-01.
- ↑ "The effect of Obamacare on employment" . Retrieved 2018-11-01.
- ↑ Moriya, Asako S.; Selden, Thomas M.; Simon, Kosali I. (2016). "Moriya, A.S., Selden, T.M. and Simon, K.I., 2016. Little Change Seen In Part-Time Employment As A Result Of The Affordable Care Act. Health affairs, 35(1), pp.119-123". Health Affairs. 35 (1): 119–123. doi:10.1377/hlthaff.2015.0949. PMID 26733709.
- ↑ Gooptu, Angshuman; Moriya, Asako S.; Simon, Kosali I.; Sommers, Benjamin D. (2016). "Gooptu, A., Moriya, A.S., Simon, K.I. and Sommers, B.D., 2016. Medicaid expansion did not result in significant employment changes or job reductions in 2014. Health affairs, 35(1), pp.111-118". Health Affairs. 35 (1): 111–118. doi: 10.1377/hlthaff.2015.0747 . PMID 26733708.
