The ACA and Access to Health Care

7/30/2019 The ACA and Access to Health Care

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Before the passage of the Affordable Care Act, approximately 15%of Americans did not have health insurance. Continue watching tosee the breakdown.43 million uninsured non-illegal

If Obama tries to provide the universal coverage, when 85% ofpeople is insured, and needs at least 51% of the votes dilemma.

When might an insured person worry about becoming uninsured: ina recession.What proportion of the uninsured can afford health insurance?FPL: Federal Poverty LevelHow much insurance for a family of four? ~ $15k per year36% of people who 400% FPL is uninsured. So uninsurance is not

restricted to the poor but dominant in the poor.

What does the typical uninsured American look like? White, workingadult, without children

The most common "type" of uninsured in America is a non-elderly,working adult. (Adults aged 65 and over are covered by Medicare.)However, the rate (i.e. proportion) of uninsurance is greater forblacks and Hispanics than for whites, and for low-income Americans

than for medium- and high-income Americans.

The typical uninsured American:White: 46% are non-Hispanic whitesWorking: more than are in working familiesYoung adults: 19-29 years old make up 32%US citizens: 81% are US citizens

Characteristics of the Uninsured: family work status:1 or more full-time workers 61%parttime workers: 16%No worker: 23%Most of the uninsured is somewhat gainfully employed

How long do most people stay uninsured? 3 yearsOver half of the uninsured stay uninsured for more than three years


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at a time. Another fifth stay uninsured for between one and threeyears. This is an important policy issue, since it means that peoplewho go without insurance do so for long periods of time. We will seein a few minutes that being uninsured deteriorates access to health

care, as well as health outcomes, compared to being privatelyinsured. half of the people, it is a long term problem(stuck with employers who do not provide coverage)

The proportion of the population that is uninsured is substantiallyhigher in the South (mostly red states) than elsewhere. TheNortheast has the lowest proportion of uninsured.

State has a variety of very creative mechanisms to discourage

people for signing on to benefits that they are legally entitle to.Medicaid is the biggest one that they put a lot of barriers because itis expensive for them. Another reason, if you are a welfare rightgroup or a group that really cares about this population and youwant to get them insured, it could be somewhat difficult to getthem onto the roles because they are concerned about stigmatizedMedicare. Medicare are not stigmatized, every one gets it, rich andpoor. Americans belief: tomorrow is gonna be better. I am notgoing through the hassle signing up for Medicaid, I am going to get a

job in a month.Most children got coverage through employment of Mom and Dad.About 40% get coverage to Medicaid or CHIP.

How does being uninsured affect health outcomes?Breast cancer in women:89% 5-year survival with insurance76% 5-year survival with Medicaid or without insuranceThat is 13% difference!

Lecture 3:

In 2010, the US spent 2.6 trillion dollars on Health Care. (~Frances GDP, #5 economy in

the world)By how many billions of dollars did health care spending rise between 2009 and 2010?

100 billions

Almost every year, growth in health care cost is 2.45% higher than the growth in GDP


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The US spends 1.5 times as much on health care as Norway, thenext highest-spending country.

It is a common misperception that our high medical spending is

composed largely of spending on prescription drugs. In fact, onlyabout 10% of health care costs go to prescription drugs.

The Congressional Budget Office estimates that less than 1% of thegrowth in health care costs is due to medical malpractice. We willreturn to this issue next week.

Causes of Health Care Cost Growth: Technology 38 65% (switchingfrom old to new technology)

Who pays the largest portion of the cost ofhealth care in the US?Of these four categories, households pay the largest proportion ofhealth care costs in the US (28%), with the federal government aclose second (27%). Note that each of these categories pays a largershare of costs than private business.

What proportion of the increase in healthcare costs is due to the aging of thepopulation?

In spite of all the media attention, the proportion of the growth inhealth care costs attributable to the aging of the population is only2%. It is true that the elderly account for a disproportionate shareof health care spending, but this is not the same as growth in healthcare costs.

The average annual health insurance premium for a family isapproximately $15,000.

What is the probability that a 60-year-old surgeon has been sued for malpractice at least


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once in his/her career? 100%

Which medical specialty is sued the most frequently? Neurosurgeons have thehighest rate of malpractice claims against them of any medicalspecialty. The top five most sued medical specialties are all surgical

specialties.Since 1990, is the frequency of medical malpractice claims..? Toocomplex of a trend to categorize

For low-risk specialties, the frequency of medical malpracticeclaims has been decreasing over the past two decades. For high-riskspecialties, it has fluctuated without a clear trend.

Approximately how often are practitioners sued when they are

negligent? 0-5% of the time98% of adverse events due to negligence did not lead to amalpractice claim. Only 1.5% of incidences of malpractice lead to amalpractice suit.Malpractice premiums, settlements, and administrative costs areapproximately $35 billion, about 2% of total health care costs.

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The ACA and Access to Health Care