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Healthcare reform in the United States Wiki2Web Clarity Challenge

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Study Guide: US Healthcare Policy and Expenditures: Legislation, Economics, and Outcomes

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US Healthcare Policy and Expenditures: Legislation, Economics, and Outcomes Study Guide

Foundational US Healthcare Legislation

Medicare and Medicaid were established under President Franklin D. Roosevelt's administration in the 1930s.

Answer: False

Explanation: Medicare and Medicaid were established in 1965 under President Lyndon Johnson's administration, not during President Franklin D. Roosevelt's tenure in the 1930s.

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The primary goal of HIPAA in 1996 was to reduce healthcare costs by eliminating insurance fraud.

Answer: False

Explanation: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 primarily focused on protecting health insurance continuity for workers and establishing standards for electronic health information, rather than directly reducing healthcare costs through fraud elimination.

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The Balanced Budget Act of 1997 introduced Medicare Part C and the State Children's Health Insurance Program (SCHIP).

Answer: True

Explanation: The Balanced Budget Act of 1997 established Medicare Part C, which formalized managed care options, and the State Children's Health Insurance Program (SCHIP) to provide coverage for uninsured children.

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The BIPA of 2000 aimed to increase cuts to Medicare and Medicaid funding to control federal spending.

Answer: False

Explanation: The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 was enacted to reverse some of the funding cuts previously made by the Balanced Budget Act of 1997, not to increase them.

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Medicare and Medicaid, established in 1965, provide health insurance primarily for which groups?

Answer: Senior citizens (Medicare) and the poor (Medicaid).

Explanation: Medicare, established in 1965, provides health insurance primarily for individuals aged 65 and older, while Medicaid provides coverage for low-income individuals and families.

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Which piece of legislation enacted in 1996 aimed to ensure health insurance continuity for workers and mandated coverage for pre-existing conditions?

Answer: The Health Insurance Portability and Accountability Act (HIPAA)

Explanation: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 aimed to ensure health insurance continuity for workers and established provisions regarding pre-existing conditions.

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The Balanced Budget Act of 1997 introduced which two significant federal healthcare programs?

Answer: Medicare Part C and the State Children's Health Insurance Program (SCHIP)

Explanation: The Balanced Budget Act of 1997 introduced Medicare Part C (Medicare Advantage) and the State Children's Health Insurance Program (SCHIP).

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What was the main objective of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000?

Answer: To reverse some of the funding cuts made by the Balanced Budget Act of 1997.

Explanation: The primary objective of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 was to counteract and reverse certain funding reductions previously enacted by the Balanced Budget Act of 1997.

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The Affordable Care Act (ACA) Reforms

The Patient Protection and Affordable Care Act (PPACA) was signed into law in 2010, followed shortly by the Health Care and Education Reconciliation Act which amended it.

Answer: True

Explanation: The Patient Protection and Affordable Care Act (PPACA) was enacted in 2010, and the Health Care and Education Reconciliation Act, which amended it, was passed shortly thereafter, solidifying the landmark healthcare reform legislation.

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The PPACA mandated that insurance companies continue to screen for and charge higher premiums based on pre-existing conditions.

Answer: False

Explanation: The Patient Protection and Affordable Care Act (PPACA) prohibited insurance companies from denying coverage or charging higher premiums based on pre-existing health conditions, representing a significant reform.

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The Supreme Court ruling in NFIB v. Sebelius required all states to expand their Medicaid programs under the PPACA.

Answer: False

Explanation: The Supreme Court ruling in *NFIB v. Sebelius* rendered the Medicaid expansion provision of the PPACA optional for states, allowing them to choose whether or not to participate.

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As of September 2023, 41 states plus Washington D.C. had expanded Medicaid coverage according to the ACA map data.

Answer: True

Explanation: According to available data as of September 2023, a significant majority of states, numbering 41 along with Washington D.C., had adopted the Medicaid expansion under the framework of the Affordable Care Act.

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The ACA mandated coverage for mental health and substance abuse disorders but did not address pre-existing conditions.

Answer: False

Explanation: The ACA mandated coverage for mental health and substance abuse disorders and crucially prohibited insurance companies from denying coverage based on pre-existing conditions.

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Which two federal statutes enacted in 2010 significantly reformed healthcare in the United States?

Answer: The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act

Explanation: The two principal federal statutes enacted in 2010 that significantly reformed the healthcare landscape were the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act.

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Which of the following insurance company practices was targeted for reform by the PPACA?

Answer: Denying coverage or charging more based on pre-existing conditions.

Explanation: The PPACA specifically targeted and prohibited insurance companies from denying coverage or charging higher premiums based on an individual's pre-existing health conditions.

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How did the Supreme Court's decision in NFIB v. Sebelius impact the PPACA's provisions regarding Medicaid expansion?

Answer: It made the Medicaid expansion optional for states, allowing them to choose whether to participate.

Explanation: The Supreme Court ruling in *NFIB v. Sebelius* determined that the mandatory nature of the Medicaid expansion under the PPACA was unconstitutional for individual states, thus making participation optional.

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According to the provided map data (as of Sept 26, 2023), what is the status of ACA Medicaid expansion in most US states?

Answer: 41 states plus Washington D.C. have adopted the expansion.

Explanation: As of September 26, 2023, data indicates that 41 states, in addition to Washington D.C., have adopted the Medicaid expansion under the framework of the Affordable Care Act.

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The ACA improved healthcare quality by mandating coverage for mental health and substance abuse disorders and also by:

Answer: Preventing denial of coverage for pre-existing conditions.

Explanation: The ACA enhanced healthcare quality by mandating coverage for mental health and substance abuse disorders and crucially prohibiting insurance companies from denying coverage based on pre-existing conditions.

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Healthcare Economics and System Performance

The United States spends less per capita on healthcare than other similarly developed nations but achieves superior health outcomes.

Answer: False

Explanation: International comparisons consistently demonstrate that the United States spends more per capita on healthcare than other developed nations, while often achieving poorer health outcomes, indicating systemic inefficiencies.

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In 2015, hospital care constituted the largest share of US healthcare expenditures, followed by prescription drugs.

Answer: False

Explanation: In 2015, hospital care represented the largest share of US healthcare expenditures, but physician and clinical services followed, with prescription drugs constituting the third largest category.

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In 2016, the US spent 17.2% of its GDP on healthcare, substantially more than the next highest OECD country.

Answer: True

Explanation: In 2016, the United States allocated 17.2% of its Gross Domestic Product (GDP) to healthcare spending, a figure significantly higher than the next highest OECD country at that time.

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Higher administrative costs in a fragmented, multi-payer system are cited as a reason for the US spending more on healthcare.

Answer: True

Explanation: The complexity and fragmentation inherent in a multi-payer healthcare system contribute to higher administrative costs, which are identified as a significant factor in the elevated overall healthcare spending in the United States.

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A 2009 World Bank statistic indicated the US had the lowest healthcare costs relative to its economy globally, despite a high uninsured rate.

Answer: False

Explanation: A 2009 World Bank statistic revealed that the US had the *highest* healthcare costs relative to its economy globally, not the lowest, despite a substantial uninsured population.

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Donald Berwick estimated that approximately 5% to 10% of healthcare spending is waste.

Answer: False

Explanation: Donald Berwick, a former CMS administrator, estimated that between 20% and 30% of healthcare spending constitutes waste, a considerably higher figure than 5% to 10%.

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It is estimated that 1% to 3% of all US healthcare expenditures are fraudulent.

Answer: False

Explanation: Estimates suggest that fraudulent activities account for 3% to 10% of all US healthcare expenditures, a range substantially higher than the 1% to 3% stated.

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A 2000 World Health Organization study found that the US system achieved superior population-based health outcomes compared to publicly funded systems.

Answer: False

Explanation: A 2000 World Health Organization study indicated that publicly funded systems generally achieved superior population-based health outcomes compared to the US system, contrary to the statement.

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Compared to other developed nations, the US healthcare system is characterized by:

Answer: Higher per capita spending and worse health outcomes.

Explanation: International comparisons consistently show that the US healthcare system exhibits higher per capita spending while often achieving poorer health outcomes relative to other developed nations.

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In 2015, what were the three largest categories of US healthcare spending?

Answer: Hospital care, physician services, and prescription drugs.

Explanation: In 2015, the largest components of US healthcare spending were hospital care (32%), physician and clinical services (20%), and prescription drugs (10%).

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Which factor is cited in the text as a reason for higher healthcare costs in the US compared to other developed nations?

Answer: Higher administrative costs due to a private, multi-payer system.

Explanation: Higher administrative costs inherent in a fragmented, multi-payer private insurance system are frequently cited as a primary driver of the disproportionately high healthcare expenditures in the United States.

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According to 2009 World Bank statistics, the US had the highest healthcare costs relative to its economy, despite approximately what percentage of the population lacking health insurance?

Answer: 16%

Explanation: In 2009, World Bank data indicated that the US had the highest healthcare costs as a percentage of GDP globally, even while approximately 16% of its population remained uninsured.

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Donald Berwick, a former CMS administrator, estimated that a significant portion of healthcare spending is waste. What percentage did he identify?

Answer: 20% to 30%

Explanation: Donald Berwick estimated that approximately 20% to 30% of all healthcare spending in the United States is attributable to waste, stemming from factors such as overtreatment, care coordination failures, and administrative complexity.

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Which of the following is identified as a primary cause of waste in healthcare spending by Donald Berwick?

Answer: Failure to coordinate patient care.

Explanation: Donald Berwick identified the failure to effectively coordinate patient care as a significant source of waste in the healthcare system, contributing to inefficiencies and suboptimal outcomes.

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In 2011, Medicare and Medicaid made approximately how much in improper payments, encompassing both errors and fraud?

Answer: $65 billion

Explanation: In 2011, Medicare and Medicaid programs collectively issued approximately $65 billion in improper payments, a figure encompassing both administrative errors and deliberate fraudulent claims.

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A 2000 World Health Organization study comparing healthcare systems found that publicly funded systems generally:

Answer: Spent less on healthcare and achieved better population health outcomes than the US system.

Explanation: The 2000 World Health Organization study concluded that publicly funded healthcare systems typically incurred lower expenditures while simultaneously achieving better population health outcomes compared to the US system.

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Access, Equity, and Health Outcomes

A 2009 Harvard study estimated that over 44,800 excess deaths occurred annually in the US due to lack of health insurance.

Answer: True

Explanation: A 2009 study published by Harvard researchers estimated that the absence of health insurance contributed to more than 44,800 excess deaths annually in the United States.

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The 'medical-industrial complex' refers to government efforts to regulate healthcare pricing.

Answer: False

Explanation: The 'medical-industrial complex' refers to the influence and operations of private, profit-driven entities within the healthcare sector, not primarily government regulatory efforts.

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The implementation of the ACA led to a decrease in uninsured rates, with racial and ethnic minorities experiencing greater benefits in coverage gains.

Answer: True

Explanation: The Affordable Care Act's implementation resulted in a significant reduction in the uninsured rate across the population, with notable improvements in coverage gains observed among racial and ethnic minority groups.

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A RAND Corporation study found a strong correlation between high patient satisfaction ratings and the technical quality of medical care received.

Answer: False

Explanation: A RAND Corporation study found no correlation between patient satisfaction ratings and the technical quality of medical care, suggesting that satisfaction is not a reliable indicator of clinical quality.

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Public opinion polls consistently show majority opposition to any government involvement in US healthcare.

Answer: False

Explanation: Public opinion polls generally indicate majority support for various levels of government involvement in US healthcare, rather than consistent opposition.

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Transportation barriers prevent a small number of individuals from accessing necessary medical care, costing the industry minimal amounts annually.

Answer: False

Explanation: Transportation barriers prevent millions of individuals from accessing necessary medical care, costing the healthcare industry an estimated $150 billion annually, which is a substantial financial impact, not minimal.

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Connecting chronically homeless individuals with housing has been shown to increase healthcare costs and emergency department utilization.

Answer: False

Explanation: Initiatives that provide housing for chronically homeless individuals have demonstrated a significant reduction in healthcare costs and emergency department utilization among this population.

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The concept of the 'medical-industrial complex' is often cited as a motivation for healthcare reform due to concerns about:

Answer: The promotion of medical treatments over preventative care and social inequity.

Explanation: The 'medical-industrial complex' refers to the influence of private, profit-driven entities within healthcare. Concerns arise from its potential to promote costly treatments over preventative measures and to perpetuate social inequities.

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What impact did the ACA's implementation have on uninsured rates, particularly for racial and ethnic minorities?

Answer: Uninsured rates decreased, with minorities showing greater gains in coverage compared to white individuals.

Explanation: The implementation of the ACA led to a significant reduction in the uninsured rate nationwide. Studies indicated that racial and ethnic minorities experienced more pronounced gains in health insurance coverage compared to white individuals.

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According to a RAND Corporation study, what is the relationship between patient satisfaction ratings and the technical quality of medical care?

Answer: There is no correlation between satisfaction ratings and technical quality.

Explanation: A RAND Corporation study concluded that patient satisfaction ratings did not correlate with the technical quality of medical care, suggesting that patient perceptions may not accurately reflect the clinical effectiveness of the care provided.

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Public opinion polls on government involvement in US healthcare generally show:

Answer: Majority support for various levels of government involvement.

Explanation: Public opinion surveys typically reveal that a majority of Americans favor some level of government involvement in healthcare, although the specific preferences can vary depending on the framing of the questions.

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What is the estimated annual cost to the healthcare industry resulting from transportation barriers preventing patient access to care?

Answer: 150 billion

Explanation: Transportation barriers are estimated to cost the healthcare industry approximately $150 billion annually by preventing patients from accessing care, leading to missed appointments and delayed treatment.

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Initiatives that provide housing for chronically homeless individuals have been observed to:

Answer: Significantly reduce healthcare costs and emergency department utilization.

Explanation: Providing housing for chronically homeless individuals has demonstrated a notable effect in reducing both overall healthcare costs and the frequency of emergency department visits among this population.

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Contemporary Healthcare Policy and Innovation

The Patient-Centered Outcomes Research Institute (PCORI) is funded by a direct appropriation from Congress annually.

Answer: False

Explanation: The Patient-Centered Outcomes Research Institute (PCORI) is funded through a fee levied on health insurance providers per covered life, not by direct annual appropriations from Congress.

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The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 primarily focused on expanding Medicare Part D prescription drug benefits.

Answer: False

Explanation: The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 primarily focused on reforming Medicare Part B reimbursement systems and extending funding for SCHIP, rather than expanding Medicare Part D benefits.

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In 2017, President Trump signed an executive order that allowed the sale of short-term health plans with comprehensive coverage.

Answer: False

Explanation: Executive Order 13813, signed in 2017, permitted the sale of short-term health plans, but these plans typically offered limited coverage, not comprehensive coverage.

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The Inflation Reduction Act of 2022 caps annual out-of-pocket prescription drug costs for seniors in Medicare Part D at $2,000.

Answer: True

Explanation: A key provision of the Inflation Reduction Act of 2022 is the establishment of a $2,000 annual cap on out-of-pocket prescription drug expenses for Medicare Part D beneficiaries.

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Advocates for a universal single-payer system argue it could increase administrative overhead due to the complexity of managing one large system.

Answer: False

Explanation: Advocates for a universal single-payer system argue that it would decrease administrative overhead by consolidating functions and reducing the complexity associated with multiple private insurers.

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Bundled payments involve paying providers for each individual service rendered for a patient's treatment.

Answer: False

Explanation: Bundled payments involve a single, consolidated payment for all services related to a patient's treatment for a specific condition or episode of care, contrasting with the fee-for-service model which pays for each individual service.

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What is the primary function of the Center for Medicare and Medicaid Innovation (CMS Innovation Center) as established by the PPACA?

Answer: To research and pilot innovative healthcare payment and service delivery models.

Explanation: The Center for Medicare and Medicaid Innovation (CMS Innovation Center) was established by the PPACA to develop and test novel payment and service delivery models aimed at reducing healthcare costs and improving health outcomes.

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The Patient-Centered Outcomes Research Institute (PCORI) was established by the ACA to conduct what type of research?

Answer: Comparative effectiveness research on healthcare treatments and services.

Explanation: The Patient-Centered Outcomes Research Institute (PCORI) was established by the ACA to conduct comparative effectiveness research, evaluating the relative benefits and risks of different medical treatments and healthcare strategies.

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Which act, passed in 2015, modified Medicare Part B reimbursement systems and extended funding for SCHIP?

Answer: The Medicare Access and CHIP Reauthorization Act (MACRA)

Explanation: The Medicare Access and CHIP Reauthorization Act (MACRA), enacted in 2015, modified Medicare Part B reimbursement systems and extended funding for the State Children's Health Insurance Program (SCHIP).

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What was a key outcome of Executive Order 13813, signed by President Trump in 2017?

Answer: It allowed the sale of short-term health plans with limited coverage.

Explanation: Executive Order 13813, signed in 2017, facilitated the sale of short-term health plans that offered limited coverage, among other regulatory adjustments impacting the healthcare market.

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The Inflation Reduction Act of 2022 includes provisions that allow Medicare to do which of the following?

Answer: Negotiate prices for certain prescription drugs.

Explanation: The Inflation Reduction Act of 2022 empowers Medicare to negotiate prices for specific high-cost prescription drugs, a significant expansion of its purchasing authority.

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Advocates for a universal single-payer system argue it could lead to cost savings primarily through:

Answer: Reduced administrative overhead and emphasis on preventative care.

Explanation: Advocates for a single-payer system posit that cost savings would be realized through substantial reductions in administrative complexity and a greater emphasis on preventative healthcare measures.

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How does the bundled payment model differ from the traditional fee-for-service model?

Answer: Fee-for-service pays for each individual service, while bundled payments provide a single payment for an episode of care.

Explanation: The fee-for-service model compensates providers for each individual service rendered, whereas bundled payments consolidate payment into a single sum for all services associated with a specific patient episode or condition.

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