POLS 3125 Exam 2 Review

According to research by Grogan and Park, approximately what percent of Americans have some type of connection to Medicaid? a) 5% b) 20% c) 33% d) 64%

d) 64%

Loss ratio

percentage of premium revenue that the current insurance company in turn spends on actually paying for care (vs. for salaries, marketing, profits)

Minimum capital requirements

state laws that set a minimum amount of net worth than an insuring organization must have in order to operate

All children in the US are eligible for CHIP or Medicaid. a) True b) False

b) False-must be low income

Which program is the largest public health insurance program in the United States? a) Medicare b) Medicaid c) Children's Health Insurance Program d) Affordable Care Act

b) Medicaid

Which program varies more across states? a) Medicare b) Medicaid

b) Medicaid

Rate band

limit on difference between most expensive and cheapest premium

Medicaid expansion to people below 139% FPL

2010

President Clinton

Health Security; Managed competition under a budget; Regional health alliances

President Carter

Nothing

The Federal Medical Assistance Percentage (FMAP) sets the relative federal versus state costs for which program? a) Medicare b) Medicaid c) Both d) Neither

b) Medicaid

Medicaid (original)

1965

Medicare (original)

1965

Children's Health Insurance Program

1997

Medicare Part D

2003

Affordable Care Act

2010

President Obama

Affordable Care Act; health insurance exchanges

President Truman

New hospital construction using federal funds

President Reagan

Nothing

Which federal law says that traditional insurance plans are subject to state government regulations but that self-insured plans are exempt from such regulations? a) ERISA b) COBRA c) HIPAA d) ACA

a) ERISA-deemer clause

Which court case determined that people using either state-based health insurance exchanges, or the federal exchange, could receive tax-credits/subsidies under the Affordable Care Act? a) King v. Burwell b) National Federation of Independent Business v. Sebelius c) Paul v. Virginia d) United States v. South Eastern Underwriters Association

a) King v. Burwell; subsidies only for people on one type of exchange vs. any type of exchange; eligible if shopping on healthcare.gov

Healthcare.gov is a) The federal level health insurance exchange set up under the Affordable Care Act b) The only health insurance exchange set up under the Affordable Care Act c) The place where a new public insurance program, different from Medicare, Medicaid, or CHIP, is available to everyone who lacks health insurance through other means d) The names of a state level health insurance exchange set up under the Affordable Care Act

a) The federal level health insurance exchange set up under the Affordable Care Act

Across states, there is an inverse relationship between state per capita income and Federal Medical Assistance Percentage (FMAP). a) True b) False

a) True

Politics is not the same as public policy. a) True b) False

a) True

Once a policy is enacted into law by legislature, this event marks the end of the policy process. a) True b) False

b) False

Medicare provides insurance for long term care. a) True b) False

b) False-Medicaid provides insurance for long term care

The ACA provides insurance for long-term care. a) True b) False

b) False-Medicaid provides insurance for long-term care

Tax credits/subsidies to help people buy private insurance through a health insurance exchange set up under the ACA are available to people below 100% FPL. a) True b) False c) It depends on whether their state of residence expanded Medicaid

b) False; 100-400% FPL can get tax credits

Which court case determined that states could choose whether or not to implement the expansion of Medicaid outlined in the Affordable Care Act? a) King v. Burwell b) National Federation of Independent Business v. Sebelius c) Paul v. Virginia d) United States v. South Eastern Underwriters Association

b) National Federation of Independent Business v. Sebelius; made Medicaid expansion optional

Which level of government has historically played a larger role in regulating health insurance? a) Federal government b) State government

b) State government

Which of the following was part of the Affordable Care Act as enacted into law? a) A "public option" (public insurance that any uninsured American could opt to use) b) An "Individual mandate" (a requirement to have health insurance coverage of some type) c) Both of the above d) Neither of the above

b) an "individual mandate" (a requirement to have health insurance coverage of some type

Guaranteed issue

before ACA, most states mandated that health insurance companies accept all applicants on individual/non-group health insurance market

Which of the following programs is currently a "block grant" program? a) Medicare b) Medicaid c) Children's Health Insurance Program d) Affordable Care Act

c) Children's Health Insurance Program

Policy form

contract specifying the configuration of health benefits that a health insurance company offers to its policyholders

Which of the following is a means of policy retrenchment that is readily visible to the public and may readily provoke protest from the latent constituency around a policy? a) Layering b) Conversion c) Drift d) Legislative repeal e) All four of these policy changes are equally visible

d) Legislative repeal

Which court case determined that the federal government did indeed have constitutional authority to regulate health insurance as a form of interstate commerce? a) King v. Burwell b) National Federation of Independent Business v. Sebelius c) Paul v. Virginia d) United States v. South Eastern Underwriters Association

d) United States v. South Eastern Underwriters Association

Exclusionary rider

denies coverage for specific aspects of healthcare, based on underwriting process

What entities receive federal funds through the Medicaid program? a) State governments b) Hospitals c) Nursing homes d) Federally qualified health centers e) All of the above f) None of the above

e) All of the above

Federal Medical Assistance Percentage (FMAP)

federal government matches a state government's spending on Medicaid at a given rate; varies across states; higher for states that have lower per capita incomes (lowest was 50%, highest was 73.6%); federal government financed about 57% of total Medicaid expenses

High risk pool

insurance system usually set up by state governments for people deemed uninsurable on the private market

Conversion

old rules are not removed nor neglected, just made to have a different impact; no new rules are introduced

Drift

old rules are not removed, just neglected and made to have a different impact; no new rules are introduced

Layering

old rules not removed, nor neglected, nor made to have a different impact; new rules are introduced

Block grant

states would receive fixed amount of money to use to administer Medicaid, and federal money going to states for Medicaid would no longer automatically increase during economic downturns or during other events that cause an increase in Medicaid-eligible individuals; often linked to greater state-level discretion in program details

Deemer clause

ERISA prohibits that state laws regulate self-funded employee benefit plans

President Nixon

Family Health Insurance Plan; Comprehensive Health Insurance Plan