Question

1.Did the Affordable Care Act have any impact on health insurance?

2.Did the Affordable Care Act have any impact on employer sponsored health insurance?

3.What is the difference between public and private financing?

4.What impact do utilization reviews have on access, quality, and cost of health care?

5.How is Medicare different from Medicaid?

6.How is Medicaid financed?

7.How is Medicare financed?

8.Who administers Medicaid and Medicare?

9What is the impact of the Affordable care act on Medicare and Medicaid ?

Answer 1

3.Difference between public and private financing.

Finance is an offshoot of economics which deals with the arrangement management and deployment of money in an optimum way. It has two main branches -Private finance and Public Finance. Private finance is all about management of finances at an individual level .

On the other hand public finance is a field of finance in which one study is the role of government and the impact of various activities undertaken by the government in an economy .

One of the main differences between Private finance and Public Finance lies in the power of an eminent domain.This means that when we talk about private finance the sources of income for an individual are confined, however in case of public finance ,the government can use its power and impose taxes, mint coins and print currency notes.

Public financing

* Public Finance refers to that branch of Finance which studies government financial dealings including government spending borrowing, deficits and taxation.

* In Public Finance the government ascertain the total expenditure to be made on different sectors first and then identifies the sources from which the revenue can be generated to meet those expenses.

* Primary objective of public finance is a welfare of the general public.

* In public finance, the government usually frames a deficit budget, during the phase of economic development, war for depression.

* In public finance, government uses public money, for providing public utility services, that is why it cannot be kept secret.

* Public finance is related to the yearly budget of the government which is fixed.

* Public finance is relatively more elastic than private finance because an individual cannot make sudden and huge changes and his income, but the same is possible in case of public finance.

Private Financing

* The study of the income expenditure and debt of private individuals firms and household is called as private financing

* In private financing any individual, household or business enterprise decides the quantum of expenditure to be made on the basis of his or her income.

* The main objective of private finance is to manage the finances in such a way which helps in earning maximum profit as against the primary objective of public financing.

* In private finance the individual seeks to maintain a surplus budget Spice painting only a certain portion of his income.

* In private finance the individuals income and his or her expenditure is his or her own affair and so it can be kept secret.

* Private finance is related to daily ,weekly or monthly budget of an individual or household.

In private finance the individual or household can postpone or avoid certain expenses if they are unnecessary or available. However in case of public finance, the government cannot avoid or delay certain expenditures ,especially expenditure on Defence,Agriculture,Research or public administration.

5. Difference between medicare and medicaid. ​​​​​​

Medicare and medicaid are two important US Healthcare programs. Each program serves different groups of people although some people are enrolled in both programs.

Medicare is a Federal Government sponsored Healthcare program for those 65 and over and for younger people who are disabled .Most people with Medicare paid FICA taxes during their working years and realize the benefits of that tax through Medicare coverage. The Federal government established the eligibility criteria for Medicare. Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It is US people over 65 primarily whatever their income and serves younger disabled people and dialysis patients.Patients pay part of costs through deductibles for hospital and other costs. Small monthly premiums are required for non hospital coverage. Medicare is a federal program .It is basically the same everywhere in the United States and is run by the centres for Medicare and medicaid services an agency of the Federal government.

Medicaid on the other hand is a Health Care program for low-income individuals who could not otherwise afford Health Insurance. Medicaid is jointly funded by the Federal Government and the state in which an enrolle lives. States establish their own eligibility standards and services for medicaid with in a general parameters set by the Federal government. Before the Affordable Care Act (ACA) most States only provided medicaid the various to disabled and elderly individuals ,preganant women ,children and low-income families. Medicaid is an assistance program. It serves low-income people of every age. patients usually pay no part of costs for covered medical expenses a small co-payment is sometimes required. medicaid is a federal state program. It varies from state to state. It is run by state and local governments within Federal guidelines.

6. Medicaid financing

Medicaid represents one out of every $1 out of every $6 spent on healthcare in the US and is a major source of Financing for states to provide coverage to meet the health and long-term needs of their low-income residents, The medicaid program is jointly funded by states and the Federal government .There has been renewed interest in how medicaid is financed in light of the additional Federal financing for the medicaid expansion under the affordable care act ACA as well as ongoing budget discussion at the federal level.This brief reviews how the medicaid program is financed as well as the implications for budgets, responsiveness to state policy choices and need, the links between Medicaid spending and state economies.Key conclusions include:

* Federal medical assistance percentage( FMAP)

The Federal government guarantee is matching funds state for qualified medicaid expenditure ;states are guaranteed at least $1 in Federal funds for every $1in state spending on the program. This open ended and financialstructures allowFederal funds to flow to states based on the actual cost and needs as economic circumstances changes.

* Enhanced matching rates

In some instances medicaid provider higher matching rate for select a serviceor population is the most notable being the ACA medicaid expansion enhanced match rate for those states that expand the Federal government will pay hundred percentage of medicaid cost of those newly eligible from 2014 to 2016.The fedral share gradually phase downs to 90% in 2020 and remains at that level there is no deadline to adopt the expansion however the Federal match rates are tied to specific years.

* Disproportionate Share Hospital payments(DSH)

Dsh payments are another source of financing available to hospitals that serve a large number of medicaid and low-income and insured patients in many states ,these DSH payments have been crucial to the financial stability of safety net hospitals. Based on the assumption of increased coverage and low-income and therefore reduced and compensated care costs under ACA, the law called for an aggregate reduction in Federal DSH allotment across all states,regardless of whether the state has expanded or not .These cuts have been deleted from FFY 2014 and 2018 and are set to continue through 2025.

* State Financing of the Non Federal Share

State have flexibility in determining the sources of funding for the non Federal share of medicaid spending. The primary source of funding for the non Federal share comes from the state general fund appropriations. Over the past decades States' use of other funds has increased slightly but steadily. This is likely tied at least in part to states' increased Reliance on provider taxes and fees to finance state share of medicaid.

7.Medicare Financing

The primary source of funding for part A is payroll tax contribution of 1.45% on both employers and Employees, with self- employed workers paying the full 2.9%.The tax revenue are added to the hospital insurance (HI)Trust fund along with interest on Federal securities held by the trust fund, Federal income taxes paid on social security benefits, and premium paid by enrollees is not entitled to premium- free Part A.In 2018 ,total revenue accrued by the H I trust fund was $306.6 billion ,total expenditures accounted for$ 308.2 billion ,and the HI assets were reduced by $1.6 billion .The assets were $200.4 billion at the beginning of 2019 ,which represents about 62 % of Expenditure .The HI assets are predicted to be depleted in 2026,at which point Medicare revenues will cover 89% of Expenditures ( in 2026),declining 77% by 2046,and rising to 83% by 2093.

Part B benefits are financed through the Supplementary medical insurance(SMI) Trust fund and are not at risk of insolvency because financing is derived through beneficial premiums with general revenues filling the gap. Beneficiary premiums are set to finance 25% is off expected program costs.Total revenue for the SMI trust fund in 2018 was$353.7 billion, and total expenditures were $337.2 billions,adding $16.5 billion to the SMI assets, which totaled $96.3 billion at the end of 2018.Payment and spending under MA (Part C) are based on spending in tradition Medicare and are taken from the HI and SMI trust funds .

Medicare part D is also financed through Federal general revenues and beneficiary premiums. beneficiary premiums are set to cover, on average, 25.5 % of the cost of a standard part D plan.Additional revenue comes from state " Claw back" payments, which reflect a portion of the amounts that the state medicaid programs would otherwise have had to pay for dual eligible enrollees drug coverage.Part D revenues are included in a separate account within the SMI trust funds. In 2018 ,the total part D expenditures were approximately $95.2 billion ,and revenues were $95.4 billion.