DIP Episode 656 - The Clutch Health Insurance Podcast (Part 2)

All right, welcome. My name is divine. This is episode 656 of the Divine Intervention Podcast. And to this podcast, we're gonna be continuing the series on health insurance. Right? So again, this is the clutch health insurance podcast is gonna be a series two. Again, this stuff is pretty high you to know for your exams. And we're gonna start off with a discussion of, you know, so we talked about like the government stuff last time. But again, I'm gonna delve a little deeper into some topics and talk about payment models today. Right? They really love to test those things on the exams. And one thing you want to pay attention to today is as I explain our discourse, hey, how can they test this? Right? How can they test this? Right? So just kind of keep those nuggets in mind as we go through this podcast. Right? So, you know, I think I'm gonna, it makes sense to talk about the affordable care act for a bit. Right? So this is something we know that came in 2010. Right? You know, during the reign of President Obama, you know, many people call it Obama care. Right? Again, I'm not gonna get political here. My job is just to teach you concepts for your exams. Right? But it made a really, really big change in the US insurance system. You know, compared to, you know, it's probably one of the biggest changes that has, that has ever happened literally since, you know, Medicare, Medicaid, where we created, right? So what are some of the key affordable care act?

And I'm gonna keep calling it ACA provisions. You should know for your exams. Well, the very first thing is that again, it had this thing that it provided called guaranteed issue. Right? Guaranteed issue. Right? Guaranteed issue. Another thing that is also kind of related is something called a community reading. Right? So what do I mean by all these terms? Well, the thing is, before ACA, right, insurers could say, you know what? We're gonna deny you coverage or charge you more for coverage because of preexisting conditions. This is a big one to know for your exams. Right? The ACA basically prohibited this really said that, hey, can do that, can do that, can do that. Right? So basically, mandated that insurers cover everybody. Right? But the only thing you can use to vary the premiums for a person, right? Is the things like age, which makes sense. Right? Like, you know, which makes sense. Older people probably more unhealthy. Right? So like things like age, geography, right? So where do you live? Right? Family sides, right? Bigger families should probably pay more money. Right? And the use of tobacco. So that one was not negotiable. Right? So like if you if you smoke, you're gonna have higher insurance premiums. Right? But we did not use health status to determine how much coverage you get or how much you paid. Right? And then the second key ACA provision to know for your exams or what I call essential health benefits. Right? Essential health benefits. Right?

So basically like what does this mean? Essentially like any plan in the ACA marketplace, they have to cover 10 things. They must cover 10 categories of things. What are those 10 categories you need to know for your exams? Ambulatory care. Right? Emergency care. So Ambulatory care is number one. Emergency care is number two. Right? Hospitalization is number three. Maternity and newborn care is number four. Right? Mental health and substance use disorder services is number five. Right? Prescription drugs. That's number six. Right? Rehabitative services. That's number seven. Lab services. That's number eight. Right? Preventive services. That's number nine. Like screenings and whatnot. Right? And then number turn up pediatric services. Right? You know, including dental and vision for children. That was mandated dental. Right? Because many people they start having dental problems like early in life. If you can Nip that in the bud, then it's not going to be a long term issue. Right? So dental and vision care for children for children. Right? And then what's the third key ACM provision you want to know for your exams? It's something called the individual mandate. Right? The individual mandates. Right? So the thing is this one though kind of is almost like gone away in a sense. Right? So basically like the AC essentially required most Americans to have insurance. Right? It basically required that hey, you got to have insurance. Right?

If you do have insurance, you were going to pay a penalty. But there was an act in 2017, right? Call the TCGA, the tax cuts and jobs jobs act of 2017. It basically reduced the federal penalty to zero. Right? You basically, they basically like made this non of no effect. Right? You basically eliminated this individual mandate on a federal level. Right? Although some states they maintain the mandate. Some states did maintain their mandates. Right? And then the fourth ACM provision you definitely want to know for your exams or the marketplace subsidies, marketplace subsidies. Right? So what does this mean? Right? This was basically a week to help with the cost of insurance. Right? So if you're telling people that hey, I require you to have insurance. It's not everybody that can afford it. You need to figure out a way to help them out. So this was the thing that helps people out. Right? Market please subsidies. Right? So basically if you had incomes that were between a hundred percent to four hundred percent of the federal poverty level. Right? Those people got like tax credits premium tax credits from the federal government. Right? That helps them basically buying insurance on the marketplace. Right? You have to be again buying insurance from the ACA marketplace. Right? And the thing is, you know, there were some kind of almost like laws and acts that were enacted like they were called like the American rescue plan, the inflation reduction act.

These things actually expanded these subsidies. Right? And actually, opts the income cap a little bit for for a season, right? Not long-term, but for a season. Opts the income cap from that four hundred percent of the federal poverty level. Right? And then what is the fifth ACA provision you want to know for your test? Young adult coverage. Right? This one is super, super high you to know for your exams. Right? Basically, it requires insurers, you know, allow adult children to stay on their parents insurance. To stay on their parents health insurance until age 26. Right? And then the next thing I'm going to talk about here, it's not necessarily an ACA provision, but it's something that is kind of related. So I'm going to talk about it. Right? Something called Cobra. Right? Cobra pops up on the USMLE is quite frequently. Right? You may be like divine. What do you mean by Cobra? I talking about snakes. I'm not talking about snakes in this podcast. Right? But Cobra stands for the Consolidated Omnibus Budget Reconciliation Act. The Consolidated Omnibus Budget Reconciliation Act. Right? Basically, it allows an employee. Right? So you work for a company. Right? It allows an employee who, you know, basically loses their job. Right? Because most Americans, the way they have health insurance is through the employer. Right? So I believe I talked about that in Clutch Health Insurance Podcast number one. Right? So you lose your job.

You know, you lose, you're like, oh, no, oh, no, I have this health insurance from my job. You lose your job. So you lose that insurance. Right? It allows you to basically continue that job-based coverage for up to 18 months, for up to what? 18 months. But here is the catch. You have to pay the full premium yourself. Right? When you were working for an employer, right? You pay some of the premium. The employer kind of picks up the rest. But now it's you that pays the whole thing plus a 2% that means straight if he. Right? So it's very expensive. Cobra is good because if you're in a bench, it helps. But it's really expensive because now you're paying what you used to pay before plus what you're employing is to pay for you plus or 2% at a minis 3d fee. Right? So it's pretty expensive. Right? So the thing is if they give you a question on your exams about a person that loses employer coverage because they lose their job. Right? And they're trying to find a new job or they're trying to find new coverage. Right? Cobra is going to be the bridge between those two things. It's going to be the bridge between those two things. That's the thing that's going to get them covered quite a number of people actually actually use it. Right? And then one thing I'm going to say is that the ACAD did a lot of good, but there's still a lot of on-insured people on the test. That's just the truth. Right? There's still a lot of on-insured Americans. Right?

About 10% of all Americans still remain on-insured. Right? And again, our friends at the MBM is the country to ask you about groups of people that tend to fall disproportionately into this group of on-insured. So what these people will tend to be people that are low income. Right? People that are low income. People of color. Right? Immigrants. Immigrants. Immigrants. Right? And people that live in states that are not very agreeable to the ACA. Right? So again, four groups of people keep that in mind. Right? Low income people. People of color. Immigrants. That's a very important population to know about for your test. Right? And residents of basically like non-expansion states that basically did not really go with many of these expansions. Right? So the thing is our friends at the MBM is they are going to connect these groups. They're going to make questions out of these groups that relates to things like, you know, you know, having delayed care. Right? So like for example, they don't get their screenings good done on time. Right? They don't get their screenings done on time. Or they can give you a question about a person where, you know, they've had symptoms for a long time. Right? And there was a delay in diagnosis. There was a delay in seeking care because they were essentially on-insured. Right? And they can also discuss these groups in the context of worse outcomes in healthcare. Right? They can basically make a bio statistics question out of this.

Where do compare people that are insured to people that are on-insured? Right? And then talk about, you know, how like one group has like worse outcomes, like higher rates of mortality from like cardiovascular disease or diabetes. And they can ask you about the reasoning or the most likely explanation for that disparity. Right? The right answer on your exams will very likely be a person just being being on-insured. Right? Another thing that they love to test. Right? So you see, I've given you two domains. Right? Delayed care, you know, bad outcomes is the second one. The third one they love to test is the use over use of emergency departments. Basically using the emergency room as primary care. Right? People that are on-insured, they tend to use the emergency room a lot. They tend to use the emergency room a lot. So emergency department overuse. That's a very high-yield integration they can test on your exams. Right? Now in this second part of the podcast, I think one big thing I think I want to address here are payment models. Oh, friends at the NBM is they love love love love you to know about payment models. They love you to know about payment models. Right? So I'm going to kind of delve quite deep here. Right? And again, I'm going to give you a lot of use. Right?

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siness, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business, your own business So I'll see you God willing episode 657, right?

So again, there's going to be a part three for sure for this clutch health insurance podcast, but again, the stuff is pretty high you to know for your exams. So please share this with your with your with your colleagues and we show the best on your exam. So God bless you. I'll see you next time. Bye for now. Thank you.

Guaranteed Issue.

Age, geography (location), and tobacco use.

Age 26.

COBRA (Consolidated Omnibus Budget Reconciliation Act). The drawback is that the individual must pay the full premium plus a significant administrative fee.

Delayed care seeking/diagnosis, and overuse of emergency departments (E Ds) for primary care needs.

Essential Health Benefits (EHB).

To provide tax credits to help people afford insurance premiums, specifically for incomes between 100% and 400% of the Federal Poverty Level (FPL).

Consolidated Omnibus Budget Reconciliation Act.

Low income people, People of color, and Immigrants.

Coverage must include dental and vision services for children.

Delayed diagnosis/care seeking in underinsured populations.

Essential Health Benefits (EHB).

To provide tax credits to help people afford insurance premiums, specifically for incomes between 100% and 400% of the Federal Poverty Level (FPL).

Consolidated Omnibus Budget Reconciliation Act.

Low income people, People of color, and Immigrants.

Coverage must include dental and vision services for children.

Delayed diagnosis/care seeking in underinsured populations.