Essentials Of Health Policy And Law 5th Edition Sara E. Wilensky, Joel B. Teitelbaum - Solutions

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Consider each of the following issues and discuss whether you support Theory X, Theory Y, neither theory, or some combination of them. Issue Theory X Theory Y Whether a person is healthy or sick Whether a person is healthy or sick Your view about how is determined randomly. an individual's health
Some people argue that the government should not intervene in the case of a market failure because the government itself is inefficient and will simply create new problems to replace the ones it is trying to fix. In addition, critics contend that the government is usually less efficient than the
Governor Sophia is in a quandary. She believes everyone should have access to health care and would like to support state policies that make care accessible and affordable. While she supported President Obama’s goal of reducing the number of uninsured, she is concerned that some of the provisions
Do you think it makes more sense to structure government healthcare programs as entitlements or block grants? What are the economic and healthcare risks and benefits of each approach? Does your answer depend on who is paying for the program? Who the program serves? What kinds of benefits does the
What are the benefits and drawbacks of having a health program that varies by state versus having one that is uniform across the country? Do you find that the positives of state flexibility outweigh the negatives, or vice versa? Does your analysis change depending on what populations are served?
Looking at Medicaid’s traditional eligibility rules, you will notice numerous value/policy judgments—pregnant women and children are favored over childless adults, the medically needy are favored over other low-income individuals with high costs, nonimmigrants are favored over immigrants. Under
Does the medically needy category make sense to you? Do you think it is a good idea to discount medical expenses of high-need individuals so they can access the healthcare services they need through Medicaid? If so, is the process just described cumbersome and likely to result in people being on
What are the implications of a two-tiered Medicaid system? Is there justification for offering some beneficiaries a less generous benefit package than others? Is it fair to impose additional requirements (categorical, asset test) on only some beneficiaries? Why do you think policymakers created
States have enormous flexibility in designing their Medicaid programs. States spend significant resources on optional services or mandatory services for optional populations. Even so, states complain that Medicaid expenditures are unsustainable and that significant reform, such as the Deficit
The DRA also included new rules on citizenship verification. Prior to the DRA, all but four states allowed beneficiaries to self-attest to their citizenship status. Under the DRA, Medicaid and CHIP applicants now have to prove their citizenship status by providing original or certified copies of
In addition to the standard FMAP formula, there are several instances where states receive additional or different matching rates:• Indian Health Service: 100%• Family planning services: 90%• Health homes: 90%• Expansion Medicaid: 90%• District of Columbia: 70%• U.S. territories: capped
Is higher Medicaid cost-sharing a good idea? What are the strongest arguments you can make for and against higher cost sharing?Should Medicaid beneficiaries have the same cost sharing responsibilities as privately insured individuals, or should the government bear more of the cost because Medicaid
Who should determine Medicaid provider reimbursement rates, and how should they compare to other insurance programs or plans? Should the federal government play a stronger role in setting provider rates? Is this an area where it is better to have state variation or national uniformity? Should the
Should states be allowed to impose work requirements as a condition for receiving Medicaid benefits? Do work requirements promote independence and upward mobility, and, if so, are those two goals legitimate objectives of the Medicaid program? Are work requirements unnecessary barriers to care?Those
What type of Medicaid reform, if any, do you support? Should Medicaid beneficiaries be treated like privately insured individuals, meaning increased cost-sharing requirements, fewer legal protections, and fewer guaranteed benefits than in the current Medicaid program? Is it fair to provide a more
Why do you think that Medicaid was created as an entitlement program but CHIP was established as a block grant? Both programs are federal–state insurance programs for low-income individuals, so does the distinction make sense? Does it matter that one program is for children and the other is
Individuals are exempt from purchasing insurance if their income is below the tax-filing threshold (in 2020, this amount was $$12,200$ for single people younger than 65 years and $$24,400$ for couples younger than 65 years), the lowest-cost plan option exceeds 8.24% of their income in 2020,
CSRs raise the actuarial value of a plan and limit the maximum out-of-pocket costs (Norris, 2019). As shown in Table 11.2, CSRs increase the actuarial value by having plans pay a higher percentage of service costs based on income level. The standard maximum out-of-pocket costs are based on health
There was a lengthy debate about whether to include a public option in health reform. A public option is some type of government-run health plan that would be available to compete with private plans. A public option could exist either within the health exchange model or outside of it. Instead of a
When designing CHIP, policymakers chose to follow the private insurance model instead of the Medicaid model. Although states have the choice to create a generous Medicaid expansion program for their CHIP beneficiaries, they also have the choice to implement a more limited insurance program with
The amount of the premium tax credit is tiered based on income and is set so that individuals will not have to pay more than a certain percentage of their income for premiums (see Table 11.1). The tax credit amount is based on the cost of the second-lowest-cost silver plan in the exchange and the
Although many Medicare beneficiaries are poor, there is no means test (income- or resource-specific eligibility level) to determine eligibility as there is with Medicaid and CHIP. Is there a good public policy reason for this difference? What would be the basis for making this distinction? Does the
Lawmakers were concerned that adding a prescription drug benefit to Medicare would encourage employers to drop prescription drug coverage to the beneficiaries who receive prescription drugs through retiree health plans. In an effort to avoid a shift in older people who rely on public insurance
The clawback provision is controversial and highlights some of the tensions concerning state flexibility and national uniformity that policymakers face when designing public programs. The clawback seems to contradict the prior decision to provide states with flexibility and program design
Controlling Medicare spending is a difficult task. Even if provider reimbursement rates are reduced, physicians and hospitals may increase volume and intensity of services to make up for lost revenue. The ACA included a number of pilot programs and demonstration projects to experiment with
Are there alternatives to the individual mandate that accomplish the same goals without engendering so much political turmoil?Could policymakers have designed an incentive system that would be as effective as a mandate? What are the pros and cons of using a mandate versus an incentive? Can you
Both AHPs and STLDs are likely to “limit benefits, be priced on the basis of an individual’s health status, and impose lifetime and annual spending limits, and insurers could reject applicants on the basis of their health and any preexisting condition” (CBO, 2018, p. 10). One review of
All plans in the state exchanges must offer the following benefits:• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health services and substance use disorder services, including behavioral health treatment• Prescription drugs•
For employers that do not offer health insurance and have at least one full-time employee who takes the premium tax credit, the penalty is $2000 per employee after the first 30 employees.For example, if such an employer has 50 employees, the employer would pay a $40,000 penalty: 50 − 30 = 20
Congress passed the various pandemic laws without paying for them. The federal deficit is projected to be $2.3 trillion in 2021, equaling 10.3% of GDP. This is the second largest deficit since 1945, only bested by the 2020 deficit (CBO, 2021). Even though in mid-2021 the U.S. economy is showing
CBO estimates that premium subsidies and CSRs will cost the federal government $$851$ billion from 2018 to 2027 (CBO, 2017c).Is this a good use of resources? Are these subsidies well designed? Are they sufficient to make health insurance affordable? Do they cover people with incomes that are too
The coronavirus pandemic created significant health insurance challenges for both individuals and insurers. In May 2020, the U.S. unemployment rate jumped to 13.3%, meaning 21 million people who wanted to work did not have a job (Bureau of Labor Statistics, 2020). To put this staggering number into
There is a debate about the proper age at which to start regular mammogram screenings to detect breast cancer in women who do not have specific risk factors for the disease. As of 2009, the U.S. Preventive Services Task Force recommended waiting until age 50 years to begin mammogram screening for
What do you think of the term medical error as a descriptor of adverse medical outcomes? After all, there are many medical procedures (e.g., invasive surgeries) and treatments (e.g., chemotherapy) that not only are inherently risky, but also cause painful and dangerous (and often unpreventable)
While Democrats passed the ACA and remain its strongest supporters, not all Democrats and progressive constituents believe the ACA’s approach was the best way to reform the healthcare system. During the 2020 election, Medicare-for-All(M4A) plans received unprecedented attention. A number of 2020
Workplace wellness programs are intended to entice employees to engage in healthy behaviors (e.g., more exercise, less smoking). Not only can such behaviors improve the individual’s health, but employers also hope to save money through lower healthcare costs and less absenteeism. Participation
Give some thought to the term national standard of care. What do you think it means, from both a healthcare quality and legal (i.e., evidentiary) perspective? Are you aware of any national body—governmental or otherwise—that determines the efficacy of new diagnostic protocols or treatment
What do you think about the role and success of tort law in promoting high-quality health care? Does it help to deter errors?If not, why?
The critical intersection between health care and health insurance as exemplified by the Davila decision leads to an important question: Is it reasonable to treat a healthcare coverage decision as having nothing to do with health care itself?Put another way, given the expense of health care today,
Public health emergency preparedness is a highly specialized area of public health practice. In order to effectively appreciate the importance of public health preparedness in keeping populations healthy following a large-scale public health emergency, the basic foundations of public health
What is public health emergency preparedness? Describe the incidents that led to the creation and/or expansion of public health emergency preparedness programs in the United States.
What is the ICS, and why is it important to preparedness and response?
What is the role of state and local governments in preparedness and response? What is meant by the phrase “whole community approach to preparedness”?
Read several articles from different sources about the Emergency Use Authorizations (EUAs) for the three COVID-19 vaccines. Why was the EUA such an important public health measure or tool in the effort to control COVID-19? What surprised you about the EUA process? How would you explain the EUA
Review the information about the quarantine case involving the nurse who returned to the United States from treating West African patients with Ebola in October 2014. Do you agree with her decision to challenge both the New Jersey and Maine quarantine orders? Why or why not? Do you agree with Judge
Considering that the ultimate responsibility for implementing measures to protect the public health lies with local officials, what are your thoughts about the measures to pull back public health powers related to masking and shut-downs during COVID-19 by some state legislators as described in the
What is the political salience of the issue?Is this a front-burner issue?Is this a controversial issue?Are your client, legislators, and the general public interested in addressing this issue?Has this or a similar healthcare issue been addressed recently?Do key constituents, opponents, interest
Who is affected by this problem?According to the client who assigned the analysis, are influential or valued people or groups affected by this problem?Is there a fairness concern relating to this issue?Is there a stigma associated with this issue?
What is the economic impact of addressing this problem? Of not addressing it?Are various people or groups impacted differently?Are there competing demands for resources that relate to this issue?What is the economic situation of the state or nation? How does this affect the politics relating to
Is it realistic to try to solve this problem?Do others need to be involved to be able to solve this problem?Is the technology available to solve this problem?Would it be more practical to solve this problem later?Are other people in a better position to solve this problem?What do we know about
Are there legal restrictions affecting this problem?Is there a need to balance public health concerns and individual legal rights?Are there legal requirements that impact the analysis?Is new legislative authority necessary to solve the problem?Is there legal uncertainty relating to this problem?Is
Does this problem address quality-of-care issues?Do some solutions focus on quality of care more than others?Do quality-of-care concerns vary based on which provider is involved?Is evidence available about the best ways to improve quality of care?Has the client already taken any actions to improve
Advocates must do background research to understand what decision makers care about and what could influence them. Ask yourself the following questions:What motivates your key decision makers?Who among your allies has a relationship with those key decision makers?What do you know about your
Explain the role of public health in emergency preparedness?
Describe generally the important role played by policy and law in the health of individuals and populations?
Describe three ways to conceptualize health policy and law?
Study based on the broad topical domains of:a. Health careb. Public healthc. Bioethics
Study based on historically dominant social, political, and economic perspectives:a. Professional autonomyb. Social contractc. Free market
Study based on the perspectives of key stakeholders:a. Individualsb. The publicc. Healthcare professionalsd. Federal and state governmentse. Managed care and traditional insurance companiesf. Employers g. Healthcare industries (e.g., the pharmaceutical industry)h. The research community i.
From a policy perspective, are the characteristics just described interrelated, or should they be addressed separately? If you are trying to reduce the number of uninsured, do you believe the focus should be on altering insurance programs or changing the effect of having one or more of these
The ACA made it a priority to reduce the number of uninsured. At what point, if any, should the government step in to provide individuals with assistance to purchase insurance coverage? Do you think such assistance should be a federal or a state responsibility?
Describe the concepts of policy and policymaking?
Describe the basic function, structure, and powers of the legislative branch of government?
Describe the basic function, structure, and powers of the executive branch of government?
Explain the role of federal and state governments in the policymaking process?
Explain the role of interest groups in the policymaking process?
Describe the role of law in everyday life?
Define the term law?
Identify the various sources of law?
Describe key features of the legal system?
Safety net providers mostly serve uninsured and publicly insured low-income patients. Many of the safety net provider features you just read about are in place to assist these patients in accessing health care. Instead of pursuing universal coverage, would it be an equally good strategy to expand
Unfortunately, evidence is not available to support the effectiveness or cost–benefit of every procedure or drug. How should policymakers and providers make decisions when faced with a dearth of evidence? Do you prefer a more cautious approach that does not approve procedures or drugs until
Do you prefer one of these health systems to the others? Why or why not? Are there features that you think should be incorporated TABLE 4.2 into the U.S. healthcare system? Are there reasons why certain features might be difficult to incorporate into the U.S. healthcare system? TABLE 4.2 Healthcare
Pick a major historical public health figure mentioned in this chapter or of whom you are aware. What was the most important contribution of this individual to the evolution of public health?Why was it important? What is this individual’s enduring legacy to public health?
Review the news headlines for the last week. How many stories are related to health? Are these predominantly stories about health care or about public health, or both? To what extent is prevention of disease highlighted in the news? Is health equity mentioned? What other themes are mentioned?
How does each of the characteristic features of a public health approach described in this chapter distinguish it from other fields, or not?
Describe the meaning and importance of the “no-duty-to-treat”principle?
Explain generally how the U.S. approach to health rights differs from that of other high-income countries?
Describe the types and limitations of individual legal rights associated with health care?
Describe the balancing approach taken when weighing individual rights against the public’s health?
At the turn of the 20th century, an Indiana physician named George Eddingfield repeatedly refused to come to the aid of Charlotte Burk, who was in labor, even though he was Mrs.Burk’s family physician. Doctor Eddingfield conceded at trial that he made this decision for no particular reason and
Depending on one’s personal experience in obtaining health care, or one’s view of the role of physicians in society, of law as a tool for social change, of the scope of medical ethics, or of the United States’ place in the broader global community, the no-duty principle might seem
Go back to the first legal principle drawn from the Canterbury decision: namely, that physicians have a duty of reasonable disclosure to include therapy options and the dangers potentially involved with each. Do you agree with the court that this duty is both a logical and modest extension of
If you were asked to distill, down to their most essential parts, the constitutional right to privacy and the right to privacy as it applies to abortion, what elements would you include?
Jacobson v. Massachusetts is a product of the early 20th century, and the public health law principles supporting it are vestiges of an even earlier time. This, coupled with more than a century of subsequent civil liberties jurisprudence and societal and political shifts, has led some commentators
The “negative constitution” is a concept over which reasonable people can easily disagree. Notwithstanding the “defensive”manner of some of the Constitution’s key provisions, there are several arguments in support of more affirmative action on the part of government health and welfare
Living through brief periods without heat or electricity is a fact of life for most of us, perhaps as a result of a powerful weather system or a blown generator. But have you experienced or considered what it would be like to be without heat or electricity more chronically, due to homelessness,
Do you think trying to achieve wide-scale health equity is a laudable goal? Why or why not? If yes, what do you think are the keys to achieving it? And what about people who are given the opportunity to achieve optimal health but do not take advantage of it; should they face consequences of some
a. Structural drivers help determine how society operates. For example, at the time of this writing—just 6 months after the 2020 election cycle—lawmakers in 47 states have introduced nearly 400 bills aiming to restrict voting rights(primarily in the areas of absentee voting, ID requirements,
Each student should begin by rank-ordering a list of the half-dozen social drivers (from those listed in this chapter or otherwise; broad or specific) that they believe most significantly affect individual health. Then get together in groups of three or four people to compare lists, discussing
Get together in groups of three or four people. As a group, take 20 minutes to make a list of all the specific ways you can think of that the law has been used to directly respond to health-harming social needs (examples exist in category 5 in this section). When time is up, compare lists across
What do you think about the differences that exist between rights that attach in the area of criminal legal representation versus those that exist in the realm of civil legal assistance? Does it seem fair to you? Why or why not? Even if you believe it is fair, do you think all individuals should
Define the basic elements of health insurance
Discuss health policy issues relating to health insurance
Most people in this country obtain health insurance through employer-sponsored plans. Although the historical background you just read explains how this system came about, it does not discuss whether it is a good or bad thing. Is our reliance on employer-sponsored health insurance ideal for
As a general matter, all types of insurance under traditional economic models cover expensive and unforeseen events, not events that have small financial risk or little uncertainty (Council of Economic Advisors, 2004, p. 195). For example, auto insurance does not cover regular maintenance, such as
A literature review of studies relating to consumer behavior with HDHPs found that these plans reduced the use of both appropriate care, such as preventive screenings, and inappropriate care, such as unnecessary emergency department visits (Agarwal et al., 2017). To date, research generally has not
In general, people with low incomes or no health insurance (or both) tend to be less healthy than those who are financially better off or insured (or both). As a result, policy proposals that suggest including poor, uninsured individuals in already-existing insurance plans are met with resistance
What populations or types of people pay more under experience rating? Does experience rating create any incentives for individuals to act in a certain way? What populations or types of people pay more under community rating? Does community rating create any incentives for individuals to act in a
Cost-containment strategies embraced by MCOs were a direct result of the FFS experience with ever-increasing utilization and healthcare costs. However, many consumers and providers chafe at the restrictions imposed by MCOs and are concerned that someone other than the provider is making treatment

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Essentials Of Health Policy And Law 5th Edition Sara E. Wilensky, Joel B. Teitelbaum - Solutions

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