Midwest Education, Inc. has been thrashing over many ideas as to how to respond to legal mandates under the Patient Protection and Affordable Care Act (ACA). At the direction of Frank Rose, COO, the Vice President for Human Resources, Larry Wilson, has conducted research into the law and gotten as much legal advice as he could. He even attended seminars that were advertised as helping companies determine how to respond and set up their compliance programs. He has discovered that there are many different options and much advice, but no one “right” way to be in compliance with the law. When he talked with Mr. Wilson about all the different possibilities and options, Frank decided to call together all of the interested players in the company and to finally make a recommendation to Judith Lund, CEO, as to how the company should respond.
Senior United States District Judge Roger Vinson presided over the court proceedings deciding the constitutionality of PPACA. The plaintiffs in this case were seeking a summary judgment by Judge Vinson and an injunction placed on the enforcement of the act scheduled to start in 2014. There were a total of two counts that court examined in regards to this case. The first challenge was over the mandate that all Americans beginning in 2014 will be required to purchase federally approved health insurance or face a monetary penalty. This requirement was set forth in section 1501 of PPACA. The defendants argued that Congress has the power to mandate the purchase of insurance by all Americans under provisions in the Commerce Clause. The second challenge in the case deals with the provision that altered and amended the Medicaid program. This amendment required states to offer Medicaid to individuals under the age of 65 with income under 133 percent of the federal poverty level. Today the Department of Health and Human Services has set the federal poverty level for a family of four at $22,350 (Hatch & Upton, 2011). New regulations under PPACA will require states to offer Medicaid to citizens making less than $29,725. The plaintiffs argue that the increase in Medicare requirements for the states violates the Spending Clause set forth to regulate government spending.
Id. at 21 (citations omitted). The U.S. Court of Appeals for the Ninth Circuit applied Ratzlaf in a health care fraud case, holding that the element of intent required the defendants to know that their conduct was unlawful and to undertake that conduct with specific intent to commit the crime. Hanlester Network v. Shalala, 51 F.3d 1390, 1400 (9th Cir. 1995). Subsequently, a district court in the Sixth Circuit disagreed with the Ninth Circuit, concluding that Ratzlaf was distinguishable because it concerned another statute whose language was arguably more ambiguous than that of the anti-kickback statute. United States v. Neufeld, 908 F. Supp. 491, 494–97 (S.D. Ohio 1995); see also United States v. Jain, 93 F.3d 436, 440–41 (8th Cir. 1996) (distinguishing the use of the term ‘willfully’ in Ratzlaf with its use in the Medicare anti- kickback statute). The U.S. Court of Appeals for the Tenth Circuit, adopting an intermediate position, has required that the prosecutor prove that there is no reasonable interpretation of the rules which could render a defendant’s statements truthful. United States v. Migliaccio, 34 F.3d 1517, 1524 (10th Cir. 1994). Thus far, the Supreme Court has not addressed the meaning of the term “willfully” in the Medicare fraud context.
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preventative care, for uninsured individuals who live below the 150th percentile federal poverty level and do not have access to employer-provided or government-funded health insurance. The clinic has an on-site laboratory, pharmacy, and provides interpreter services in most languages spoken by its patients. The clinic is staffed by six full-time paid personnel and over 300 active volunteers, including approximately 60 volunteer interpreters. The clinic, which has been in operation since 2005, has no affiliation with any religious organizations and is funded by non-
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captured a different construct than quantitative scales such as the JSPE. The different construct may not have triggered the same differences in responses among student sub- groups as the JSPE. However, it is important to note that although sub-group differences were not found among the traditional groups (people-/technology-oriented and core-/non- core), there was a clear continuum of expressed empathy or ability to take the perspective of the other reflected in the student writings. Of particular note is that students in the people-oriented and primary care-core sub-groups also expressed varying levels of expressed empathy. Learners in all specialties vary in their comfort level engaging with community members, eliciting intimate details about their lives, and communicating those experiences in writing. Given the debate about the effectiveness of teaching strategies to engender empathy, this study sheds light on potential points of intervention. The work of Afghani and colleagues’ (2011), Shapiro (2002), and Wear and Zarconi (2008) suggests that good role models are essential for student learning of empathetic behavior. Medical educators will need to consistently model perspective taking and engagement beyond the level of gathering information required for the SOAP note, if we hope to instill in students the importance of this attribute.
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The overhaul of the U.S. health care system by The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 involves a significant cost to the government. This cost is expected to be recouped through widespread changes in the tax law which will affect most taxpayers. Revised and altogether new tax provisions will affect individuals as well as businesses, higher income individual taxpayers as well as lower income taxpayers, investors as well as blue collar workers, and mom and pop businesses as well as multinational companies. Although many of the tax changes will not take effect now but will become operative over the next several years, familiarity with the changes to come enables taxpayers to plan presently for these new financial burdens.
employment situation, would have access to benefits. This would ensure that mothers who work for small businesses, act as independent contractors or receive hourly wages instead of salaries have equal access to the protections afforded under the law. This change would have the effect of extending benefits to women in vulnerable populations, thereby increasing breastfeeding rates in lower socioeconomic groups. Second, employers should also be required to offer flexible work hours, non-traditional work arrangements and/or job sharing opportunities, which would capture millions of women employed in traditionally inflexible jobs (e.g., physicians, flight attendants, bus drivers, military personnel, etc.) (Guendelman et al., 2009; Johnston & Esposito, 2007; Mandal, Roe & Fein, 2010; Shealy, et al., 2005).
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Abstract: The Patient Protection and Affordable Care Act (2010) and the Mental Health Parity and Addiction Equity Act (2008) expand substance use disorder (SUD) care services in the USA into general medical settings. Care offered in these settings will engage substance-using patients in an integrated and patient-centered environment that addresses physical and mental health comorbidities and follows a chronic care model. This expansion of SUD services presents a great need for evidence-based practices useful in general medical settings, and reveals several research gaps to be addressed. The National Drug Abuse Treatment Clinical Trials Network of the National Institute on Drug Abuse can serve an important role in this endeavor. High-priority research gaps are highlighted in this commentary. A discussion follows on how the National Drug Abuse Treatment Clinical Trials Network can transform to address changing patterns in SUD care to efficiently generate evidence to guide SUD treatment practice within the context of recent US health care legislation.
While particular frames were emphasized by the White House, a story in Sep- tember of 2009 reveals that the lack of information from the White House was strategized. This contributed to journalists’ confusion and speculation. The CBS story on September 9, 2009, ran nearly 9 months after the introduction of the health care reform initiative. Then News Secretary David Axelrod stated in the interview that the Obama administration had strategized specifically to not in- itially roll-out a completed health care reform plan. Instead, they approached health care reform as an idea which needed to be formalized and asked for bi- partisan input on the final product (Cortes, 2009). This approach, while gather- ing input and buy-in from various stakeholders, was strategically lacking in de- tail, thus creating a barrier to journalists’ ability to accurately lay-out the plan in full. With no formal plan in place until well into the roll-out, the White House released little information on the PPACA. Within the over three-year time frame of the study, only 13 news releases were published by the White House concern- ing the PPACA. This sparse number of news releases had implications for jour- nalists’ ability to understand the PPACA and provide detail to the viewing au- dience.
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My proposed legislation will educate the public using features consisting of three key parts. The key parts will require that: (1) insurance companies modify educational material to the eighth grade reading level; (2) the federal, state, and local government agencies implement and facilitate educational campaigns; and (3) appropriate federal government agencies implement and facilitate comprehensive social media health education campaigns. Federal, state, and local educational campaigns must be initiated at all levels in order to achieve the maximum degree of health literacy. Prescribed state literacy campaigns will be funded by the federal government. Insurance companies would be required to immediately modify prescription labeling, marketing, and educational materials, targeting all materials at the eighth grade reading level. The education material would be in the form of pamphlets, videos, and internet advertisements. Literacy presents a major barrier to health care access.
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and Florida lower courts (1) failed to adequately identify the “market” that Congress intended to impact, (2) did not understand the expansive public health policy objectives generated by PPACA, and (3) created unnecessary uncertainty regarding Congress’s authority to act in the best interest of an individual involving public health issues. 45 Additionally, Professor Randy E. Barnett contends PPACA’s
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The U.S. Supreme Court has agreed to hear a legal challenge to the way in which health insurance subsidies are administered. Most states have decided not to set up state health exchanges. In those states, residents rely on the federal health exchange marketplace to obtain coverage. Residents currently receive subsidies regardless of whether their state has set up its own state health exchange. However, the language of the Patient Protection and Affordable Care Act states that such subsidies relate to an “exchange established by the state”. If this legal challenge prevails, residents in states that rely upon the federal marketplace will not be eligible to receive subsidies. Accordingly, the Patient Protection and Affordable Care Act is sometimes referred to as a “work in process”. Although it is anticipated that this new law will result in more reliance on hospital-based providers, at this time, the effect it may have upon medical malpractice insurance premiums is unclear.
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Abstract: The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while provid- ing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.
Abstract: While substance use problems are considered to be common in medical settings, they are not systematically assessed and diagnosed for treatment management. Research data suggest that the majority of individuals with a substance use disorder either do not use treatment or delay treatment-seeking for over a decade. The separation of substance abuse services from mainstream medical care and a lack of preventive services for substance abuse in primary care can contribute to under-detection of substance use problems. When fully enacted in 2014, the Patient Protection and Affordable Care Act 2010 will address these barriers by supporting preventive services for substance abuse (screening, counseling) and integration of substance abuse care with primary care. One key factor that can help to achieve this goal is to incorporate the standardized screeners or common data elements for substance use and related disorders into the electronic health records (EHR) system in the health care setting. Incentives for care providers to adopt an EHR system for meaningful use are part of the Health Information Technology for Economic and Clinical Health Act 2009. This commentary focuses on recent evidence about routine screening and intervention for alcohol/drug use and related disorders in primary care. Federal efforts in developing common data elements for use as screeners for substance use and related disorders are described. A pressing need for empirical data on screening, brief intervention, and referral to treatment (SBIRT) for drug-related disorders to inform SBIRT and related EHR efforts is highlighted.
Health care facilities of U S A are largely owned and operated by private sector businesses. According to United States Census Bureau (2012), out of entire population only 32.6% is availing benefits provided by Public Health Coverage, Private Health Coverage is 63.9%, and uninsured people are 15.4 %. Public programs provide the primary source of coverage for most seniors and low-income children. Families covered under Medicare are 15.7%, Medicaid are 16.4% and Military Health Insurance are 4.4%. Private insurance for non-elderly working population form major part of health coverage in United States which involves Consumer Driven, Managed Care and Health saving Account. Due to costly health services in America, people cannot able to afford it and hence Obama care or Patient Protection and Affordable Care Act (PPACA) came into picture with the goals of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. The basic idea of capitalism is seen even in healthcare were in the system encourages generation of money and has followed principles of revenue generation through business. In US the healthcare is dominated by the private insurance agencies who have inflated the cost of healthcare for earning maximum profits. In such capitalistic dominated health care system the patient is seen as a customer with adequate money.
So, this is the point where we're really into the care side of things, helping Hispanics and other multicultural consumers sign up for the preventive services that they are eligible for under the Affordable Care Act plans, helping them find a doctor that speaks Spanish, helping them access services that, you know, are going to benefit them and are linguistically and culturally relevant to their needs.
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retirement and the receipt of retirement income. We look at both stock and flow measures of these outcomes; that is, for example, we look both at the probability that a given individual is retired at a point in time and at the probability of transitions into or out of retirement. None of these outcomes shows a differential response in expansion versus nonexpansion states. The lack of a labor supply response stands in contrast to the large gains in coverage observed in 2014. We fail to find labor supply effects even for population subgroups most likely to have benefitted from the new coverage options that became available in 2014: individuals in fair or poor health and those with low levels of education. These results suggest that for Americans approaching retirement the Affordable Care Act achieved its primary goal of increasing coverage without the unintended consequence of reducing labor supply.
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Better measurement will be key to achieving the goals of the ACA. Although signi ﬁ cant progress has been made, 10 better tools to assess the quality of perinatal and NICU care across multiple clinical and ef ﬁ ciency domains are needed. Assessment should occur within individual NICUs, across provider net- works, and even across disciplines (eg, combined measurement of obstetric, neonatal, and early pediatric ambulatory care). Network-level measurement tools should guide strategic planning for care optimization and promote trans- disciplinary collaboration. Seamless delivery of preventive and therapeu- tic services will require alignment and common measurement of key contributors to overall network per- formance. These tools should also guide the appropriate regionalization of services.
DOI: 10.4236/tel.2019.95101 1587 Theoretical Economics Letters tivity with which Hispanic consumers searched for information regarding health insurance. The data revealed a tendency from Hispanic consumers to rely on others to provide them with such information, meaning that public healthcare workers were only able to help those who actively reached out for their assis- tance. A potential solution would be to educate consumers about healthcare and health insurance in high school, this would ensure that consumers would at least have the basic information to be able to reach out and continue on the informa- tion seeking stage on their own should they need to. These same consumers could then act as trusted informants for family and friends by providing infor- mation through word-of-mouth, thus increasing awareness of health insurance among their social networks.
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The Affordable Care Act is a law which is launched for improving health insurance and expanding insurance coverage to uninsured people. Since the advent of the ACA, it has had a great impact in the U.S. medical system. Because of the ACA, the uninsured people reduced from 16% in 2010 to 9.1% in 2015 (Obama, 2016). Many studies concern about the effect of the ACA and the use of preventive care. Lau et al. (2014) found that the ACA provision to expand or increase insurance coverage for young adults, and these young adults increase demand for preventive care. Cantor et al. (2012) investigated how the ACA affected preventive care among young adults. However, the data they used was from the Current Population Survey 2005-2011, and the data after the ACA is just one year data, it was not large enough.
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