A total of 26 states, including texas, formally challenged which part of the affordable care act?

The Commonwealth Fund’s 2022 Scorecard on State Health System Performance evaluates states on 56 performance indicators grouped into five dimensions, including a new dimension focused on how well states responded to and managed the COVID-19 pandemic.

The report generally reflects data from 2020. The seven new measures related to efforts to combat COVID-19 incorporate data through the first quarter of 2022.

Access and Affordability (8 indicators): includes rates of insurance coverage for children and adults, as well as individuals’ out-of-pocket expenses for health insurance and medical care, cost-related barriers to receiving care, rates of medical debt, and receipt of dental visits.

Prevention and Treatment (14 indicators): includes measures of receipt of preventive care and needed mental health care, as well as measures of quality in ambulatory, hospital, postacute, and long-term care settings.

Avoidable Hospital Use and Cost (14 indicators; including several measures reported separately for distinct age groups): includes indicators of hospital and emergency department use that might be reduced with timely and effective care and follow-up care, estimates of per-person spending among Medicare beneficiaries and working-age adults with employer-sponsored insurance, and the share of Medicare and employer-sponsored insurance spending directed toward primary care.

Healthy Lives (13 indicators): includes measures of premature death, health status, health risk behaviors and factors (including smoking and obesity), tooth loss, and state public health funding.

COVID-19 (7 indicators): includes measures to reflect state progress in vaccinating residents, COVID-related hospitalization rates and health system stress, and COVID-related mortality through the end of March 2022.

For several measures in our COVID-19 domain (high ICU stress, hospital staffing shortages, hospitalizations, nursing home deaths), data did not become consistently available, across all states, until May–August 2020, depending on the data source. This means that information from the earliest months of the pandemic may not be fully reflected in our assessment of state COVID-19 performance. This may have a larger impact on states like New York, where the pandemic first emerged in early 2020.

INCOME DISPARITY DIMENSION

This year, the State Scorecard reports on performance differences within states associated with individuals’ income level for 13 of the 56 indicators where data are available to support a population analysis by income; these indicators span three of the five dimensions. For each indicator, we measure the difference between rates for a state’s low-income population (generally less than 200% of the federal poverty level) and higher-income population (generally more than 400% of the federal poverty level). States are ranked on the magnitude of the resulting disparities in performance.

The income disparity indicators are different than those used in previous scorecards; hence, these disparity rankings are not strictly comparable to those published previously. For some indicators, we combined multiple years of data to ensure adequate sample sizes for stratified analysis.

RACIAL AND ETHNIC HEALTH EQUITY DIMENSION

This year, the State Scorecard ranks states based on racial and ethnic health equity. To do this, we incorporated summary state health system performance scores for each of four racial and ethnic groups, pulled directly from our November 2021 report, Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance.

That report aggregated data on 24 performance indicators (reflecting health outcomes, health care access, and health care quality), stratified by race and ethnicity for Black, white, Latinx/Hispanic, American Indian/Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations.

Each population group in each state received a percentile score from 1 (worst) to 100 (best) reflecting the state’s overall health system performance for that group. This enabled comparisons within and across states. For example, a state health system score of 50 for Latinx/Hispanic people in California indicates that the health system is performing better for those residents than Latinx/Hispanic people in Florida, who have a score of 38, but worse than for white residents in California, who have a score of 89.

The overall percentile scores from that report for AIAN, AANHPI, Black, and Latinx/Hispanic people were used in this year’s State Scorecard to reflect each state’s performance for nonwhite racial and ethnic groups. States were evaluated and ranked on their health system performance for each of the four groups separately (contingent on data availability), and those scores were then combined for the state’s final overall equity composite score. Summary scores for each group can be found in Appendix I1. State health system performance scores for white residents are included in the appendix for comparative purposes.

We also include performance data for each of the 24 metrics used in that equity report — updated to the most current year — in each state’s 2022 scorecard profile.

GUIDING PRINCIPLES

The following principles guided the development of the State Scorecard:

Performance Metrics. The 56 metrics selected for this report span health care system performance, representing important dimensions and measurable aspects of care and response to the COVID-19 pandemic. Where possible, indicators align with those used in previous scorecards. Several indicators used in previous versions of the State Scorecard have been dropped either because all states improved to the point where no meaningful variations existed (for example, measures that assessed hospitals on processes of care) or the data to construct the measures were no longer available (for example, hospitalizations for children with asthma). New indicators have been added to the State Scorecard series over time in response to evolving priorities or data availability (e.g., measures of maternal mortality and medical debt).

Measuring Change over Time. We were able to track performance over time for 45 of the 56 indicators. Not all indicators could be trended because of changes in the underlying data or measure definitions, and some reflect newly collected data (e.g., COVID-19-specific measures).

For indicators where trends were possible, there were generally five years between indicators’ baseline and current-year data observation, though the starting and ending points depended on data availability (see Appendix A1).

We considered a change in an indicator’s value between the baseline and current-year data points to be meaningful if it was at least one-half (0.5) of a standard deviation larger than the indicator’s combined distribution over the two time points — a common approach used in social science research. We did not formally evaluate change over time for indicators in the income dimension.

Data Sources. Indicators generally draw from publicly available data sources, including government-sponsored surveys, registries, publicly reported quality indicators, vital statistics, mortality data, and administrative databases. The most current data available were used in this report whenever possible. Appendix A1 provides detail on the data sources and time frames.

Scoring and Ranking Methodology. For each indicator, a state’s standardized z-score is calculated by subtracting the 51-state average (including the District of Columbia as if it were a state) from the state’s observed rate, and then dividing by the standard deviation of all observed state rates. States’ standardized z-scores are averaged across all indicators within the performance dimension, and dimension scores are averaged into an overall score. Ranks are assigned based on the overall score. This approach gives each dimension equal weight and, within each dimension, it weights all indicators equally. This method accommodates the different scales used across State Scorecard indicators (for example, percentages, dollars, and population-based rates).

As in previous scorecards, if historical data were not available for a particular indicator in the baseline period, the current-year data point was used as a substitute, thus ensuring that ranks in each time period were based on the same number of indicators.

REGIONAL COMPARISONS

The State Scorecard groups states into the eight regions used by the Bureau of Economic Analysis to measure and compare economic activity. The regions are: Great Lakes (Illinois, Indiana, Michigan, Ohio, Wisconsin); Mid-Atlantic (Delaware, District of Columbia, Maryland, New Jersey, New York, Pennsylvania); New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont); Plains (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota); Rocky Mountain (Colorado, Idaho, Montana, Utah, Wyoming); Southeast (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, West Virginia); Southwest (Arizona, New Mexico, Oklahoma, Texas); and West (Alaska, California, Hawaii, Nevada, Oregon, Washington).

The Affordable Care Act (ACA) is the comprehensive healthcare reform signed into law by President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act and often called Obamacare, the law includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured Americans.

The act expanded Medicaid eligibility, created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage (or charging more) due to pre-existing conditions. It also allows children to remain on their parents' insurance plan until age 26.

• The Affordable Care Act (ACA), also known as Obamacare, was signed into law in March 2010.
• It was designed to extend health coverage to millions of uninsured Americans.
• The act expanded Medicaid eligibility, created a Health Insurance Marketplace, prevented insurance companies from denying coverage due to pre-existing conditions.
• The ACA also required plans to cover a list of essential health benefits.

The ACA was designed to reduce the cost of health insurance coverage for people who qualify for it. The law includes premium tax credits and cost-sharing reductions to help lower expenses for lower-income individuals and families.

Premium tax credits lower your health insurance bill each month. Cost-sharing reductions, meanwhile, reduce your out-of-pocket costs for deductibles, copays, and coinsurance, as well as lowering your out-of-pocket maximum: the total amount you pay in a year for covered health expenses.

All ACA-compliant health insurance plans—including every plan that's sold on the Health Insurance Marketplace—must cover specific "essential health benefits" including:

• Ambulatory patient services
• Breastfeeding
• Emergency services
• Family planning
• Hospitalization
• Laboratory services
• Mental health and substance use disorder services
• Pregnancy, maternity, and newborn care
• Prescription medications
• Preventive and wellness services and chronic disease management
• Pediatric services
• Rehabilitative and habilitative service

The Inflation Reduction Act of 2022 would extend the expanded ACA for three years through 2025 for people who need financial assistance. It would also allow Medicare to negotiate the cost of prescription drugs and place an annual cap of $2,000 on the cost drugs. The legislation passed in both the House of Representatives and the Senate and was awaiting signature by President Biden as of Aug. 11, 2022.

In addition, the ACA requires most insurance plans, including those sold on the Marketplace, to cover at no cost to policyholders a list of preventive services. These include checkups, patient counseling, immunizations, and numerous health screenings. It also allowed states that opted in to extend Medicaid coverage to a wider range of people. As of July 21, 2022, 39 states (including the District of Columbia) had exercised that option.

Every year, there is an open enrollment period on the Health Insurance Marketplace during which people can buy or switch insurance plans. If you miss this time, you cannot enroll until the following year unless you qualify for a special enrollment period because your circumstances change—for example, you marry, divorce, become a parent, or lose a job that provided health insurance coverage.

A critical part of the original ACA was the individual mandate, a provision requiring all Americans to have healthcare coverage—either from an employer or through the ACA or another source—or face tax penalties. The mandate was eliminated in 2017.

This mandate served the double purpose of extending healthcare to uninsured Americans and ensuring that there was a sufficiently broad pool of insured individuals to support health insurance payouts.

Critics of the ACA have pointed out that it represented an unprecedented expansion of federal power within the healthcare industry because it required all individuals to purchase a service (health insurance) whether they wanted to or not.

This aspect of the law was a major focus of debate, and it was challenged in the U.S. Supreme Court in 2012 by the National Federation of Independent Business. The court ruled in favor of the individual mandate as a constitutional exercise of the taxing authority of Congress, characterizing the penalties levied against the uninsured as a tax.

After President Obama left office, the ACA weathered opposition and a number of significant changes. If the Inflation Reduction Act passes, it will bring more changes.

On Jan. 20, 2017, President Donald Trump's first executive order after taking office signaled his intention to defund the ACA, saying executive agency heads should "delay the implementation of any provision or requirement of the [Patient Protection and Affordable Care] Act that would impose a fiscal burden on any State." The intention of this order signaled the first phase of Republican efforts to repeal and replace the ACA.

Attempts by the government in 2017 to repeal the law altogether were not successful. However, the government substantially scaled back its outreach program to help Americans sign up for the ACA and cut the enrollment period in half.

Changes have been made to the law that addressed some of the objections raised by opponents, while still keeping the Marketplace open for users. For example, in December 2017, as part of the Tax Cuts and Jobs Act (TCJA), Congress removed the penalty for not having health insurance. Starting with the tax year 2019, the individual mandate penalty was reduced to zero dollars, essentially removing the requirement that many Republicans had opposed.

By 2018, the number of Americans covered under the ACA had dropped to 13.8 million (from 17.4 million in 2015), according to a report from healthcare research organization Kaiser Family Foundation. By 2021, there were 11.3 million people with plans through the ACA, but 14.8 million people newly enrolled in Medicaid through the ACA expansion.

In March 2019, House Democrats unveiled legislation to shore up the act and expand coverage, while the Trump Administration revealed it would seek to repeal the entirety of the ACA. In a letter to a federal appeals court, the Justice Department said it agreed with a federal judge in Texas, who declared the healthcare law unconstitutional and added that it will support the judgment on appeal. The case was heard by the Supreme Court in November 2020, with a coalition of 21 attorney generals defending the ACA.

President Joseph Biden, who helped Obama pass the law, has aimed to strengthen the ACA during his term after vetoing further legislative attempts to overturn it.

In addition to setting up a new special enrollment period, the executive order President Biden signed on Jan. 28, 2021, also focused on "rules and other policies that limit Americans' access to health care." This executive ordering federal agencies to examine five areas and decide whether action is needed there:

• Protections for people with pre-existing conditions
• Work requirements and other limitations on access to Medicaid and the ACA
• Policies undermining health insurance markets, including the Health Insurance Marketplace
• Policies increasing the difficulty of enrolling in Medicaid and the ACA
• Policies reducing affordability or financial assistance for recipients or dependents

The proposed Inflation Reduction Act, H.R. 5376 is a scaled-down version of the Build Back Better Act proposed in 2021. It was awaiting signature of President Biden as of Aug. 12, 2022. The bill is designed to lower inflation and reduce the deficit, but it includes provisions that affect healthcare.

The Inflation Reduction Act would extent financial assistance for people enrolled in ACA through 2025 instead of 2022. It also expands eligibility, allowing more middle-class people to receive premium assistance. The ACA extension would cost an estimated $64 billion.

The Affordable Care Act (ACA) was created in 2010 and is more commonly known as Obamacare. It extended healthcare coverage to millions of previously uninsured Americans. The act required that all Americans purchase (or otherwise obtain) health insurance and prohibited insurance companies from denying coverage (or charging more) due to pre-existing conditions. It also allows children to remain on their parents' insurance plan until age 26.

The ACA also created the Health Insurance Marketplace, through which eligible people may find and buy health insurance policies. All ACA-compliant health insurance plans, including those sold through the marketplace, must cover a number of essential health benefits. The ACA may continue to evolve with any new legislation.

What part of the Affordable Care Act did Texas reject quizlet?

What was the relationship between Texas and the Obama administration quizlet?

In what way do federal military installations provide a benefit to the state of Texas?

Why did Texas surpass California as the state with the most residents without health insurance?