Introduction to Health Care and

Public Health in the U.S.

Financing Health Care, Part 1

Lecture a
This material (Comp 1 Unit 4) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 Financing Health Care, Part 1
Learning Objectives - 1
• Describe the role of the health insurance
industry in financing health care in the
United States, and Federal laws that have
influenced the development of the
industry. (Lecture a)
• Explain the importance of the health care
industry to the U.S. economy and the role
of financial management in health care.
(Lecture b)
2
 Financing Health Care, Part 1
Learning Objectives - 2
• Describe models of health care financing
in the U.S. and in selected other countries.
(Lecture c)
• Describe the organization and function of
Medicare and Medicaid. (Lecture d)

3
 Affordable Care Act

• The most major recent health care

insurance legislation is the Patient
Protection and Affordable Care Act
(PPACA), also known as
– The Affordable Care Act (ACA)
– Obamacare
• The ACA has two major goals
– Expansion of health insurance coverage
– Improving quality of care while reducing cost
4
 ACA Expansion of Health
Insurance Coverage – 1
• Subsidies for those who do not receive
employer-provided health insurance up to
400% of U.S. poverty level
• Medicaid expansion by the states for those
earning up to 133% of poverty level
• Coverage for children on adults’ policies
up to age 26
• Disallows denial for pre-existing conditions
or becoming ill
5
 ACA Expansion of Health
Insurance Coverage – 2
• Small business tax credits
• Requirement for larger (>50) employers to
offer health insurance coverage
• Close Medicare “donut hole”
• Individual mandate for health insurance

6
 Benefits of ACA

• Rate of uninsurance has fallen from 18% to

11% (Gallup, 2016)
• Continued slowing of spending growth;
amount due to ACA unknown (Martin, 2016)
• No change in employment or reported hours
worked (Moriya, 2015)
• Increased economic growth, especially in
states expanding Medicaid (ASPE, 2015)
• Reduced uncompensated care (ASPE, 2015)
7
 State-Licensed
Insurance Organizations - 1
• Commercial Health Insurers
– Most are owned by stockholders or stock
companies
– Mutual insurance companies are owned by their
policyholders
• BlueCross BlueShield
– Association of 39 different companies in 50 states
– Locally operated; some are for-profit
– Largest insurer, covering 1 in 3 Americans

8
 State-Licensed
Insurance Organizations - 2
• Managed Care Organizations
– Combine health insurance and health care
services
– Cost control and utilization control
– Some hire their own doctors and have their
own facilities
– 3 main types:
o Health maintenance organizations (HMOs)
o Preferred provider organizations (PPOs)
o Point-of-service (POS) plans
9
 Self-Funded Employer Plans

• Health benefit plans regulated by federal

law
• Created by employers, employee
organizations, or a combination
• Employer assumes risk for workers and
pays for care directly
• Employer may choose to have a third-
party administrator administer the plan

10
 Publically-Funded Health Care

• Government programs, some of them

funded through income taxes and payroll
taxes
• Begin in federal legislation
• Voted into law by Congress
• Help specific population groups
• Run by federal government and federal-
state partnerships
11
 Examples of Government
Health Care Programs - 1
• Affordable Care Act (ACA)
• Medicare
• Medicaid
• Children’s Health Insurance Program
• Veterans Health Administration
• TRICARE
• Indian Health Service

12
 Examples of Government
Health Care Programs - 2
• Government payors: Programs whereby
the government pays health care
organizations to provide health care
services
• Government operated delivery systems:
Self-contained systems that operate
facilities and have government-employed
providers

13
 Roles of U.S. Government - 1

• 3 key roles: provider, payor, and lawmaker

• Provider of health care services
– Veterans Health Administration and TRICARE
– Indian Health System
– Supports research into new models of health
care
• Payor of third-party services
– Outsources health care services, claims
paperwork, grants for research
14
 Roles of U.S. Government - 2

• Lawmaker role 1: Ensure fair competition

– Sherman Anti-Trust Act, 1890
– Clayton Act, 1914
• Lawmaker role 2: Protect the public
– Food, Drug, and Cosmetic Act created FDA,
1938
– Hatch-Waxman Act, 1984
– American with Disabilities Act, 1990

15
 Financing Health Care, Part 1
Summary – 1 – Lecture a
• U.S. health care payors
– Historical and governmental influences for the
unique U.S. system
– Federal and state laws have influenced the
development of different types plans
o Privately funded plans
o Publically funded or government programs

16
 Financing Health Care, Part 1
Summary – 2 – Lecture a
• Government Role in Health Care
– Enact laws
o Regulate
o Protect

– Provide services
– Payor

17
 Financing Health Care, Part 1
References – 1 – Lecture a
References
Anonymous. U.S. Uninsured Rate at 11.0%, Lowest in Eight-Year Trend. 2016.
Washington, DC, Gallup. http://www.gallup.com/poll/190484/uninsured-rate-lowest-
eight-year-trend.aspx. Accessed January 23, 2017
BlueCross Blue Shield Association.
http://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Association. Accessed January
23, 2017.
California Office of the Patient Advocate. What is an HMO? 2016.
http://www.opa.ca.gov/Pages/WhatisanHMO.aspx. Accessed January 23, 2017.
Centers for Medicare and Medicaid Services. Medicaid program: General Information.
https://www.cms.gov/medicare/medicare-general-
Information/medicareGenInfo/index.html. Updated July 2014. Accessed January 23,
2017.
U.S. Department of Health and Human Services. Health Insurance Coverage and the
Affordable Care Act, 2010 – 2016. https://aspe.hhs.gov/pdf-report/health-insurance-
coverage-and-affordable-care-act-2010-2016. Accessed January 23, 2017.
Illinois Department of Human Services. Health insurance carriers and managed care.
http://www.dhs.state.il.us/page.aspx?item=31583. Accessed January 23, 2017.
18
 Financing Health Care, Part 1
References – 2 – Lecture a
References
Indian Health Service. Indian Health Service fact sheet.
https://www.ihs.gov/newsroom/factsheets/. Accessed January 23, 2017.
Kaiser Family Foundation reference 2011
Key Facts about the Uninsured Population. http://kff.org/uninsured/fact-sheet/key-facts-
about-the-uninsured-population/. Accessed January 23, 2017.
OurDocuments.gov. Social Security Act (1935).
http://www.ourdocuments.gov/doc.php?flash=true&doc=68. Accessed January 23,
2017.
U.S. Department of Health and Human Services. Hill-Burton Free and Reduced-Cost
Health Care. http://www.hrsa.gov/gethealthcare/affordable/hillburton/. Accessed
January 23, 2017.
U.S. Department of Health and Human Services. Health information privacy.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html. Accessed January
23, 2017.

19
 Financing Health Care, Part 1
References – 3 – Lecture a
References
U.S. Department of Health and Human Services, Office of the General Counsel. Drug
Price Competition and Patent Term Restoration Act.
http://library.findlaw.com/1999/Mar/10/130703.html. Accessed January 23, 2017.
U.S. Department of Justice, Civil Rights Division. Americans with Disabilities Act:
Questions and Answers. http://www.ada.gov/q%26aeng02.htm. Updated February 4,
2009. Accessed January 23, 2017.

20
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 1

Lecture b
This material (Comp 1 Unit 4) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 The Role of Health Care
in the U.S. Economy - 1
• Health care spending
– Economic impact and gross domestic product
– Health care jobs
• The History of the U.S. Health Insurance
Industry
– Historic legislation and factors contributing to
the current U.S. system of insurance
– Roles of government in health care

22
 The Role of Health Care
in the U.S. Economy - 2
• Privately funded health care
• Publically funded health care
– Role Important federal laws

23
 Health Care Financing
& Expenditures - 1
• Health Care Financing
– The collection and pooling of funds used to
pay the cost of health care services provided
by a health care system
– Includes a method for distributing payment

24
 Health Care Financing
& Expenditures - 2
• Health Care Expenditures
– Represent the total value of the health care
services delivered during some time period
– Methods for examining spending include:
o Category of Service
o Contributor
o payor

25
 Health Care Financing
& Expenditures - 3
• Health Care Services
– Hospital, nursing, home health care
– Physician, dental, and ancillary services
– Prescription medications
– Equipment, public health activities, research,
administration, and infrastructure

26
 The U.S. Health Care Industry

• U.S. Health Care

– Fifth largest sector of the economy by sales
– 11.8 million employees
o More than any other sector

– 10 of 20 fastest growing occupations

o 3.2 million new jobs by 2018

27
 National Health Care Spending
2013
• Gross Domestic Product (GDP): 17.35T
• National Health Spending: $3.0T
– As a percentage of GDP: 17.5%
– Per capita cost: $9,255
– Projected spending as a percentage of GDP
(2024): 19.6%

28
 Financing Health Care, Part 1
Summary – Lecture b
• U.S. Health Care and the Economy
– Highest health care costs in the world
– Health care cost represent almost one-fifth of
GDP
– Health care jobs continue to grow

29
 Financing Health Care, Part 1
References – Lecture b
References
Bureau of Labor Statistics. Employment and wages in healthcare occupations.
http://www.bls.gov/spotlight/2015/employment-and-wages-in-healthcare-
occupations/home.htm December 2015. Accessed January 23, 2017.
California Healthcare Foundation. Health care costs 101: reaching a spending plateau?
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20H/PDF%20
HealthCareCosts15.pdf November 2015. Accessed January 23, 2017.
Centers for Medicare and Medicaid Services. National health expenditure accounts.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NHE-Fact-Sheet.html. Updated December 2,
2016. Accessed January 23, 2017.
Guzick, D. S. (2014, June 11). Caring for Those Without Health Insurance: Practical
Implications of the Affordable Care Act. Retrieved January 23, 2017, from
https://m.ufhealth.org/news/2014/caring-those-without-health-insurance-practical-
implications-affordable-care-act
National Health Expenditure Data. (n.d.). Retrieved January 23, 2017, from
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/Downloads/PieChartSourcesExpenditures2014.p
df
30
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 1

Lecture c
This material (Comp 1 Unit 4) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 Health Care in Other Countries

• Benefits/drawbacks of two public (tax-

funded) health care plans
• Compare a multi-payor health care system
with a single-payor system
• The role of private health insurance in
each system

32
 Types of Health Care Systems

• Mixed Delivery System

– Primarily private health care organizations
and providers
– Government operated system
o Affordable Care Act (ACA)
o Veterans Health Administration
o Military Health System
o Indian Health Service

33
 Single vs. Multi-Payor Systems

• United Kingdom
– Public payor
o Public funded
o Provides basic services
– Private payor
o Employer plans
• Canada
– Single public payor in each province or territory
– Limited or no private payor

34
 Public Health Care in the
United Kingdom and Canada
• United Kingdom: National Health Service
– Department of Health funds 5 regional health
care plans throughout the country
• Canada: MEDICARE
– Provincial/Territorial Single Payor
– Medicare funds provinces and territories,
which run their own health plans

35
 Five Single-Payor Systems
in the United Kingdom
• The U.K. Department of Health:
– Funds the National Health Service (NHS)
– Ten regional health authorities
– Primary Care Trusts (PCTs)
o Salary
o Fee-for-service
o Capitation

36
NHS Governance & Responsibilities

• The Department of Health

– Administers and provides funds
– Responsible for NHS
o Public
o Parliament

– Improving public health

o Environmental health hazards
o Medication safety
o National policies
o Health education
37
 What the NHS Provides

• Universal coverage for all U.K. residents

• Primary care, specialists, hospital care,
long-term care, and preventive care
• Mental health, rehabilitation, dental, and
eye care

38
 U.K. Private Health Insurance

• 12% of population
– Employer sponsored
– Self-pay for private insurance
• Provides more choices and shorter wait
lists
– NHS or private hospitals
• NHS working to reduce wait times
– Hospital specialist : 18 weeks or less

39
 Post-2010 NHS Reform

• Health services determined locally,

not centrally
– Groups of local general practitioners,
specialists, nurses, and consumer advocates
• Requirements:
– Provide urgent and emergency care
– Address health and social needs of all users
– Protect patients’ interests, quality, and
efficiency through outcomes
40
The Canadian Health Care System
(MEDICARE)
• Similar to the NHS
– Taxpayer-funded
– Universal coverage
• Different from the NHS
– Nationwide and regional funding
– Federal government cannot run regional
health care plans
– Limitations on private health insurance

41
 Financing Canada’s Health Care

• Canada Health Act 1984

– Increased access
– Lowered individual costs
– Defined medically necessary services
• Financing
– Federal income tax distributed to provinces
and territories
– Province/territory fund a portion

42
 Hospital & Provider Dichotomy

• Hospitals
– Most hospitals public institutions
• Providers
– Most providers in private practice
– Paid fee-for-service

43
 Five Principles of
the Canada Health Act
• Public administration
• Comprehensiveness
• Universality
• Portability
• Accessibility

44
 Public Administration and
Comprehensiveness
• First two principles explain how plans are
administered
– Public administration:
o Publicly administered
o Non-profit organizations
o Accountable to the public

– Comprehensiveness:
o Must provide all medically necessary services
o Each province or territory decides what is
medically necessary
45
 Universality, Portability,
and Accessibility
• The last three principles protect patient
rights
– Universality
o Right to health care

– Portability
o Provides coverage between regions or travels
outside of Canada
– Accessibility
o Provided regardless of health, age, or income

46
 MEDICARE Coverage in Canada

• Medically necessary services

– Medical and surgical care
– Preventive care
– Hospitalization due to illness or injury
– Medical Equipment
– Dental surgery
• Extended health care services
– No requirement for coverage
– Many areas provide some coverage
– Average $580 per year out-of-pocket

47
 The Role of Private Insurance

• Private insurance
– Available through employers or purchase
– Supplement for non-covered Medicare
services
– Prohibited from paying for medically
necessary services
• Private insurance payments
– 30% of Canada’s total health care
expenditures
48
 Limiting Private Insurance

• Effects include:
– Does not improve access to basic services
already covered by MEDICARE
– Increases the public cost of universal
coverage
• Some want to expand the role of private
insurance to solve these problems
• Others want to continue restriction to
ensure equal access for all
49
 Public Health Benefits
of the Canadian System
• Statistics show Canadians benefit from
good health care
• Life expectancy
– 80 years as of 2005
– Among highest in industrialized nations
• Infant mortality cut in half from 1979 to
2005

50
 Financing Health Care, Part 1
Summary – 1 – Lecture c
• Health plans in the United Kingdom and
Canada reflect different national priorities
– Both have tax-funded universal coverage
• United Kingdom NHS
– Centrally administered and funded
– Services at government operated facilities
– Providers employees of NHS
– Private insurance allows for additional access
and choice
51
 Financing Health Care, Part 1
Summary – 2 – Lecture c
• Canada MEDICARE
– Services at government facilities by private
providers
– Private health insurance limited to provide
equal access
• Challenge of wait times
– UK permits private insurance
– Canada does not

52
 Financing Health Care, Part 1
References – 1 – Lecture c
References
British Broadcasting Corporation. Birth of the National Health Service: the early history of
the NHS. http://www.bbc.co.uk/archive/nhs. Accessed January 23, 2017.
British Broadcasting Corporation. The NHS at 50: making Britain better.
http://news.bbc.co.uk/2/hi/events/nhs_at_50/special_report/119803.stm. July 1, 1998.
Accessed January 23, 2017.
Canadian Health Care. www.canadian-healthcare.org. Accessed January 23, 2017.
Citizens Advice Bureau [United Kingdom]. National insurance—contributions and
benefits.
http://www.adviceguide.org.uk/index/life/benefits/national_insurance_contributions_an
d_benefits.htm. Accessed January 23, 2017.
Citizenship and Immigration Canada. Health care in Canada.
http://www.cic.gc.ca/english/newcomers/after-health.asp. Accessed January 23,
2017.

53
 Financing Health Care, Part 1
References – 2 – Lecture c
References
Commonwealth Fund. 2015 International profiles of health care systems.
http://www.commonwealthfund.org/~/media/files/publications/fund-
report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf. Accessed January 23,
2017.
Department of Health [United Kingdom]. History of the department.
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Aboutus/HowDHworks
/DH_074813. Updated May 23, 2007. Accessed January 23, 2017.
Department of Health [United Kingdom ]. About us.
https://www.gov.uk/government/organisations/department-of-health/about. Accessed
January 23, 2017.
Health Canada. About Health Canada: activities and responsibilities. http://www.hc-
sc.gc.ca/ahc-asc/activit/index-eng.php. Updated May 3, 2008. Accessed January 23,
2017.
Madore O. The Canada Health Act: overview and options. Library of Parliament,
Parliamentary Information and Research Services.
http://www2.parl.gc.ca/content/lop/researchpublications/944-e.htm. Updated May 16,
2005. Accessed January 23, 2017.
54
 Financing Health Care, Part 1
References – 3 – Lecture c
References
National Health Service. Help with health costs.
http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Abouthealthcosts.aspx. Updated.
January 15, 2015. Accessed January 23, 2017.
National Health Service. Care equipment, aids and adaptations
http://www.nhs.uk/conditions/social-care-and-support-guide/pages/equipment-aids-
adaptations.aspx. Accessed January 23, 2017.
National Health Service. NHS history. Updated July 5, 2007.
http://www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx.
Accessed January 23, 2017.
National Health Service. What is NHS continuing healthcare?
http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=155&SubCategoryID=155.
Updated April 29, 2015. Accessed January 23, 2017.

55
 Financing Health Care, Part 1
References – 4 – Lecture c
References
National Health Service. Encyclopaedia Britannica.
https://www.britannica.com/topic/National-Health-Service. Accessed January 23,
2017.
NationTalk. Canada’s new government announces patient wait times guarantees with all
the provinces and territories. http://nationtalk.ca/story/canadas-new-government-
announces-patient-wait-times-guarantees-with-all-the-provinces-and-territories. April
4, 2007. Accessed January 23, 2017.
Steinbrook R. Private health care in Canada. N Engl J Med. 2006;354:1661-1664.

56
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 1

Lecture d
This material (Comp 1 Unit 4) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 The Government as
Insurance Payor
• Insurance Managed by the Centers for
Medicare and Medicaid Services (CMS)
– Medicare
– Medicaid
– Children’s Health Insurance Program (CHIP)
• Medicaid/Medicare Fraud and Abuse
• Workers’ Compensation

58
 Government-Funded Health Care

• Government-Provided Health Care

Services
– TRICARE
– Veterans Health Administration
– Indian Health Service
• Government Health Insurance
– Medicare
– Medicaid
– Children’s Health Insurance Program
59
 Medicare

• Created by Social Security Act of 1965

– Determines Medicare eligibility
– Processes premium payments
• FICA - Financed by payroll taxes
1.45% from employee
+ 1.45% from employer
2.9% deduction
– Pays for Medicare Part A (hospital insurance)

60
 Medicare Part A

• Hospital insurance
• Inpatient care (including psychiatric hospital)
• Hospital outpatient care
• Skilled nursing facility or rehabilitation facility
• Long-term care facility
• Hospice (end-of-life care)
• Patient pays deductible
• No premiums after 10 years of payments
– Can purchase through premiums
61
 Prospective Payment System
(PPS)
• System for reimbursing providers
– Controls costs
– Pays predetermined, fixed dollar rate regardless
of services provided
– The rate depends on the patient’s diagnosis-
related group (DRG)
o Age
o Gender
o Principal diagnosis
o Other conditions
o Surgical procedures
62
 Medicare Part B

• Medical insurance
• Coverage
– Doctors’ services
– Outpatient care
– Home health services
– Some preventive services
– Other medical services
• Patient pays premium and deductible

63
 Medicare Part C - 1

• Medicare Advantage plans

– Offered by private companies approved by
Medicare
• Provide all Part A and Part B
– Vision
– Hearing
– Dental
• Most plans include Part D
• Patient pays premium and deductible
64
 Medicare Part C - 2

• Differences in Advantage Plans:

– Out-of-pocket costs
– Rules for services
– Change each year
• Part C options include:
– Health maintenance organization (HMO)
– Preferred provider organization (PPO)
– Private fee-for-service plan
– Special needs plan
65
 Medicare Part D

• Created in 2003
• Prescription drug coverage
• Voluntary enrollment
• Pay premium to company approved by
Medicare
• Patients pay deductible & co-payment
– After certain point, may pay up to 50% of drug
costs themselves (“doughnut hole”)

66
 Medicaid - 1

• Helps pay costs for people with limited

income and resources
– Joint federal and state program
– Some Medicare patients qualify for Medicaid
– Funded by taxpayers’ income tax payments

• Administered through CMS at state level

– Formulate and administer plan subject to federal
regulations and guidelines
– Outlines nature and scope of services provided

67
 Medicaid - 2

• Differs by State
– Eligibility requirements
– Co-payments
– Counting income and resources
• Must provide payments for hospital and
physician services
• May provide payments for pharmacy,
dental, and eye care
• Must not provide payments for abortions
68
 Medicaid - 3

• Programs have different names in different

states
• Federal government reimburses states for
expenditures
• States accepting funding must provide
coverage to people who receive:
– Temporary Assistance to Needy Families
– Supplemental Security Income (SSI)

69
 Children’s Health Insurance
Program (CHIP)
• Low-cost coverage for children
– Family doesn’t qualify for Medicaid but can’t
afford private health insurance
• Each state has its own program and
eligibility criteria
– Eligibility is based on child’s status, not
parents
– Example: child who is U.S. citizen qualifies
even if parent is not a citizen
• Low-income pregnant women eligible 70
 Medicaid and CHIP

• Children covered by CHIP, may also

qualify for Medicaid
• Range of benefits include:
– Doctor visits, emergency care, hospital care
– Prescription drugs, vision, hearing, dental
– Free preventive care, including vaccinations
• Low premiums and cost-sharing may be
available for other services

71
 Financing Health Care, Part 1
Summary – lecture d
• Government health insurance programs
operate on the federal level, state level, or
both
• Can be eligible for multiple programs
• All programs are subject to legislative
change over time

72
 Financing Health Care, Part 1
References – 1 – Lecture d
References
American Association of Preferred Provider Organizations. Resources.
http://aappo.interactivemedialab.com/Resources.aspx. Accessed January 23, 2017.
American Association of Preferred Provider Organizations. PPO?.
http://aappo.interactivemedialab.com/Portals/0/Documents/PPO%20Toolkit.pdf.
Accessed January 23, 2017.
Bihari M. Understanding the Medicare Part D donut hole: learn about the Medicare Part D
coverage gap.
http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm. Updated
December 15, 2014. Accessed January 23, 2017.
Centers for Medicare and Medicaid Services. Children’s Health Insurance Program
(CHIP). https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-
Native/AIAN/CHIP-Grantees/Overview.html. Accessed January 23, 2017.
Centers for Medicare and Medicaid Services. http://www.cms.gov. Accessed March 30,
2016.

73
 Financing Health Care, Part 1
References – 2 – Lecture d
References
Congressional Budget Office. Statement of Douglas W. Elmendorf, Director. CBO’s
analysis of the major health care legislation enacted in March 2010 before the
Subcommittee on Health, Committee on Energy and Commerce, U.S. House of
Representatives. March 30, 2011.
https://www.cbo.gov/publication/22077?index=12119. Accessed January 23, 2017.
Cornell University Law School. Workers’ Compensation: an overview.
http://topics.law.cornell.edu/wex/Workers_compensation. Accessed January 23,
2017.
Department of Labor. Employee Retirement Income Security Act (ERISA) plan
information. http://www.dol.gov/general/topic/health-plans/erisa. Accessed January
23, 2017.
Health and Human Services. Summary of the HIPAA security rule.
http://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/. Accessed
January 23, 2017.
Kaiser Family Foundation. The facts on Medicare spending and financing. 2015.
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/.
Accessed January 23, 2017.
74
 Financing Health Care, Part 1
References – 3 – Lecture d
References
Levey NM. Questions and answers about new rules on appealing rejections of health
insurance claims. Los Angeles Times. July 22, 2010.
http://articles.latimes.com/2010/jul/22/nation/la-na-health-rules-qa-20100723.
Accessed January 23, 2017.
Marcinko DE. Understanding the Medicare Prospective Payment System. September 17,
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References – 4 – Lecture d
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