Budget and Manage Health Care

CAROL PORTER FOR THE WASHINGTON POST
Lesson 
The Patient Protection and Affordable Care Act, passed in 2010, focuses attention on the role of federal and state governments, insurance companies, businesses and individuals in providing for health care, from preventive care to benefits of insurance coverage and the use of technology to enroll citizens. Students locate the facts, analyze the issues, study different stances, and use a variety of media to express their points of view.
Difficulty 
Primary Disciplines 

The United States Constitution was established to “promote the general Welfare.” As President Obama’s health care initiative made its way through the legislative branch to become the Patient Protection and Affordable Care Act, debate was under way. Was this act within the scope of the government imperative? 

Those who questioned the constitutionality of the law argued the legislation to the Supreme Court. Other concerns included the extent of compliance with its provisions in states, the law’s impact on small businesses, the influence of HealthCare.gov glitches, and communication with the young and healthy to enroll.

This curriculum guide provides Washington Post resources — editorials, editorial cartoons, articles, blogs and commentary — to get the facts and informed opinions. Suggested activities encourage students to do a crossword puzzle, set up an e-Replica monitor, think like explanatory journalists, write about the Affordable Care Act and take part in preventive health care.

 

November 2013

 

Health Care Budgeting
Resource Graphic 
HEALTHCARE.GOV

Study Vocabulary
Economics, English, Health
The vocabulary associated with the Patient Protection and Affordable Care Act is both familiar and technical. Whether talking about access, comprehensiveness or subsidies, Americans need to know the meaning of terms as each applies to health care insurance and other provisions. Review In the Know terms with students.

See if they can find the terms in newspaper coverage and use the terms correctly in conversation. When students write about the Affordable Care Act, expect them to use these terms.

 

What is the Affordable Care Act?
Economics, Health, Journalism, Reading, U.S. Government

Get the facts. This is a basic tenet of journalism. Use primary documents as a starting point. Patient Protection and Affordable Care Act begins with a listing of the topics and terms by section. Use this “table of contents” to assign students different areas to read. What does the law say?

A concise summary of the law is found on HealthCare.gov

Patient Protection and Affordable Care Act cases are gathered on the Supreme Court website. Students can read documents and listen to audio/transcripts.

The Washington Post introduced a new feature in 2013, GovBeat, where state and local government professionals gather. The website features in-depth analysis, graphics, interactives and forums. Read “29 states want the Supreme Court weighing in on another Obamacare mandate” for a summary of the states’ concerns.  


Do the Crossword Puzzle
Health, Journalism, U.S. History

After your students have worked with the vocabulary in In the Know and reading about the Affordable Care Act, give them "Health Care in 2013." This crossword puzzle includes many of the terms associated with this legislation and securing health insurance. Answers to the puzzle are found in "Affordable Care Act Resources." After they have completed the puzzle, ask students to use five or more of the terms in an informative paragraph.


What Are People Saying About the ACA?
Economics, Health, Journalism, Technology

Read the newspaper and online news sources and listen to broadcast sources to collect quotations from federal and state government officials, health care professionals and economists. Read to find out what citizens are saying about the ACA, online problems, its benefits and drawbacks. Be sure to record the name and title/job of each individual, source of the quotation (headline and section page number) and date you accessed the comment.

 

Gather in groups of three to five students. Discuss the comments you have collected. Is there a general theme? Are there one or more questions that the quotations to which the individuals are responding? Put the topic in the form of a question.

 

Classify the quotations in Pro, Con and Undecided columns under the question. For example, Is the Affordable Care Act helping American families? Or: Should the technical problems of accessing sign-up online reflect on the health care options provided? Use "For, Against or Undecided?" to record responses.

Take Care of Your Health
Resource Graphic 
THE WASHINGTON POST

What Happens When Technology Doesn't Work?
Health, Journalism, U.S. Government, U.S. History, Technology

Brian Fung covers technology in his column The Switch. On October 30 he covered "HealthCare.gov had a glaring security flaw that wasn't patched until last week." Read his column and others to get the technology wonk's view of the online side of the rollout. Compare and contrast his views with those of other Post writers in the News, Business, and Science & Health sections. Students can locate these articles with an e-Replica Monitor or using the Post's archives.

 

Hone Your Search
Health, Journalism, Reading, U.S. History, Technology 

The content of The Washington Post may be accessed through the print edition, washingtonpost.com, and the e-Replica format. Use "Inside e-Replica: Monitor" to lead your student through the steps of setting up the monitor feature and searching for Post coverage related to the Affordable Care Act. This is also an exercise in honing students' ability to narrow topics to get useful results.

 

Can Technology Get in the Way of Information?
Economics, Health, Mathematics, U.S. History, U.S. Government

Much attention has been placed on the problems and malfunction of HealthCare.gov. While agreeing this has its place, others are calling for attention to be placed on the provisions of the Affordable Care Act. This activity draws attention to the cost of health insurance.

Before discussing insurance policies and premiums with students review the following terms: “accessibility,” “affordability,” “competitive market,” “comprehensiveness,” “individual market,” “premium,” and “subsidy.” Teachers might add “wonk” to the list. A wonk knows details about a particular field; perhaps, becoming overly absorbed in minutia.

Editor of Wonkblog and a business columnist at The Washington Post, Ezra Klein uses simple illustrations to explain the issue of the cost of insurance premiums. Read “The Health-Care Trilemma: How Obamacare is changing insurance premiums.”

Discussion would include:
1. What information about the ACA does a new report support?
2. What do the terms “accessibility,” “affordability,” and “comprehensiveness” mean in relation to insurance premiums? 
3. Why does Klein argue that these are essential to comparing and contrasing the costs of premiums? 
4. What is a “subsidy”? What role do subsidies play in determining final costs of health insurance? 
5. Is the media providing balanced and reliable information about the technical failures as well as the success of the new health care program?

 

What Does Tom Toles Think of the Issue?
Art, Journalism, U.S. Government    

Found on the op-ed page, the work of The Washington Post's editorial cartoonist provides visual commentary on current events. Four of his August-October cartoons are grouped for review and discussion of the debates over the debt ceiling and national budget entertwined with the Affordable Care Act. Give students "Tom Toles | The Patient Protection and Affordable Care Act." Call attention to Toles' alter ego found in the lower right corner. Word play, allusion to literary and historic figures, and sarcasm add to the point of view expressed.

Toles' October 14, 2013, editorial cartoon brings together a number of the elements that surround the Obamacare debates. What opponents used in a disparaging manner, Obamacare, was accepted by the president as a shorthand for his initiative. Discussion questions are provided to aid exploration of the multiple levels of the image.

 

Read About Health

What Other Health Issues Are in the News?
Economy, Health, Journalism, Physical Education

Health and developments in medical research and preventive care are news. The Affordable Care Act is likely to remain in the news just as Medicare and Medicaid have over the years. Still, there are many other health issues and developments that are today’s news. 

The Washington Post’s Health & Science section is devoted to covering these stories. Additional health-related news and its influence can be found in Business, Washington Forum, Outlook and A sections. These articles may be local, national or international. These news, feature, editorial and commentary articles and blogs inform readers in an area that directly influences daily lives.

Introduce students to these sections through the following health-related articles.
• "Now the drug can be your bank, too," Wonkblog 
• "Driving Away Hunger," Eli Saslow with photographs by Michael Williamson 
• "In India, 400 million await their right to food," Annie Gowen 
The unnecessary test that saved my mother's life," Jason H. Wasfy 
• "And living well without it: Finding hope, companionship — and a good meal — despite celiac disease," Dana Scarton about a fifth grader 
• "A genetic test shows he too has fatal disease," David Brown, related to a discussion about pre-existing conditions 
• "TOO MUCH of Too Little: A diet fueled by food stamps is making South Texans obese but leaving them hungry," Eli Saslow with photographs by Michael Williamson 

 

Think Like a Reporter
Journalism, Media Arts, Media Literacy, Reading 

When the big stories are complex with many levels of entry — cultural, social, medical, political, economic, religious and ethical — reporters need to use their expository, descriptive and narrative skills. Explanatory journalists provide information to help readers access the story. Reporters, photographers, informational graphics creators and their editors make the complicated stories easier to understand.

Give students "The Explanatory Journalist." Read and discuss the guidelines given to fulfill the role of the explanatory journalist.

The sidebar on the third page of the activity suggests longer, exemplary works. Read and discuss these with students. Teachers may ask students to write a journal before reading each article. What do students know about the topic? What would they like to understand about the topic?

In The Know 
Accessibility   Easily obtained
Affordable Care Act Known as the health care law or Obamacare, passed and amended in March 2010. It puts in place strong consumer protections, provides new coverage options and has tools to help citizens make informed choices about their health coverage.   
Affordability    Believed to be within your financial means
Brand name drugs

A drug sold by a company under a specific name or trademark and protected by a patent. They are available by prescription or over the counter.

Competitive market

Open bidding for federal contracts by independent groups that compete for the contract. Economists say the more competition, the more likely firms are to be efficient and prices to be low.

Comprehensiveness Large in scope, containing completely or broadly
Co-payment The amount you pay out-of-pocket for medical services and products, such as a doctor’s visit, medical procedure, hospital stay or prescription drugs. For example, if your co-payment is $20 and a visit to your doctor is $100, you pay $20. Your health plan pays the remaining $80.
Fixed payment Unchanging; therefore, you can more easily budget for this cost
Generic drug

A drug that works the same as a brand-name drug, but cost less because it does not have the same expensive research and advertising costs

Individual market Health plans for people who don’t have health insurance through a job. Typically, you pay the entire amount of the premiums.
Insurance

In economic terms, anything used to reduce the downside of risk. It is provided through a policy purchased from an insurance company. Conventional insurance works by pooling the risks of many people; all of whom might make a claim but in practice only a few actually do.

Medicare

A federal government program that gives health care to people age 65 and older or with a disability. It includes coverage for hospital (Medicare Part A), medical (Medicare Part B), and prescription drugs (Medicare Part D). Medicare Part A and B together are known as Original Medicare. Additional benefits can be provided through a Medicare Advantage plan (Medicare Part C). 

 Out-of-pocket cost Expenses for medical care that aren't reimbursed by insurance. These include deductibles, coinsurance, and copayments.
 Premium  A monthly payment you make to your health insurer for insurance. Your employer may pay part or all of these payments for you.
Preventive care Routine health care that includes screenings, check-ups and counseling to help prevent diseases or other health problems
Routine costs  Expected out-of-pocket expenses, such as a co-payment
Single plan

A health plan that covers just one person (not dependents like a spouse or children).

Subsidized coverage Health coverage that is obtained through financial assistance from programs to help people with low and middle incomes
Unexpected expenses

Unusual, and often more expensive, expenses; your insurance may cover all or part of the cost, depending on your policy

  Sources: Economics A-Z, HealthCare.gov, Health Care Plain and Simple, Merriam-Webster Dictionary

ANSWERS

The Health-Care Trilemma: How Obamacare is changing insurance premiums.
1. Premiums are much lower than the Congressional Budget Office estimated when the law first passed.
2. See "In the Know."
3. One has to look at what the cost (premium) was providing to whom (coverage).
4. Premiums are adjusted by income of individuals and families through subsidies.
5. Answers will vary. Ask students to support their response. 

District of Columbia Public Schools Academic Content Standards 

Health. Students comprehend concepts related to health promotion and disease prevention. (Strand 1: Health Promotion and Disease Prevention) Compare and contrast prevention and treatment of diseases and health conditions prevalent in adolescents, including obesity, diabetes, Lyme disease, STIs, and HIV/AIDS. (7.1.10)

 

Health. Students demonstrate the ability to analyze the influence of family, culture, media, and technology on health and health behaviors. (Strand 4: Analyzing Influences)

Describe the ways technology can affect personal health and health behaviors for better and for worse, such as through new, effective medicines; improved exercise equipment; and the availability and nutrient quality of food. (8.4.4)

 

Government. Students formulate questions about and defend their analyses of tensions within our constitutional democracy and the importance of maintaining a balance between the following concepts: majority rule and individual rights; liberty and equality; state and national authority in a federal system; civil disobedience and the rule of law; freedom of the presses and the right to a fair trial; and the relationship of religion and government. (Principles of U.S. Government, 12.2)

 

Learning Standards for DCPS are found online at http://dcps.dc.gov/DCPS/In+the+Classroom/What+Students+Are+Learning

 

Maryland Academic Content Standards 

Government. The Foundations and Function of Government.

2. The student will analyze historic documents to determine the basic principles of United States government and apply them to real-world situations (1.1.1).
   a. Describe the purposes of government, such as protecting individual rights, promoting the common good and providing economic security

3. The student will evaluate roles and policies the government has assumed regarding public issues (1.1.3).
     • Public issues: Environment (pollution, land use), Entitlements (Social Security, welfare), Health care and public health (costs,  substance abuse, disease), Censorship (media, technology), Crime (prevention, punishments), Equity (race, ethnicity, region, religion, gender, language, socioeconomic status, age, and individuals with disabilities).

   b. Analyze significant issues in domestic policy and how they reflect the national interest, values and principles, such as healthcare, high level of security awareness, environmental concerns
   c. Analyze the decisions made by government on domestic issues and their effect on society, such as entitlements, socioeconomic status, individuals with disabilities, welfare reform
   f. Define public health and health care issues and evaluate existing government policy, such as smoking in public places, Medicare and Medicaid

 

Health. Apply the components of personal well-being to develop lifelong wellness skills and strategies.
   a. Explain the importance of assuming responsibilities of personal health behavior.
   b. Compose a personal health goal and measure progress towards its achievement.

 

The Maryland Voluntary State Curriculum Content Standards can be found online at http://mdk12.org/assessments/standards/9-12.html

Virginia Academic Content Standards 

Economics and Personal Finance. The student will demonstrate knowledge of the role of government in a market economy by
a) identifying goods and services provided by government to benefit society;
e) explaining that taxes and fees fund all government-provided goods and services. (EPF. 8)

 

Economics and Personal Finance. The student will demonstrate knowledge of the role of insurance in risk management by
a) evaluating insurance as a risk management strategy;
b) distinguishing among the types, costs, and benefits of insurance coverage including automobile, life, property, health, and professional liability, and
c) explaining the roles of insurance in financial planning. (EPF. 14)

 

Health. The student will demonstrate an understanding of health concepts, behaviors, and skills that reduce health risks and enhance the health and wellness of self and others throughout life. (Knowledge and Skills, 10.1)

 

Government. The student will demonstrate knowledge of the process by which public policy is made by
a) examining different perspectives on the role of government;
b) describing how the national government influences the public agenda and shapes public policy;
c) describing how the state and local governments influence the public agenda and shape public policy;
d) describing the process by which policy is implemented by the bureauracy at each level;
e) analyzing how individuals, interest groups, and the media influence public policy. (GOVT. 9)

 

Standards of Learning currently in effect for Virginia Public Schools can be found online at www.doe.virginia.gov/testing/sol/standards_docs/index.shtml

 

Common Core Standards 

Literacy in History/Social Studies, Science & Technical Subjects. Integrate and evaluate multiple sources of information presented in diverse formats and media (e.g., visually, quantitatively, as well as in words) in order to address a question or solve a problem. (Integration of Knowledge and Ideas, CCSS.ELA-Literacy.RH.11-12.7)

 

Literacy in History/Social Studies, Science & Technical Subjects. Integrate information from diverse sources, both primary and secondary, into a coherent understanding of an idea or event, noting discrepancies among sources (Integration of Knowledge and Ideas, CSS.ELA-Literacy.RH.11-12.9)

 

Common Core standards are found online at http://www.corestandards.org/