Transcript Slide 1

Health Care Reform
Sherry Glied
[email protected]
Health Reform was Not Inevitable
(1) Some people have said that it would be a miracle if we passed
health care reform. But I believe we live in a time of great change
when miracles do happen.
(2) The cost of our health care has weighed down our economy and
the conscience of our nation long enough. So let there be no
doubt: health care reform cannot wait, it must not wait, and it will
not wait another year
(3) I believe that comprehensive health insurance is an idea whose
time has come. I believe that some kind of program will be enacted
this year.
(4) Millions do not now have protection or security against the
economic effects of sickness. And the time has now arrived for
action to help them attain that opportunity and to help them get
that protection.
Public Opinion
1993
• 20% of voters ranked health care as the most important issue
in the 1992 presidential election1
2008
• 9% indicated health care was the most important issue in the
2008 campaign
1
Kaiser Family Foundation Election Spotlight. Data collected
from 1992 Presidential Election Exit Polls
2 CNN Exit Polls, November 4, 2008
1993
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GDP
– 2.9% Change from 1992
Budget Deficit as % of GDP
– 3.9% (1993)
Public Debt as a percentage of GDP
– 66.2% (1993)
Unemployment rate
– 6.9% (1993)
2009
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GDP :
– -3.5% Change from 2008
Budget Deficit as % of GDP:
– 10.1% (2009)
Public Debt as a percentage of GDP
– 85.2% (2009)
Unemployment
– 9.3% (2009)
Economic
Landscape
Political Landscape
1992
• Clinton 370, Bush 168
• House: 258 (D), 176 (R)
• Senate: 57 (D), 43 (R)
2008
• Obama 349, McCain 173
• House: 256 (D), 178 (R)
• Senate: 55(D), 42(R), 2(I)
April 27: Arlen Specter (R)→(D)
June 20: Al Franken (D)
1. Reform of Insurer Practice
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Rate Review – review of increases>10%
Transparency/appeals
Lifetime limits
Medical Loss Ratio
Annual limits
Pre-existing conditions
Underwriting and rating limits
Risk adjustment
Annual Limits
• Minimum limits
– 2010 – $750,000
– 2011 – $1.25 million
– 2012 – $2 million
– 2014 – not permitted
Limited Benefit Plan
• McDonald’s
– $56 per month – up to $2,000 benefits/year
• Ruby Tuesday
– $18.43 per week - $1,250 outpatient; $3000
inpatient
• Denny’s
– No inpatient, up to $300 doctor visits
Waivers
3 million people in 1,372 mini-med plans
2. Improvements in Coverage
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Preventive services in Medicare
Part D donut hole in Medicare
Preventive services with no copay
Essential Health Benefits
Standardized cost-sharing
– Actuarial value
Preventive Services with No Copay
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USPSTF A and B
November 2009 – Mammography
Mikulski amendment
IOM Committee
Contraceptive coverage
3. Expansions of Coverage
• Young adults
• Tax credits to 400% FPL
• Health Insurance Exchanges
– 20-22 million (including much current non-group)
• Medicaid expansion to 133% FPL
– 16-17 million
• Requirements to offer and obtain coverage
- Individual mandate
- Employer requirements
2014 Expansions
Number Newly Enrolled/Insured
40
14%
35
12%
30
10%
25
8%
20
6%
15
4%
10
2%
5
0
0%
Newly enrolled 1965 Expansions (19681972)
Newly enrolled 2016 ACA
Medicare B
Newly insured 1965 Expansions (19681972)
Medicaid <65
Newly insured 2016 ACA
% of Population
Effect of Expansions on the
Uninsurance Rate
0
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
1965 Expansion
Medicare B
2016 ACA
Medicaid <65
4. Prevention and Public Health Fund
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Community transformation grants
Tobacco prevention
Clinical prevention
Workforce training
Data systems
5. Delivery System Reforms
• Accountable Care Organizations
• Innovation Center
– Bundled Payments
– Duals
– Challenges
– Pioneers
CMS Innovation Center
“The purpose of the Center is to test innovative payment and
service delivery models to reduce program expenditures
under Medicare, Medicaid and CHIP…while preserving or
enhancing the quality of care furnished…”
– “Preference to models that improve coordination, quality and
efficiency of health care services.”
• Resources - $10 Billion in funding for FY2011 through 2019.
• Opportunity to “scale up”: HHS Secretary has authority to
expand successful models to the national level.
6. Cost Containment
• Reductions in payments to Medicare
Advantage plans - $156 billion
• Change in Medicare non-MD payment update
formula - $415 billion
• IPAB - $3 billion
• Excise tax on high cost plans – beginning 2018
- $111 billion
Cost Containment in the ACA
Medicare Share of GDP - ACA Effect
(adjusted for doc fix)
5.0%
4.8%
Share of GDP
4.6%
4.4%
4.2%
4.0%
Share of GDP - no ACA
3.8%
Share of GDP - ACA
3.6%
3.4%
3.2%
3.0%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
20.0%
Projected Effect of the ACA on NHE (GDP
Share)
19.5%
% GDP
19.0%
18.5%
18.0%
17.5%
17.0%
16.5%
No ACA
ACA