2016 Political Economy

Impact On HC

A National Tragedy

Main Topics Today

Current Economic Situation

2016 Presidential Race

Future Growth for HC

US GDP

Q2 2016 GDP Estimate

Unemployment: U-3 and U-6

Fed’s Fav Inflation Gauge

5yr US Dollar Index

US 2yr Treasury Yield

Political Econ Growth Pts.

Free Trade=lower tariffs

Reg. Relief=reduced costs

Tax reform=capital formation w/incentives

Infrastructure=efficiency

Why it matters for HC

Trump PlanCut Corp Tax to 15%

Limit Pass Thru 15%

1x 10% Repat Tax

Ag TPP and NAFTAImpose tariffs on imported goods

Big Drop in InterestDeductibility

Trump HC Plan

Allow health insurance to cross state lines

Full individual deduction of HC premiums

Repeal Obamacare: no individual mandate

HSA: tax free and allowed to accumulate

Price Transparency

Medicaid Block Grants

Allow access to imported drugs

Trump HC Contradictions

2/18 “I like the mandate.”

3/1: Repeal mandate and ACA

Repeal Obamacare: no individual mandate

Feb. CNN: he wants to “take care of” poor people “through maybe concepts

of Medicare”

Next day, tweets his proposal would use “private plans”

Trump plans help/hurt

Help: big tech & big pharma

Hurt: debt heavy balance sheets

Help: industrials & manufacturers

Hurt: free tradeHurt: ACA managed care, hospitals, Medicaid HMOs

CLINTON PLANNo Change 4 Corp or Pass Thru Taxes

Tax Credits forProfit Sharing/

Apprenticeships

New BABs and CollegeTuition Plan

No Free Trade

$275b Infrastructure

Big Change to Cap Gains

Tax Foundation

Clinton HC Plan

Defend the Affordable Care Act

Crack down on rising prescription drug prices

100% 3yr match for states joining expanded Medicaid coverage

$5,000 tax credit per family for excessive out-of-pocket and premium costs above 5% of their income.

Transform HC to reward value and qualityvia bundled payments and ACOs

Clinton’s Comments“We have to go after price gougingand monopolistic practices and get

Medicare the authority to negotiate.”“…I’ll defend ACA, build on its successes,

and go further to reduce costs.”

“What we have to do, I think, is defend ACA and fix it.”

“I will direct the government to reevaluateMedicare and Medicaid payment practices to remove

obstacles to reimbursement and helpintegrate care for addictions into standard practice.”

Clinton plans help/hurt

Help: ACA managed care, hospitals, Medicaid HMOs

Hurt: raises taxes on top earners/capital formation

Help: construction, enginering firms

Help: cities and students

2016 Difference Recap

Clinton: no big biz tax plans, large infrastructure plans,

build on current regulations, build on ACA HC

Trump: tax cut plans,reduce regulations, full expensing,

hurt free trade, hurt ACA related HC,block grants for Medicaid

2016 HC Similarity Recap

Increased price transparency

Allow Medicare to negotiatedrug prices directly with pharma

1st Time Ever: Trump is ahead!

Maybe not…

Don’t Forget The Senate!

Future HC growth is value

Do you deliver a better outcome?

Do you deliver a superior customer experience?

Do you deliver a lower price and cost?

Chronic Care Focus

CMS recognizes care management as one of the critical components of primary care that contributes to better health and care for individuals, as well as

reduced spending. BeginningJanuary 1, 2015 Medicare pays separately under the

Physician Fee Schedule (PFS) under American Medical Association Current Procedural Terminology

(CPT) code 99490, for non-face-to-face carecoordination services furnished to Medicare

beneficiaries with multiple chronic conditions.

Pressure on PriceOver the period from 2005 to 2014, premiums for employment-based insurance grew by 48 percent for single coverage and by 55 percent for family coverage. CBO and JCT expect them to grow at similar rates over the next decade—by about 5

percent per year, on average, or about 2 percentage points faster than income per capita. As a result of that growth, average premiums for employment-

based coverage are projected to be about $10,000 for single coverage and about $24,500 for family coverage in 2025, nearly 60 percent higher than

they were in 2016.CBO Feb 2016

Pricing TransparencyCastlight: mission is to empower people to make

the best choices for their health, and help companies make the most of their health benefits.

MD Insider: we analyze doctor performanceusing big data

Guroo: At guroo.com, you'll find data on health care costs and quality. We have national, state,

and local prices.

Strata Decision: Our passion and our mission is to help hospitals and health systems drive margin to fuel their mission.

New Research MethodsMiroculus

New Models/Competitors

Final Thoughts…