healthcare reform and you

Healthcare Reform and You.

Presented by:Martin Trussell, SVP First Horizon Msaver, Inc.

HealthCampNash, May 30, 2009


Healthcare Reform

� Why now?

� What will it look like?

� How will it affect me?� Carriers & TPAs

� Brokers & Agents

� Employers

� Individuals

� Providers

� Others…


Why Now?

� Economic crisis.

� Medicare and Medicaid.

� Stakeholder consensus.

� Needs to happen in 1st Term.


Why Now?

� National healthcare spending reached $2.2 trillion, or $7,421 per person, in 2007 representing more than 16% of the gross domestic product.

� Continuing at the same pace, it will reach 20.3% of the country's gross domestic product by 2018.


Why Now?

� 32% of state budgets now go to paying for Medicaid.

� Growth rates for Medicare is unsustainable.


What will it look like?

� We don’t know, for sure.

� Legislation to be revealed in June.

� Passed by July 31.



� The promise:

� All Americans guaranteed affordable,

� high-quality healthcare

� the freedom to choose whatever doctor or health plan they want,

� all at a savings of some $2,500 per family.



� The cost: $1.5 trillion.



� Individual mandate.

� Sufficient coverage.

� Elimination of underwriting.

� Tax equity, subsidy (indiv. vs. group).

� Public Plan to complete.

� Emphasis on prevention & wellness.

� Elimination of waste.

� Electronic data keeping.

� Comparative effectiveness.


Employer

� Elimination or reduction the favored tax status of healthcare expenses.

� Revenue “lost” to current policy at $194.2 billion a year.

� Less control over plan designs offered to employees.

� Loss of members to individual plans.


Carriers

� Competition from “Public Plan.”

� Inability to underwrite.

� Increased regulation.

� Shift to individual policies.

� Looking for $2T in savings.


TPAs

� Potential loss of FSA/HRA admin.

� Potential gain of HSA substantiation.

� Shift from groups to individuals.


Brokers and Agents

� Competition from “Connectors.”

� Shift to individual market.

� Relief from underwriting.


Individuals

� Requirement to purchase insurance.

� Tax credits or subsidy.

� Reduced the tax advantages of HSAs, FSAs and itemized deductions of medical expenses.

� New “sin taxes” on products such as alcohol and sugary soft drinks.


Providers

� Reduced Medicare spending on home healthcare, durable medical equipment, medical imaging and prescription drugs.

� Increased demand for services, especially primary care.

� 5% bonus payment for office visits and other “primary care services.”

� Input on “best practices.”

� Looking for $2T in savings.


Providers (Medicare)

� Increase payments to doctors who regularly exceed “national benchmarks” for the quality of care.

� Bonuses to hospitals that provide superior care for heart attacks, heart failure, pneumonia and selected other conditions.

� Doctors could receive extra payments if they hire nurses to manage follow-up care for chronic cases.

� Government to set national standards for the appropriate use of CAT scans, magnetic resonance and other diagnostic imaging techniques.


Providers (Medicare)

� Medicare would make a single “bundled payment” for all the services provided to a hospital patient.

� Bad for nursing homes, home care, hospice, etc.


Pharmaceuticals

� Reduce government spending on prescription drugs.

� Re-importation of drugs from other countries to lower costs.

� Shifting insurance coverage toward prevention, could increase sales for heart, diabetes and other drugs that patients take long term.

� Increased Rx spend by $15 to $18 billion.

� Looking for the $2T in savings.


Wellness

� Tax credits or other subsidies to employers who offer wellness programs that meet federal criteria.

� Make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees.


Health IT Providers

� $20 billion in Stimulus Money.

� Electronic Health Records.


Marketing Communications

� Need to communicate new programs.


Benefits Attorneys

� Need to interpret new regs.


Thank you.

Martin Trussell, SVP First Horizon Msaver, Inc.

HealthCampNash, May 30, 2009

healthcare reform and you

Economy & Finance