Latino Health Disparities

and the ACA

Senator Irene Aguilar, MD

Table 2: Estimate of ACA Effect, 2016

No Reform With ACA ACA Impact

ESI 2,630,000 2,600,000 -30,000

Small Firm ESI (1-50 employees) 560,000 540,000 -20,000

Other ESI 2,070,000 2,060,000 -10,000

Unreformed Non-group 340,000 60,000 -280,000

Reformed Non-group 0 620,000 620,000

Tax Credit Recipients 0 470,000 470,000

Non-Recipients 0 150,000 150,000

Public Insurance 550,000 710,000 160,000

Uninsured 860,000 400,000 -460,000

Total 4,390,000 4,390,000→ →

→

Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011

Dr. Jonathan Gruber 9/16/11

22%

39%

10%

29%

5

Federal Poverty Level Among the Uninsured, Colorado 2011

Massachusetts: Private, Medicare & Medicaid Payment for Professional Procedures

MinPrice

Max Price

Office Visit

$45 $330

MRI Brain

$104 $646

Colon-oscopy

$203 $1,045

Private Payer Payment Variation

Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost Trends: Price Variation in Massachusetts Health Care Services, May 2011.

Determinants of Health

2011 U.S.

Healthcare Spending:

$2.7 Trillion

Number of U.S. Deaths from Behavioral Causes

Smoking prevalence by race and ethnicity 2008-2012, Colorado adults

Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

Per

cen

t

Obesity prevalence by race and ethnicity 2008-2012, Colorado adults

Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

Per

cen

t

Diabetes prevalence by race and ethnicity 2008-2012, Colorado adults

Source: Colorado Behavioral Risk Factor Surveillance System, Colorado Department of Public Health and Environment

Per

cen

t

Source: Small Area Income and Poverty Estimates (SAIPE) , US Census Bureau

Colorado unemployment rates, 2010

Colorado high school graduation rates, 2011

Source: Colorado Department of Education

Years of potential life lost

Leading causes of YPLL-65 by race/ethnicity: Colorado residents, 2010-2012

Race/ethnicityLeading causes of years of potential life lost before age 65 (YPLL-65)

First Second Third Fourth Fifth

All races/ethnicities

Unintentional injuries Cancer Suicide Heart disease Perinatal period

conditions

White, Non-Hispanic

Unintentional injuries Cancer Suicide Heart disease Perinatal period

conditions

White, Hispanic Unintentional injuries

Perinatal period conditions Cancer Suicide Heart disease

Black/African American

Unintentional injuries

Perinatal period conditions

Homicide/legal intervention Cancer Heart disease

Asian/Pacific Islander Cancer Suicide Unintentional

injuries Birth defects Heart disease

American Indian/Native

Alaskan

Unintentional injuries Suicide

Chronic liver disease and

cirrhosisCancer Heart disease

Source: Vital Statistics Unit, Colorado Department of Public Heath and Environment

A Uniquely Colorado Solution:The Colorado Health Care Cooperative

ORIGINAL BY: John A. Nyman, PhDUniversity of Minnesota 19

US v. Other G7 Countries Updated

Canada France Germ. Italy Japan UK Avg USA

MD visits (2009)per capita

6.5 6.9 8.2 NA 13.2* 5.0 6.3 3.9

Hosp dischargesper 100 pop (2009)

8.4 17.0 26.3 NA NA 13.3 16.0 13.1

Avg hospitalLOS (2009)

7.7 5.2 7.5 NA NA 6.8 5.9 5.4

Hospital days per 100 population

144.0 83.2

HC spending (2010)

per capita (PPP)

$4,445

$3,974

$4,338

$2,964

NA $3,433

$3,831

$8,232

HC spending as % of GDP (2010)

11.4 11.6 11.6 9.3 NA 9.6 10.6 15.8

LE at birth (2010)

80.8 (08)

80.2 80.5 82 (09) 83 80 81.1 78.7

Infant deaths per 1000 live births (2010)

NA 3.6 3.4 3.4 2.3 4.2 3.4 6.1OECD website : http://stats.oecd.org/index.aspx

The spending per capita numbers were converted from the currency of the country to US dollars by a PPP index.

IOM: Best Care at Lower Cost

9.8%

7.2%

27.5%

17%

13.7%

24.8%

INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste

$ 765 Billion

Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included.

Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Household Component, 2009.

Concentration of Health Care Spending in the U.S. Population, 2009

(≥$51,951) (≥$17,402) (≥$9,570) (≥$6,343) (≥$4,586) (≥$851) (<$851)

Perc

ent o

f Tot

al H

ealth

Car

e Sp

endi

ng

What is a Health Care Cooperative?

A nongovernmental, nonprofit, member- owned and operated corporation

Residents of Colorado are the owner-membersThe cooperative operates for the benefit of

Coloradans—providing quality health care for all, while saving members’ money

It’s not a farm or

electric cooperative.

Figure 4. Share of Colorado population without health insurance coverage, alternative funding

programs, 2015-24.

Savings under the Cooperative come from reducing administrative waste

SAVINGS: 2016: $7.7 billion @ 16% 2024: $ 24 billion @ 28%

Cooperative would put Colorado on sustainable path: Spending growing no

faster than the GSP

Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation

Martin Luther King, Jr.

Cowardice asks the question: is it safe?

Expediency asks the question: is it politic?

Vanity asks the question: is it popular?

But conscience asks the question: is it right?

And there comes a time when one must take a position that is neither safe, nor politic, nor popular- but one must

take it simply because it is right.