overview of health reform: why and what
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Overview of Health Reform: Why and What. Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL Health Network www.equalhealth.info 415-922-6204 [email protected] September, 2010. Historic Achievement. Congress has passed the most substantial health reform since Medicare and Medicaid in 1965 - PowerPoint PPT PresentationTRANSCRIPT
September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network
Overview of Health Reform: Overview of Health Reform: Why and WhatWhy and What
Ellen R. Shaffer PhD MPHEllen R. Shaffer PhD MPHJoe Brenner MAJoe Brenner MA
EQUAL Health NetworkEQUAL Health Networkwww.equalhealth.infowww.equalhealth.info
415-922-6204 [email protected] [email protected]
September, 2010September, 2010
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Historic Achievement Historic Achievement
Congress has passed the most substantial Congress has passed the most substantial health reform since Medicare and health reform since Medicare and Medicaid in 1965Medicaid in 1965
Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act (ACA)(ACA)
Important steps to expand coverage and Important steps to expand coverage and improve quality, begins to control costsimprove quality, begins to control costs
Complex, Complex, somesome misunderstandings misunderstandings
September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network
What Do You Think?What Do You Think?
Great law – about time!Great law – about time!
Pretty good, wish it were single payerPretty good, wish it were single payer
All depends how it gets implemented…All depends how it gets implemented…
September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network
We Are All AmbassadorsWe Are All Ambassadors
If you’re here today, you stand to benefitIf you’re here today, you stand to benefit
Whether insured or not, employed or notWhether insured or not, employed or not
What you do – or don’t do – will make a What you do – or don’t do – will make a differencedifference
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EQUAL Health Network EQUAL Health Network EEquitable, quitable, QQuality, uality, UUniversal, niversal, AAffordable ffordable
health carehealth care
Network for progressive policy and advocacyNetwork for progressive policy and advocacy– Links: Public health, women, seniors, faith Links: Public health, women, seniors, faith
groupsgroups– Policy-makersPolicy-makersCenter for Policy Analysis, anchorCenter for Policy Analysis, anchor
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EQUAL’s Program:EQUAL’s Program:Making Health Reform WorkMaking Health Reform Work
EducateEducateHandout and website: summary of the lawHandout and website: summary of the law
ImplementImplement
Comment on regulationsComment on regulations
ImproveImproveNext steps toward EQUAL health careNext steps toward EQUAL health care
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Why The Affordable Care Act: Why The Affordable Care Act: Access, Quality, CostsAccess, Quality, Costs
ACA: The Gains ACA: The Gains
Implementing the LawImplementing the Law
Improving the FutureImproving the Future
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Why We Needed to Do This: Why We Needed to Do This: The ProblemsThe Problems
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People Are SufferingPeople Are Suffering~ ~ Access, Cost, QualityAccess, Cost, Quality
46 million uninsured in U.S. 46 million uninsured in U.S. – 6.7 million in California6.7 million in California
44,000 deaths a year due to lack of insurance44,000 deaths a year due to lack of insurance
60% of U.S. bankruptcies due to health costs 60% of U.S. bankruptcies due to health costs
– – Mostly to people Mostly to people with insurancewith insurance
Highest costs in the world: $2.5 Trillion/yearHighest costs in the world: $2.5 Trillion/year
3737thth in Quality in Quality
Amazing FactAmazing Fact
The More People We Cover The More People We Cover The Better We Can Control The Better We Can Control
CostsCosts
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MedicareMedicare
Popular federal government program Popular federal government program covers entire population over age 65covers entire population over age 65
Costs controlled better than insurance Costs controlled better than insurance for people under 65for people under 65
Even though Medicare covers oldest Even though Medicare covers oldest and sickestand sickest
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Employment-Based InsuranceEmployment-Based Insurance
Most people under age 65 get insurance through Most people under age 65 get insurance through work – but employers don’t have to provide itwork – but employers don’t have to provide it
Large employers: 96% offerLarge employers: 96% offer
Small employers: 43% offerSmall employers: 43% offer– (fewer than 50 employees)(fewer than 50 employees)
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52%
56%
60%
64%
68%
72%
1979 1985 1991 1997 2003Per
cen
t co
vere
d b
y o
wn
em
plo
yer
insu
ran
ce
Private employer-provided health
insurance
The Great Risk Shift in Health CareThe Great Risk Shift in Health Care69.0%
54.9%
Over 15 percentage point decline
Source: Economic Policy Institute, State of Working America, 2006/2007
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Fragmented Coverage Drives Up Fragmented Coverage Drives Up Costs. Costs. (Other reasons too…)(Other reasons too…)
Without mandates (or universal coverage): Without mandates (or universal coverage): Healthy people will opt out.Healthy people will opt out.If premiums based on health status, sick people can’t If premiums based on health status, sick people can’t afford them. afford them. Insurance industry uses expensive administrative tools to Insurance industry uses expensive administrative tools to weed out sick people from coverage.weed out sick people from coverage.Uninsured delay care, need more costly treatment if/when Uninsured delay care, need more costly treatment if/when they do get care.they do get care.– Uninsured pay more for same services than the insured.Uninsured pay more for same services than the insured.– Some costs shifted to the insured.Some costs shifted to the insured.
Are there other factors driving up health care costs? Yes:Are there other factors driving up health care costs? Yes:
inadequate bargaining power with providers, too many specialists and acute care, inadequate bargaining power with providers, too many specialists and acute care, administration, profit.administration, profit.
But expanding coverage is indispensible to controlling But expanding coverage is indispensible to controlling costscosts..
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ACA: The GainsACA: The Gains
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TimelineTimeline: : ACA Benefits Phased In ACA Benefits Phased In
2010-20132010-2013– Consumer protections from insurance co. practicesConsumer protections from insurance co. practices– Affordability and quality improvementsAffordability and quality improvements
2014: Major coverage expansions2014: Major coverage expansions– Health Insurance ExchangesHealth Insurance Exchanges
For individuals, small business employeesFor individuals, small business employeesIndividual Mandate Individual Mandate
– Subsidies to 400% of poverty ($88,000/yr family of 4)Subsidies to 400% of poverty ($88,000/yr family of 4)
Employers contribute to Exchange if employees use subsidyEmployers contribute to Exchange if employees use subsidyMembers of Congress and staff must buy thru ExchangesMembers of Congress and staff must buy thru Exchanges
– Medicaid ExpandedMedicaid ExpandedEveryone up to 133% of poverty levelEveryone up to 133% of poverty level
2020: “Donut hole” in Medicare drug coverage gone 2020: “Donut hole” in Medicare drug coverage gone
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Immediate ImprovementsImmediate Improvementsin 2010in 2010
Coverage:Coverage:– New High Risk Pool for uninsuredNew High Risk Pool for uninsured– Coverage for Young Adults through Age 26 on Coverage for Young Adults through Age 26 on
parents’ plansparents’ plans
Affordability:Affordability:– Small business tax credits of up to 35%Small business tax credits of up to 35%– Rebates begin to close gaps in Medicare coverage for Rebates begin to close gaps in Medicare coverage for
drug costs – the “donut hole”drug costs – the “donut hole”– Reduces cost of early retiree coverageReduces cost of early retiree coverage
Down payments on Cost Control: Down payments on Cost Control: – Quality Improvements, Primary care, Public Health Quality Improvements, Primary care, Public Health
and Prevention, Rate Regulationsand Prevention, Rate Regulations
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Immediate ImprovementsImmediate Improvements
Stops Insurance Abuses:Stops Insurance Abuses:– Discrimination against children with pre-existing Discrimination against children with pre-existing
conditions prohibitedconditions prohibited– Rescissions Illegal (withdrawal of care)Rescissions Illegal (withdrawal of care)– Bans lifetime limits on coverage Bans lifetime limits on coverage
QualityQuality– First dollar coverage of preventive careFirst dollar coverage of preventive care– Increased funding for Community ClinicsIncreased funding for Community Clinics
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Insured Through Work?Insured Through Work?New ProtectionsNew Protections
Bankruptcy protection:Bankruptcy protection:Limits on out-of-pocket spendingLimits on out-of-pocket spending
No co-payments on preventive health careNo co-payments on preventive health care
Insurance abuse protection:Insurance abuse protection:No recissions: cannot withdraw coverage No recissions: cannot withdraw coverage
Workplace abuse protection:Workplace abuse protection:You don’t have to keep your job to keep your You don’t have to keep your job to keep your
health insurancehealth insurance
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MedicareMedicare
Insolvency delayed almost 2 decadesInsolvency delayed almost 2 decades
Changes to Medicare AdvantageChanges to Medicare Advantage
Promising trials on quality improvementPromising trials on quality improvement
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Making It Work:Making It Work:Implementing the LawImplementing the Law
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Implementing the LawImplementing the Law Comment on Regulations to HHS Comment on Regulations to HHS
ISSUEISSUE ONLY CONCERNS ONLY CONCERNS WONKS WHO…WONKS WHO…
Rate ControlRate Control Care about costsCare about costs
Medical Loss RatioMedical Loss Ratio Care about costsCare about costs
Determining Determining Prevention Benefits Prevention Benefits - Contraception- Contraception
Might’ve ever used a Might’ve ever used a contraceptive…I don’t contraceptive…I don’t really know… have toreally know… have to
ask around…ask around…
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California Reforms PendingCalifornia Reforms Pending
Create an Insurance Exchange:Create an Insurance Exchange: AB 1602 (Bass) & AB 1602 (Bass) & SB 900 (Alquist). SB 900 (Alquist). To offer transparent rates and To offer transparent rates and benefits, available to buyers inside and outside the benefits, available to buyers inside and outside the ExchangeExchange
Facilitate a public health insurance option: SB 56 Facilitate a public health insurance option: SB 56 (Alquist). C(Alquist). County-organized health plans and other ounty-organized health plans and other health benefits programs can form joint ventures.health benefits programs can form joint ventures.
Reform individual insurance:Reform individual insurance: SB890 (Alquist). SB890 (Alquist). Specific plans with basic benefits so consumers can Specific plans with basic benefits so consumers can do “apples-to-apples” comparisons:do “apples-to-apples” comparisons:
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Improving the FutureImproving the Future
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Policy Issues for the FuturePolicy Issues for the Future
Reproductive health careReproductive health care
Immigrants’ inclusionImmigrants’ inclusion
AffordabilityAffordability
State options for innovative approaches State options for innovative approaches – Single payerSingle payer
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What To Do NowWhat To Do Now
Analyze/EducateAnalyze/Educate– Get the facts about the lawGet the facts about the law– Spread the wordSpread the word
Implement The LawImplement The Law– Make It WorkMake It Work
Improve The LawImprove The Law
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Network with EQUAL toNetwork with EQUAL to Help Make History! Help Make History!
Join the EQUAL ListservJoin the EQUAL Listserv Send a blank message toSend a blank message to [email protected]@list.equalhealth.info
See our website:See our website:www.equalhealth.infowww.equalhealth.info
Thanks for contributions to this presentation to EQUAL partners Thanks for contributions to this presentation to EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason, Keely Monroe (Lisa Kernan Adelson, Lee Lawrence, Robert Mason, Keely Monroe (Lisa Kernan Social Justice Fellow), Jeoff Gordon, UULM-CA Social Justice Fellow), Jeoff Gordon, UULM-CA Other source: Health Access CAOther source: Health Access CA