Public Health:Public Health:Medicare and Medicare and MedicaidMedicaid

Law and PovertyLaw and Poverty

Insurance Coverage - Insurance Coverage - USUS 60% Private Insurance 60% Private Insurance 19% Have No Insurance – 46 million19% Have No Insurance – 46 million 27% Public/ Government Insurance27% Public/ Government Insurance

14% Medicare14% Medicare 13% Medicaid13% Medicaid

Source: Census, Income Poverty, Health Source: Census, Income Poverty, Health Insurance, August 2005 p60-229Insurance, August 2005 p60-229

Rising Healthcare Rising Healthcare CostsCosts Since 2000, the cost of family Since 2000, the cost of family

health insurance has risen 87%health insurance has risen 87% Since 2000, consumer prices Since 2000, consumer prices

overall are up 18%overall are up 18% Since 2000, worker pay is up 20%Since 2000, worker pay is up 20% Overall cost is $11,000+ /yearOverall cost is $11,000+ /year

Milt Freudenheim, “Health Care Costs…” NYT Milt Freudenheim, “Health Care Costs…” NYT

9.27.069.27.06

Declining Employer Declining Employer Coverage of InsuranceCoverage of Insurance In 2000, 69% of businesses gave In 2000, 69% of businesses gave

some of their workers health ins;some of their workers health ins; By 2006, it was down to 61%;By 2006, it was down to 61%; Even in businesses that offer Even in businesses that offer

health insurance, many health insurance, many employees not covered, employees not covered, especially in small firms.especially in small firms.

Kaiser Family Foundation ReportKaiser Family Foundation Report

MedicareMedicare

What is it?What is it? What kind of law is it?What kind of law is it? How is a person eligible?How is a person eligible? What is the benefit conferred?What is the benefit conferred? Who administers it?Who administers it? Who pays for it?Who pays for it? What is its constituency?What is its constituency? What is its history?What is its history? Who are collateral beneficiaries?Who are collateral beneficiaries? What size is it?What size is it?

What is Medicare?What is Medicare?

Federal LawFederal Law Medicare is a nationwide federal Medicare is a nationwide federal

health insurance program for the health insurance program for the aged and certain disabled persons. aged and certain disabled persons. It has two parts: It has two parts:

Part A...hospital insurancePart A...hospital insurance Part B...supplementary medical Part B...supplementary medical

insuranceinsurance

Eligibility for MedicareEligibility for Medicare

Depends on partDepends on part

Part A- hospital insurancePart A- hospital insurance– almost all persons over 65, (those who are covered by SS)almost all persons over 65, (those who are covered by SS)– If not SS eligible, pay $393/month in 2006 (less if If not SS eligible, pay $393/month in 2006 (less if some some

coverage)(2-5)coverage)(2-5)– Fed employees - special rules (2-5)Fed employees - special rules (2-5)

[[PLUSPLUS SSD recips after 24 months] SSD recips after 24 months]

Part B - outpatient insurance Part B - outpatient insurance all persons over 65, whether SS eligible or all persons over 65, whether SS eligible or

notnotby paying a monthly premium (in 2006 it is by paying a monthly premium (in 2006 it is

$88.50)$88.50)

What is Medicare What is Medicare Benefit?Benefit?

Very much like insurance with co-pays, Very much like insurance with co-pays, deductibles, etc.deductibles, etc.

Part A: inpatient hospital services, Part A: inpatient hospital services,

Also up to 100 days of post-Also up to 100 days of post-hospital skilled nursing facilityhospital skilled nursing facility

Part B: outpatient servicesPart B: outpatient services

Administration of Administration of Medicare?Medicare?

CMS, within the Dept of Health and CMS, within the Dept of Health and Human Services; CMS=Center for Human Services; CMS=Center for Medicare and Medicaid ServicesMedicare and Medicaid Services

With help from insurance carriers With help from insurance carriers (who handle claims)(who handle claims)

Who pays for Who pays for Medicare?Medicare?

Part A: recips pay a deductiblePart A: recips pay a deductibleFinanced by HI, (hospital insurance) part Financed by HI, (hospital insurance) part

of FICA; 1.45% on all earnings from ee and er of FICA; 1.45% on all earnings from ee and er - pays for 85% (2-10)- pays for 85% (2-10)

Part B: program pays 80%, after $100 Part B: program pays 80%, after $100 deductibledeductible

Financed by premiums (about 25% of Financed by premiums (about 25% of actual costs)actual costs)

And by general government revenuesAnd by general government revenues

What is Medicare’s What is Medicare’s Constituency?Constituency?

Over 41 million people enrolled in Over 41 million people enrolled in Medicare as of 2003 Medicare as of 2003

35 Million Seniors35 Million Seniors

6 Million Disabled6 Million Disabled

Medicare CoverageMedicare Coverage

Medicare HistoryMedicare History

Enacted in 1965, the Medicare program Enacted in 1965, the Medicare program immediately covered 19.1 million people immediately covered 19.1 million people when it went into operation on July 1, 1966. when it went into operation on July 1, 1966.

Before 1966, only about half of all older Before 1966, only about half of all older Americans had health insurance. Americans had health insurance.

In 1972, Congress extended eligibility for In 1972, Congress extended eligibility for Medicare to permanently disabled people Medicare to permanently disabled people who have received Social Security Disability who have received Social Security Disability Insurance (SSDI) payments for two years Insurance (SSDI) payments for two years and individuals with end-stage renal and individuals with end-stage renal disease (ESRD). disease (ESRD).

Medical Care in Other Medical Care in Other CountriesCountries In 1883, GermanyIn 1883, Germany passed a sickness passed a sickness

insurance law which created mandatory insurance law which created mandatory sickness funds for certain classes of sickness funds for certain classes of industrial workers. Contributions were industrial workers. Contributions were mandated both from employers and mandated both from employers and employees and a small state contribution. employees and a small state contribution. Was, as in other European countries that Was, as in other European countries that followed, support of laborers. followed, support of laborers.

In In BritainBritain sickness insurance was a part sickness insurance was a part of the of the National Insurance Act of 1911.National Insurance Act of 1911.

Who are collateral Who are collateral beneficiaries?beneficiaries?

:                                              

Where Do Medicare Dollars Where Do Medicare Dollars Go?Go?

How Much Does How Much Does Medicare Cost?Medicare Cost? 2006 Estimate $345 billion2006 Estimate $345 billion 2004 was $283 billion2004 was $283 billion 1999 was $212 billion1999 was $212 billion

New Medicare BenefitNew Medicare Benefit

Prescription Drug Prescription Drug CoverageCoverage

Medicare Drug Benefit Medicare Drug Benefit ChoicesChoices From January 2006 beneficiaries can From January 2006 beneficiaries can

choose to choose to (a) stay in traditional Medicare, a current (a) stay in traditional Medicare, a current

Medicare HMO or a retiree plan without Medicare HMO or a retiree plan without signing up for the drug benefit; signing up for the drug benefit;

(b) stay in traditional Medicare and enroll (b) stay in traditional Medicare and enroll in a stand-alone drug plan; in a stand-alone drug plan;

(c) enroll in a private health plan that (c) enroll in a private health plan that offers drug coverage and Medicare health offers drug coverage and Medicare health services. services.

Medicare Drug Medicare Drug BenefitsBenefits Enrollees will have an annual deductible of $250, Enrollees will have an annual deductible of $250, an estimated premium of $35 a month (may vary an estimated premium of $35 a month (may vary

in private plans) in private plans) and a 25 percent copayment of drug costs up to and a 25 percent copayment of drug costs up to

$2,250 in a year.$2,250 in a year. After that, enrollees pay all drug costs until they After that, enrollees pay all drug costs until they

have spent $3,600 out of pocket (equal to $5,100 have spent $3,600 out of pocket (equal to $5,100 in annual costs for those with no other drug in annual costs for those with no other drug insurance). insurance).

At that point catastrophic coverage kicks in, and At that point catastrophic coverage kicks in, and enrollees pay 5 percent of prescriptions or copays enrollees pay 5 percent of prescriptions or copays of $2 for generics and $5 for brand names of $2 for generics and $5 for brand names (whichever is greater). (whichever is greater).

Annual deductible of $250;Annual deductible of $250;

Premium of $35 a month (may vary in private plans); Premium of $35 a month (may vary in private plans);

25 percent Copayment of drug costs up to $2,250/ 25 percent Copayment of drug costs up to $2,250/ year;year;

After $2,250, pay all drug costs until they have spent After $2,250, pay all drug costs until they have spent $3,600 out of pocket (equal to $5,100 in annual costs $3,600 out of pocket (equal to $5,100 in annual costs for those with no other drug insurance); for those with no other drug insurance);

At that point, catastrophic coverage kicks in, and At that point, catastrophic coverage kicks in, and enrollees pay 5 percent of prescriptions or Copays of enrollees pay 5 percent of prescriptions or Copays of $2 for generics and $5 for brand names (whichever is $2 for generics and $5 for brand names (whichever is greater). greater).

Low-Income Drug Low-Income Drug Subsidies:Subsidies: People eligible for Medicaid and People eligible for Medicaid and

Medicare will pay no premium or Medicare will pay no premium or deductible and have no gap in deductible and have no gap in coverage. They will pay $1 per coverage. They will pay $1 per prescription for generics and $3 prescription for generics and $3 for brand names. Copays are for brand names. Copays are waived for those in nursing waived for those in nursing homes. homes.

People with incomes below about $13,000 People with incomes below about $13,000 ($17,600 for couples) in 2006 and assets of ($17,600 for couples) in 2006 and assets of under $6,000 ($9,000 for couples) will pay no under $6,000 ($9,000 for couples) will pay no premium or deductible and have no gap in premium or deductible and have no gap in coverage. They will pay $2 for generics, $5 coverage. They will pay $2 for generics, $5 for brand names and nothing above the for brand names and nothing above the catastrophic limit.catastrophic limit.

People with incomes between $13,000 and People with incomes between $13,000 and $14,400 ($17,600 and $19,500 for couples) in $14,400 ($17,600 and $19,500 for couples) in 2006 and assets under $10,000 ($20,000 for 2006 and assets under $10,000 ($20,000 for couples) will pay premiums on a sliding scale, couples) will pay premiums on a sliding scale, a $50 deductible and 15 percent of drug costs a $50 deductible and 15 percent of drug costs with no gap in coverage. After spending with no gap in coverage. After spending $3,600 out of pocket in a year, copays will be $3,600 out of pocket in a year, copays will be $2 for generics, $5 for brand names.$2 for generics, $5 for brand names.

2007 Medicare 2007 Medicare Changes: Changes: The Part B premium will be linked The Part B premium will be linked

to income for the first time, to income for the first time, starting in 2007. starting in 2007.

People with incomes over $80,000 People with incomes over $80,000 ($160,000 for couples) will pay ($160,000 for couples) will pay more on a sliding scale – up to an more on a sliding scale – up to an extra $70 per month.extra $70 per month.

Will impact 1-2 m recips (of 40+)Will impact 1-2 m recips (of 40+) Robert Pear, “Medicare Premiums to Rise,” NYT 2006Robert Pear, “Medicare Premiums to Rise,” NYT 2006

Drug Profits – Fortune Drug Profits – Fortune MagazineMagazine

MedicaidMedicaid

What is it?What is it? What kind of law is it?What kind of law is it? How is a person eligible?How is a person eligible? What is the benefit conferred?What is the benefit conferred? Who administers it?Who administers it? Who pays for it?Who pays for it? What is its constituency?What is its constituency? What is its history?What is its history? Who are collateral beneficiaries?Who are collateral beneficiaries? What size is it What size is it

MedicaidMedicaid

A federal-state program A federal-state program providing medical assistance to providing medical assistance to low-income persons who are low-income persons who are aged, blind, disabled, members aged, blind, disabled, members of families with dependent of families with dependent children, and certain other children, and certain other pregnant women and children.pregnant women and children.

Medicaid LawMedicaid Law

Joint Federal and State LawJoint Federal and State Law

Eligibility for MedicaidEligibility for Medicaid

FINANCIAL REQUIREMENTS:FINANCIAL REQUIREMENTS: First must be indigentFirst must be indigent Income andIncome and ResourcesResources

Eligibility Medicaid: Eligibility Medicaid: MandatoryMandatory

Families Aid to Families with Dependent Children (AFDC);Families Aid to Families with Dependent Children (AFDC);

Supplemental Security Income (SSI) recipients;Supplemental Security Income (SSI) recipients;

Infants born to Medicaid-eligible pregnant women;Infants born to Medicaid-eligible pregnant women;

Children under age 6 and pregnant women whose family income is Children under age 6 and pregnant women whose family income is at or below 133% of the Federal poverty level. States are required at or below 133% of the Federal poverty level. States are required to extend Medicaid eligibility until age 19 to all children born after to extend Medicaid eligibility until age 19 to all children born after September 30, 1983 in families with incomes at or below the September 30, 1983 in families with incomes at or below the Federal poverty level. Federal poverty level.

Recipients of adoption assistance and foster care under Social Recipients of adoption assistance and foster care under Social Security Act; Security Act;

Certain people with MedicareCertain people with Medicare

What benefit is What benefit is conferred? conferred?

MUST OFFER:MUST OFFER: inpatientinpatient

outpatientoutpatient nursing home carenursing home care

MAY OFFER:MAY OFFER: eyeglasseseyeglasses

prescription drugsprescription drugs

Administration of Administration of MedicaidMedicaid

FEDERAL: CMS AND HHSFEDERAL: CMS AND HHS

STATE:STATE:

Within federal guidelines:Within federal guidelines:

each state establishes:each state establishes:

eligibilityeligibility

scope of servicesscope of services

sets the payment ratessets the payment rates

Medicaid varies Medicaid varies considerably considerably among statesamong states

Who Pays for Who Pays for Medicaid?Medicaid?

Total of $329 billionTotal of $329 billion

Federal funds (out of general budget Federal funds (out of general budget funds) pays 57%funds) pays 57%

State funds (with sliding scale, State funds (with sliding scale, depending on poverty of state) pay 43% depending on poverty of state) pay 43%

Source: Pew Trust Source: Pew Trust

Medicaid Financial Medicaid Financial ProblemsProblems States pay on average 21% of States pay on average 21% of

total state budgets on Medicaidtotal state budgets on Medicaid

Costs of Medicaid expected to rise Costs of Medicaid expected to rise 7.7% per year over next decade7.7% per year over next decade

Source: Pew TrustSource: Pew Trust

Medicaid ConstituencyMedicaid Constituency

58 million people receive 58 million people receive Medicaid – Medicaid –

Some receive both Medicare and Some receive both Medicare and MedicaidMedicaid

Elderly and MedicaidElderly and Medicaid

Medicaid & Nursing Medicaid & Nursing HomesHomes

34% of Medicaid funds are spent 34% of Medicaid funds are spent on nursing home care 15-57on nursing home care 15-57

70% of Medicaid $ on people over 70% of Medicaid $ on people over 65 is spent on nursing home care65 is spent on nursing home care

Likelihood of Needing Likelihood of Needing Long Term Care – Gender Long Term Care – Gender and Length of Stayand Length of Stay

Long Term Nursing Care by AgeLong Term Nursing Care by Age

Likelihood of Nursing Likelihood of Nursing Home Home The U.S. General Accounting The U.S. General Accounting

Office reported in 2000 thatOffice reported in 2000 that nearly 40% of people age 65 nearly 40% of people age 65 now are likely to spend some now are likely to spend some time in a nursing hometime in a nursing home. About . About half of them will stay less than six half of them will stay less than six months, and 20% will spend five months, and 20% will spend five years there. years there.

Medicaid Financial Medicaid Financial Planning?Planning? Medicaid PlanningMedicaid Planning, or the act of shifting , or the act of shifting

assets out of a Medicaid recipient's name so assets out of a Medicaid recipient's name so they can qualify for Medicaid, is a problematic they can qualify for Medicaid, is a problematic legal issue. legal issue.

Under current Medicaid laws, there is a Under current Medicaid laws, there is a "3-year "3-year look-back window," look-back window," which essentially means which essentially means the government will scrutinize any transfer of the government will scrutinize any transfer of assets that were in the applicant's name for assets that were in the applicant's name for three years prior to the Medicaid application three years prior to the Medicaid application being filed. Assets that have been transferred being filed. Assets that have been transferred out the applicant's name within the 3-year look-out the applicant's name within the 3-year look-back window may delay when Medicaid actually back window may delay when Medicaid actually starts paying for the nursing home. starts paying for the nursing home.

How Poor to Qualify How Poor to Qualify for Medicaid?for Medicaid? The government will not pay for The government will not pay for

nursing home care for people who nursing home care for people who possess non-housing assets of possess non-housing assets of $2,000 or more. (Even a house is $2,000 or more. (Even a house is included if there is no one living included if there is no one living in it and the nursing home in it and the nursing home resident is not expected to go resident is not expected to go home.)home.)

Policy Issues?Policy Issues?Policy Decision

to Protect the Assets of Wealthy Seniors?but not the others?

Contrast Medicaid with estate taxes:The estate tax affects only

estates larger than $1 million over the next few years

($2 million for husband and wife). Only 2% of families will be expected to pay estate

taxes.

Policy IssuesPolicy Issues

Recall History of Law and Poverty, FAMILY Recall History of Law and Poverty, FAMILY RESPONSIBILITY: 3 generation responsibilityRESPONSIBILITY: 3 generation responsibility

Tension between:Tension between:Do not want hard working seniors to Do not want hard working seniors to

have to impoverish themselves in order to have to impoverish themselves in order to get nursing home careget nursing home care

versusversusWhy should I pay for YOUR Why should I pay for YOUR

grandparents nursing home care?grandparents nursing home care?

CHIPCHIP

CHIP:CHIP: Children’s Health Insurance ProgramChildren’s Health Insurance Program Structure much like MedicaidStructure much like Medicaid Federal / State PartnershipFederal / State Partnership States have significant leeway in States have significant leeway in

establishing benefit levelsestablishing benefit levels Matching Matching Benefit: Health Care Coverage for Kids Benefit: Health Care Coverage for Kids

under 18 in low-income familiesunder 18 in low-income families Low Income is Usually 200% of Poverty Low Income is Usually 200% of Poverty

LevelLevel Administration: Fed and StateAdministration: Fed and State Recipient Families can be charged Recipient Families can be charged modest modest

premiums, and deductiblespremiums, and deductibles How much cost? $40 billion over 10 yearsHow much cost? $40 billion over 10 years

Uninsured in USUninsured in US

46 Million People46 Million People

What About What About Uninsured?Uninsured?

Twenty-five percent of all working class Twenty-five percent of all working class families in LA have no health insurance families in LA have no health insurance coverage all year long, more than 500,000 coverage all year long, more than 500,000 people above the poverty line. people above the poverty line.

885,000 people under and over poverty line 885,000 people under and over poverty line do not have health insurance. do not have health insurance.

20% of all Louisiana children have no health 20% of all Louisiana children have no health insurance. insurance.

The number uninsured part of the year is 1.4 The number uninsured part of the year is 1.4 million (e.g. people between coverages or million (e.g. people between coverages or between jobs). Nationally 18% of all workers between jobs). Nationally 18% of all workers do not have health insurance. do not have health insurance.

Consequences of Lack of Consequences of Lack of Health Insurance (part Health Insurance (part one) one) ¨ Uninsured Americans get about half ¨ Uninsured Americans get about half

the medical care of those with health the medical care of those with health insurance. As a result, they tend to be insurance. As a result, they tend to be sicker and to die sooner.sicker and to die sooner.

¨ About 18,000 unnecessary deaths ¨ About 18,000 unnecessary deaths occur each year because of lack of occur each year because of lack of

health insurance.health insurance.

Consequences (cont)Consequences (cont)

¨ Only half of uninsured children visited a ¨ Only half of uninsured children visited a physician during 2001, compared with three-physician during 2001, compared with three-quarters of insured children. Lack of regular quarters of insured children. Lack of regular care can result in more expensive care for care can result in more expensive care for preventable or treatable conditions, and preventable or treatable conditions, and disruptions in learning and development.disruptions in learning and development.

¨ When even one family member is ¨ When even one family member is uninsured, the entire family is at risk for the uninsured, the entire family is at risk for the financial consequences of a catastrophic financial consequences of a catastrophic illness or injury.illness or injury.

Consequences (cont)Consequences (cont)

¨ Tax dollars paid for an estimated 85 ¨ Tax dollars paid for an estimated 85 percent of the roughly $35 billion in percent of the roughly $35 billion in un-reimbursed medical care for the un-reimbursed medical care for the uninsured in 2001.uninsured in 2001.

¨ The burden of uncompensated care ¨ The burden of uncompensated care has been a factor in the closure of has been a factor in the closure of some hospitals and the unavailability some hospitals and the unavailability of services in others. Disruptions in of services in others. Disruptions in service can affect all who are served service can affect all who are served by a facility, even those who have by a facility, even those who have health insurance.health insurance.

What Happens When What Happens When Some of the 46 Million Some of the 46 Million Uninsured Get Sick?Uninsured Get Sick?

Uninsured - ConclusionUninsured - Conclusion

¨ The United States loses the ¨ The United States loses the equivalent of $65 billion to $130 equivalent of $65 billion to $130 billion annually as a result of the poor billion annually as a result of the poor health and early deaths of uninsured health and early deaths of uninsured adults. adults.

Source: National Academy of Source: National Academy of SciencesSciences

What Happens When What Happens When Some of the 46 million Some of the 46 million Uninsured Get REALLY Uninsured Get REALLY Sick?Sick?

EMTALAEMTALA

Emergency Medical Emergency Medical Treatment and Active Treatment and Active Labor ActLabor Act

Anti-Dumping Law, 42 usc Anti-Dumping Law, 42 usc 1395dd1395dd

History of EMTALAHistory of EMTALA

History: Hill-Burton gave hospitals big $, in History: Hill-Burton gave hospitals big $, in return asked for uncompensated care; worked, return asked for uncompensated care; worked, didn't work? Had to get a bigger stick, EMTALA didn't work? Had to get a bigger stick, EMTALA is itis it

Hill-Burton was passed in 1946, authorizing Hill-Burton was passed in 1946, authorizing grants to construct hospitals. In return the grants to construct hospitals. In return the hospitals were to provide a certain amount of hospitals were to provide a certain amount of uncompensated indigent care to the uncompensated indigent care to the community. In 1974, it was found that hospitals community. In 1974, it was found that hospitals actual provision of care was minimal. New rules actual provision of care was minimal. New rules and regs were promulgated and hospitals were and regs were promulgated and hospitals were forced to notify patients in writing of their forced to notify patients in writing of their obligation to provide hill-burton careobligation to provide hill-burton care

Two Duties on Two Duties on HospitalsHospitals

1. 1. appropriate medical screening appropriate medical screening to determine whether patient has to determine whether patient has emergency medical conditionemergency medical condition

2. 2. hospital cannot transfer a hospital cannot transfer a patient with an emergency patient with an emergency medical condition until that medical condition until that condition has stabilizedcondition has stabilized

All Hospitals?All Hospitals?

duty on "duty on "participating participating hospitalshospitals" (42 usc 1395dd (e)" (42 usc 1395dd (e)(2))(2))

Take public funds $ andTake public funds $ and hospitals with emergency rooms hospitals with emergency rooms

to screen incoming emergency to screen incoming emergency patients (whether or not they patients (whether or not they have insurance) to determine:have insurance) to determine:

What Emergency What Emergency Conditions Must Hospital Conditions Must Hospital Treat?Treat?

Q: whether they have an Q: whether they have an emergency medical condition?emergency medical condition?

i. health in serious jeopardy ori. health in serious jeopardy or ii. is a woman in laborii. is a woman in labor

If Emergency ConditionIf Emergency Condition

If so, must stabilize If so, must stabilize priorprior to transfer to transfer or dischargeor discharge

transfer is allowed if doctor transfer is allowed if doctor certifies, in writing, that:certifies, in writing, that:– 1. the benefit to the patient outweighs 1. the benefit to the patient outweighs

the riskthe risk– 2. the receiving hospital has the 2. the receiving hospital has the

space, personnel, and agrees to space, personnel, and agrees to receivereceive

Remedies for EMTALA Remedies for EMTALA Violations?Violations?

if violated, civil penalties, atty fees, if violated, civil penalties, atty fees, personal injuries action, but most personal injuries action, but most importantlyimportantly

"if the violation is gross and flagrant "if the violation is gross and flagrant or is repeated, ...exclusion from or is repeated, ...exclusion from participation." 42 usc 1395dd (d) (1)participation." 42 usc 1395dd (d) (1)

Actual Logo of Personal Injury Firm of Actual Logo of Personal Injury Firm of

Friedman, Domiano and Smith, Cleveland, OhioFriedman, Domiano and Smith, Cleveland, Ohio

Who pays for the Who pays for the uninsured do for uninsured do for healthcare?healthcare? Who pays for the cost of Who pays for the cost of

uncompensated care?uncompensated care?

Public health care subsidies Public health care subsidies or or Private health insurance plansPrivate health insurance plans

National Academy National Academy of Sciences says:of Sciences says: ¨ Tax dollars paid for an ¨ Tax dollars paid for an

estimated 85 percent of the estimated 85 percent of the roughly $35 billion in un-roughly $35 billion in un-reimbursed medical care for the reimbursed medical care for the uninsured in 2001.uninsured in 2001.

We Do Have A National We Do Have A National Healthcare System:Healthcare System:

* Private insurance (premiums * Private insurance (premiums subject to market) – citizenssubject to market) – citizens

* Public insurance - Medicare & * Public insurance - Medicare & Medicaid & Chip – citizensMedicaid & Chip – citizens

* Uninsured & EMTALA* Uninsured & EMTALA - citizens- citizens

Public Policy Public Policy Considerations?Considerations? Is This The Best System?Is This The Best System? Is This The Least Expensive Is This The Least Expensive

System?System? Does This System Provide the Does This System Provide the

Best Healthcare?Best Healthcare? Are There Alternatives?Are There Alternatives?

US Healthcare SystemUS Healthcare System

To be To be continued….continued….