gail r. wilensky project hope november 14, 2002 what the elections will mean for health care
TRANSCRIPT
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Gail R. Wilensky
Project HOPENovember 14, 2002
What The Elections Will Mean For Health Care
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When The Election Was Over --
Most pundits were surprised
White House -- Republican
House -- Republican
Senate -- Republican
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What Happened?
Voter intensity is hard to measure
and
Republicans had the better turnout
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-- It’s Not Clear Yet --
“51 Votes is Nice But Not a Lock”
What Will This Mean ForHealthcare
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Lots of Turmoil in Health Care…
MedicareManaged Care
Employer-Sponsored
InsuranceMedicaid
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Growing Sense of Frustration
Spending is High and Growing
Value is Uncertain
Patient Safety & Quality Are Problems
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Hot Issues for Congress and the Administration
Medicare Reform and Prescription Drugs
“Other” Rx Issues
Medicaid
Medical Liability
Uninsured
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Medicare Spending Is Again On The Increase
(Growth Rates)
‘97 - ‘98 1.5%‘98 - ‘99 -0.5%‘99 - ‘00 3.3%‘00 - ‘01 10.2% (8.7% adj)
Projected ’02 – ’12 6.9% (annual)
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Spending Isn’t Medicare’s Only Problem
1960s Coverage
Cumbersome Program
Long-Term Financing Problem
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Most Agree -- Seniors Should Have Rx Coverage
Lots of Proposals different structures, different costs
Lots of debate over How Much to change or reform Medicare
BUT
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Republican Position --
Medicare Needs to be Reformed
and
Rx Coverage is Part of The Reform
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Likely Starting Point for Rx Discussion
“Tripartisan Bill” ($370 b over 10 years)
-- Subsidies Paid to Private Insurers
-- Premium $24 month; deductible $250 ann.
-- 50% coinsurance to $3,450; 10% thereafter
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Implications for Medicare
Specifics of design are important
Costs of new benefits always underestimated
Long-term fiscal pressures remain serious
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What’s Likely to Happen?
“Too Soon to Tell”
Lots of Interest, but --
Any Rx proposal will be a tough sell
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Major Medicare Reform???
Won’t be driven by the HI Trust Fund Current projections suggest solvency til 2029
Linkage w/Rx coverage could drive reform
If not linked, major Medicare reform will be
A Long Way Off!!!
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Other Rx Issues --
Access to Generics
Patent Protection
Drug Reimportation
Medicaid Actions
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Medicaid Spending Is Also Increasing
Medicaid Spending 11% in FY 2001
-- Fifth year of spending growth acceleration -- 9% growth per year expected over next decade
Rx Spending is Especially Big
19% in 200122% in 200018% in 1999
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States Are Responding To Fiscal Squeeze
For FY 2003 ---
40 States to limit Rx spending thru cost controls
29 States to or freeze provider payments
15 States to Medicaid benefits
18 States to Medicaid eligibility
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Most Common Medicaid RxChanges for FY 2003
AWP Less Greater Discount More Rx Under Prior Authorization Preferred Drug List New / Higher CoPays Supplemental Rebates
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Medical Liability and Tort Reform
Historic Republican Issue
-- 108th Congress is best chance for passage
-- House Bill is a likely starting point
Pain & suffering capped at $250,000 Punitive damages limited to $250,000 or 2x economic damages
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As For The Uninsured --
-- Expect continued push for tax credits-- Long standing philosophical battle, between
Dems and Republicans
But –
Trade bill showed compromises can occur
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2003 is the best year for action
Still a closely divided Congress
Deficit will make all spending bills a little tougher
Bottom Line