the truth about health reform: what it means to us ellen r. shaffer phd mph joe brenner ma equal...
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October, 2010October, 2010 EQUAL Health NetworkEQUAL Health Network 11
The Truth About Health Reform:What It Means To Us
Ellen R. Shaffer PhD MPHJoe Brenner MA
EQUAL Health Networkwww.equalhealth.info
415-922-6204 [email protected]
October, 2010
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EQUAL
EEquitable, quitable, QQuality, uality, UUniversal, niversal, AAffordabffordablle health caree health care
Center for Policy Analysis, anchor Center for Policy Analysis, anchor Network for progressive policy and advocacyNetwork for progressive policy and advocacy– Links: Labor, Public health, women, seniors, faith Links: Labor, Public health, women, seniors, faith
groupsgroups– Policy-makersPolicy-makers
ForumsForumsPolicy StatementsPolicy Statements
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EQUAL’s Program:Making Health Reform Work
EducateEducate
ImplementImplement
ImproveImprove
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How We Got Here:The Problems
The Affordable Care Act:What It Does
Making it Work
Building for the Future
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How We Got Here:Historic Achievement
Congress has passed the most substantial Congress has passed the most substantial health reform since Medicare and Medicaid in health reform since Medicare and Medicaid in 19651965
Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act (ACA)(ACA)
The new law takes important steps to expand The new law takes important steps to expand coverage and improve quality, and begins to coverage and improve quality, and begins to control costscontrol costs
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The Problems
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People Are Suffering
50 million in U.S. uninsured
6.7 million uninsured in California
44,000 deaths each year due to lack of health
insurance– 1 person died every 12 minutes
60% of U.S. bankruptcies due to health costs– 75% of medical bankruptcies happen to people with
health insurance
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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 Care69.0%
54.9%
Over 15 percentage point decline
Source: Economic Policy Institute, State of Working America, 2006/2007
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Insurance, Access, Costs – Costs Increase, Coverage Decreases
Private for-profit insurance companies Private for-profit insurance companies face incentives to avoid spending face incentives to avoid spending premiumspremiums– Identify and avoid “risky” patientsIdentify and avoid “risky” patients– Exclude pre-existing conditionsExclude pre-existing conditions
Insurance companies run up Insurance companies run up administrative costs to avoid “expensive” administrative costs to avoid “expensive” enrollees (sick people)enrollees (sick people)
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ACA: The Gains Expanded Coverage and Access
Improving Quality
Consumer Protections
ALL = Lower CostsHow Will We Benefit?How Will We Benefit?
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ACA Benefits Phased In 2010-2020
2010-20132010-2013– Consumer protectionsConsumer protections– 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, Employer contributionsIndividual Mandate, Employer contributions
– Medicaid ExpandedMedicaid ExpandedEveryone up to 133% of poverty levelEveryone up to 133% of poverty level
2020: Medicare drug price “doughnut hole” gone 2020: Medicare drug price “doughnut hole” gone
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Immediate Improvementsin 2010
Coverage:Coverage:– New High Risk PoolNew High Risk Pool– Covers Young Adults through Age 26 on Covers Young Adults through Age 26 on
parentsparents’’ coverage coverageQualityQuality– First dollar coverage of preventive careFirst dollar coverage of preventive care– Increased funding for Community ClinicsIncreased funding for Community ClinicsStops Insurance Abuses:Stops Insurance Abuses:– Discrimination against children with pre-Discrimination against children with pre-
existing conditions prohibitedexisting conditions prohibited– Rescissions Illegal (withdrawal of care)Rescissions Illegal (withdrawal of care)– Bans lifetime limits on coverage Bans lifetime limits on coverage
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Immediate Improvements
(cont.)
Affordability:Affordability:– Small business tax credits of up to 35%Small business tax credits of up to 35%– Rebates begin to close the Medicare Part D Rebates begin to close the Medicare Part D
Doughnut HoleDoughnut Hole– Reduces cost of early retiree coverageReduces cost of early retiree coverage
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Insurance Exchanges: WhoState-based Exchanges begin in 2014
Uninsured individuals, self-employed and small businesses can buy coverage
NOT FOR MEDICARE!!
Workers can opt-out of employer-based coverage and seek a voucher if cost is between 8% and 9.8% of income
Safety net for insured who lose a job
Est. 2.4 million eligible in CA
Applies to Members of Congress
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Cost Control: Regulating Premiums
Expanding Public Health Protecting Medicare
Improving Quality
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What Happens to Medicare?
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3 Facts – The New Law Will:
1. Improve many Medicare benefits Quality Improvement Programs set models
for health care system NO CUTS in basic Medicare benefits
2. Extend Medicare’s solvency by 12 years to 2029.
3. Help people obtain long-term care at home.
NCOA
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The A-B-C-D’s of Medicare
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Medicare Part A Trust Fund
Pre-health reform: 2017 projected insolvency date
Assets as a share of annual spending:
Post-health reform: 2029 projected insolvency date
Projection: Health reform legislation will extend the life of the Medicare Part A Trust Fund from 2017 to 2029
Exhibit 14
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Part D Donut Hole
In 2007, over 8 million seniors hit the “doughnut hole”
Costs discourage drug use by about 14% –threat to managing chronic diseases like diabetes, high blood pressure
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Other Improvements forSeniors
New protections against elder abuse, neglect, financial exploitationBetter training for workers caring for seniorsNursing home quality improvementsHelp to keep premiums down for early retireesBonuses for primary care doctors (other doctor payment issues not addressed)
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How Will It Be Paid For?
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ACA: The Gains Expanded Coverage and Access
Improving Quality
Consumer Protections = Lower Costs
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Making It Work:Implementing the Law
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California ReformsCreate a Transparent Insurance Market
Create an Insurance Exchange:Create an Insurance Exchange: transparent, transparent, consumer-friendly, easy-to-use, fairly governed, consumer-friendly, easy-to-use, fairly governed, negotiates to provide the best value to negotiates to provide the best value to consumers:consumers: – AB 1602 (Bass) & AB 1602 (Bass) & SB 900 (Alquist)SB 900 (Alquist)
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Building for the Future
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Building for the Future
Reproductive Health – Retreat from Reproductive Health – Retreat from current lawcurrent law
Immigrants’ inclusion: Allow to purchase Immigrants’ inclusion: Allow to purchase thru Exchangethru Exchange
AffordabilityAffordability
State options for innovative approaches State options for innovative approaches – Single payerSingle payer
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Single Payer: What it Is and Why It Is Still on the Table
A government-sponsored system like MedicareA government-sponsored system like Medicare
Everyone automatically covered, most cost Everyone automatically covered, most cost efficient, contributes to social & economic equity, efficient, contributes to social & economic equity, good outcomes…good outcomes…
Gives government the authority to constrain Gives government the authority to constrain health care spendinghealth care spending
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What To Do Now
Get the facts about the lawGet the facts about the law
Spread the work: tell Union Spread the work: tell Union members, friends and familymembers, friends and family
Make It WorkMake It Work
Build for the futureBuild for the future
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Work with EQUAL
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.centerforpolicyanalysis.orgwww.centerforpolicyanalysis.org
Thanks for contributions to this presentation to: Keely Thanks for contributions to this presentation to: Keely Monroe, Lisa Kernan Social Justice Fellow; EQUAL partners Monroe, Lisa Kernan Social Justice Fellow; EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason; and Jacob HackerAdelson, Lee Lawrence, Robert Mason; and Jacob Hacker
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Thank YouFor Making History!