healthcare for everyone? like the rest of the civilized world rob stone md director, hoosiers for a...
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Healthcare for Everyone?
Like the rest of the civilized world
Rob Stone MDDirector, Hoosiers for a Commonsense Health Plan
Director, Palliative Care, IU Health Bloomington Assistant Clinical Professor of Medicine, IUSM
DISCLOSURES
Dr. Rob Stone has no relevant financial relationships with commercial interests.
Slides can be downloaded at: HCHP.info/Presentations
Countries with Universal Healthcare
What Are We Paying For?
An incredibly complex system Thousands of plans Armies of people to:
-deny coverage and payments- collect payments- determine eligibility
What Do We Get For Our Money?
The most expensive health care in the world
The best health care in the world?
WHO Global Health Rankings
☤ At the top: France is #1
☤ US ranks 37th, between Costa Rica and Slovenia
Tobacco Smokers
OECD, 2004 (2002 Data, U.K is 2001)
Why spend so much AND get so little?
Reason # 1: Our profit-driven insurance system
AND As long as millions are
left out, everyone will suffer
US Census Dept, “Income, Poverty, and Health Insurance Coverage” Sept 2012 Himmelstein et al, American Journalof Medicine, August 2009
Health Insecurity Indiana
• 800,000 to 900,000 Hoosiers uninsured
• Hoosier bankruptcy filings because of medical bills:
> 27,000 annually
Is the ACA Going in the Right Direction?
Affordable Care Act
• Original projection: 30-35 million newly covered
• Half thru Health Insurance Exchanges (Mandate)
• Half thru Medicaid expansion• Supreme Court Decision Summer 2012
Two Very Different Public Programs
MedicarePre-paid health
insuranceWho• Age >65, dialysis,
disability
How• 100% federally funded,
the same in every state
Medicaid The only safety net
Who• Low-income people with
additional eligibility criteria
How• 60% federal, 40% state
funded
Medicaid 101
• Established in 1965 with Medicare • Administered by states within broad federal
parameters
What
• 73% Caucasian, 19% African American, 5% Hispanic
• Largest numbers covered – children • Largest expense – care of frail elderly, esp in
nursing homes
Who
Indiana Medicaid 2014400%
($95,400)
300% ($71,550)
200% ($47,700)
100% ($23,850)
FPL 0 Children Pregna
ntParents Childless Adults
19%
200%250%
Y-axis is % of Federal Poverty Level; Example of a family of four
Premium
NoPremium HIP
ACA as Planned
Sliding scale premium subsidies:
100% - 400% of poverty level
Medicaid in all states: up to 138% of poverty
100-138% poverty: patient’s choice
Y-axis is % of Federal Poverty Level; Example of a family of four
400% ($95,400)
300% ($71,550)
200% ($47,700)
100% ($23,850)
0
Medicaid Expansion Would Help People We All Rely On
Hoosier Medicaid Expansion
• Estimated 350 – 450 thousand lives covered, ~ half the uninsured
• Largest increase in coverage in >50 years
• $11.50 a day versus $30,000 a year eligibility
Medicaid Expansion – Good for All of Us
• Traditional Medicaid 60/40 Federal/State• ACA Medicaid 100% tapering to 90%
Federal• Cost to Indiana taxpayers: $50-150 million• Federal subsidy: $1.7 billion a year
A Deal Too Good to Refuse
• HIP cigarette taxes - $121 million• High risk pool - $48 million• Savings from prisons and jails
“I’m just here for the dental.”
A Deal Too Good to Refuse
• HIP cigarette taxes - $121 million• High risk pool - $48 million• Savings from prisons and jails• Hospitals avoid $345 M/year unpaid care• 30,000 new jobs• >$100 million new tax revenues
Indiana Hospital Association Report 2/11/13
Indiana Is Being TaxedFor a Program We’re Turning Down
Federal responsibility for cost of expansion population
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
0%
25%
50%
75%
100%
Our federal tax dollars arepaying for Medicaid but IN is
not getting the benefits
Losing $5 Million a Day
Michigan Chamber Applauds Passage of Medicaid Reform Legislation
“Make no mistake, the Michigan Chamber remains strongly opposed to Obamacare,” said Jim Holcomb, Senior Vice President for the Michigan Chamber. “However, our Board of Directors believes Medicaid reform makes sense for our state and the business community.”
June 13, 2013
Governor Pence has
called Medicaid a
“broken program”
Is Medicaid worse than no insurance at all?
Oregon: Expand Medicaid, Increase ER Usage by 40%
Taubman, S. Science Magazine. Jan 2, 2014.
No Medicaid Medicaid0
1
2
3
4
5
0.68 0.95
Annual emergency
room visits per person
A 40% relative increase means
one extra visit per person
every four years
Medicaid Expansion Is About
Life and Death In Indiana
Annual data for Indiana from Dickman S, Himmelstein D, McCormick D, and Woolhandler S. Opting out of Medicaid Expansion: The Health and Financial Impacts. Health Affairs Blog. January 30, 2014
Better women’s health• 5,893 more mammograms• 14,246 more Pap smears
Better treatment of chronic diseases• 14,225 more diabetics receiving
medications• 23,971 less adults with depressionFewer preventable deaths• Between 240 and 758 preventable deaths
avoided• Consistent with the “Culture of Life”
International Timeline of Universal HealthcareGermany 1883
Switzerland 1911New Zealand 1938France 1945United Kingdom 1946Sweden 1947USA 1947*Japan 1961Canada 1966Australia 1974Italy 1978Spain 1986Taiwan 1995
*President Truman proposed but failed to pass National Health Insurance
Why Health Care for All -
Young and Old, Rich and Poor?
What Can We Do?
✔Educate Ourselves✔Find Our Voices✔Join In
PNHP.org
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