health care reform sherry glied [email protected]

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Health Care Reform Sherry Glied [email protected]

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Page 1: Health Care Reform Sherry Glied sag1@columbia.edu

Health Care Reform

Sherry [email protected]

Page 2: Health Care Reform Sherry Glied sag1@columbia.edu

Health Reform was Not Inevitable(1) Some people have said that it would be a miracle if we passed

health care reform. But I believe we live in a time of great change when miracles do happen.

(2) The cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year

(3) I believe that comprehensive health insurance is an idea whose time has come. I believe that some kind of program will be enacted this year.

(4) Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.

Page 3: Health Care Reform Sherry Glied sag1@columbia.edu

Public Opinion1993 • 20% of voters ranked health care as the most important issue

in the 1992 presidential election1

2008• 9% indicated health care was the most important issue in the

2008 campaign

1 Kaiser Family Foundation Election Spotlight. Data collected from 1992 Presidential Election Exit Polls2 CNN Exit Polls, November 4, 2008

Page 4: Health Care Reform Sherry Glied sag1@columbia.edu

1993• GDP

– 2.9% Change from 1992• Budget Deficit as % of GDP

– 3.9% (1993)• Public Debt as a percentage of GDP

– 66.2% (1993)• Unemployment rate

– 6.9% (1993)

2009• GDP :

– -3.5% Change from 2008• Budget Deficit as % of GDP:

– 10.1% (2009)• Public Debt as a percentage of GDP

– 85.2% (2009)• Unemployment

– 9.3% (2009)

Economic Landscape

Page 5: Health Care Reform Sherry Glied sag1@columbia.edu

Political Landscape1992

• Clinton 370, Bush 168• House: 258 (D), 176 (R)• Senate: 57 (D), 43 (R)

• Obama 349, McCain 173• House: 256 (D), 178 (R)• Senate: 55(D), 42(R), 2(I)April 27: Arlen Specter (R)→(D)

June 20: Al Franken (D)

2008

Page 6: Health Care Reform Sherry Glied sag1@columbia.edu

1. Reform of Insurer Practice• Rate Review – review of increases>10%• Transparency/appeals• Lifetime limits• Medical Loss Ratio • Annual limits• Pre-existing conditions• Underwriting and rating limits• Risk adjustment

Page 7: Health Care Reform Sherry Glied sag1@columbia.edu

Annual Limits

• Minimum limits– 2010 – $750,000– 2011 – $1.25 million– 2012 – $2 million– 2014 – not permitted

Page 8: Health Care Reform Sherry Glied sag1@columbia.edu

Limited Benefit Plan

• McDonald’s– $56 per month – up to $2,000 benefits/year

• Ruby Tuesday– $18.43 per week - $1,250 outpatient; $3000

inpatient• Denny’s– No inpatient, up to $300 doctor visits

Waivers3 million people in 1,372 mini-med plans

Page 9: Health Care Reform Sherry Glied sag1@columbia.edu

2. Improvements in Coverage

• Preventive services in Medicare• Part D donut hole in Medicare• Preventive services with no copay• Essential Health Benefits• Standardized cost-sharing– Actuarial value

Page 10: Health Care Reform Sherry Glied sag1@columbia.edu

Preventive Services with No Copay

• USPSTF A and B• November 2009 – Mammography• Mikulski amendment • IOM Committee• Contraceptive coverage

Page 11: Health Care Reform Sherry Glied sag1@columbia.edu

3. Expansions of Coverage

• Young adults• Tax credits to 400% FPL• Health Insurance Exchanges– 20-22 million (including much current non-group)

• Medicaid expansion to 133% FPL – 16-17 million

• Requirements to offer and obtain coverage- Individual mandate- Employer requirements

Page 12: Health Care Reform Sherry Glied sag1@columbia.edu

2014 Expansions

Page 13: Health Care Reform Sherry Glied sag1@columbia.edu

Newly enrolled 1965 Expansions (1968-1972)

Newly enrolled 2016 ACA Newly insured 1965 Expansions (1968-1972)

Newly insured 2016 ACA0

5

10

15

20

25

30

35

40

0%

2%

4%

6%

8%

10%

12%

14%

Number Newly Enrolled/Insured

Medicare B Medicaid <65 % of Population

Page 14: Health Care Reform Sherry Glied sag1@columbia.edu

1965 Expansion 2016 ACA-0.6

-0.5

-0.4

-0.3

-0.2

-0.1

0

Effect of Expansions on the Uninsurance Rate

Medicare B Medicaid <65

Page 15: Health Care Reform Sherry Glied sag1@columbia.edu

4. Prevention and Public Health Fund

• Community transformation grants• Tobacco prevention• Clinical prevention• Workforce training• Data systems

Page 16: Health Care Reform Sherry Glied sag1@columbia.edu

5. Delivery System Reforms

• Accountable Care Organizations• Innovation Center– Bundled Payments– Duals– Challenges– Pioneers

Page 17: Health Care Reform Sherry Glied sag1@columbia.edu

CMS Innovation Center“The purpose of the Center is to test innovative payment and

service delivery models to reduce program expenditures under Medicare, Medicaid and CHIP…while preserving or enhancing the quality of care furnished…” – “Preference to models that improve coordination, quality and

efficiency of health care services.”

• Resources - $10 Billion in funding for FY2011 through 2019.

• Opportunity to “scale up”: HHS Secretary has authority to expand successful models to the national level.

Page 18: Health Care Reform Sherry Glied sag1@columbia.edu

6. Cost Containment

• Reductions in payments to Medicare Advantage plans - $156 billion

• Change in Medicare non-MD payment update formula - $415 billion

• IPAB - $3 billion• Excise tax on high cost plans – beginning 2018

- $111 billion

Page 19: Health Care Reform Sherry Glied sag1@columbia.edu

Cost Containment in the ACA

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 20213.0%

3.2%

3.4%

3.6%

3.8%

4.0%

4.2%

4.4%

4.6%

4.8%

5.0%

Medicare Share of GDP - ACA Effect (adjusted for doc fix)

Share of GDP - no ACAShare of GDP - ACA

Shar

e of

GDP

Page 20: Health Care Reform Sherry Glied sag1@columbia.edu

20092010

20112012

20132014

20152016

20172018

20192020

202116.5%

17.0%

17.5%

18.0%

18.5%

19.0%

19.5%

20.0%

Projected Effect of the ACA on NHE (GDP Share)

No ACAACA

% G

DP

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