the truth about health reform: what it means to us

September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network 11, ,

The Truth About Health The Truth About Health Reform:Reform:

What It Means To UsWhat It Means To UsEllen R. Shaffer PhD MPHEllen R. Shaffer PhD MPH

Joe Brenner MAJoe Brenner MAEQUAL Health NetworkEQUAL Health Network

Center for Policy AnalysisCenter for Policy Analysis

www.equalhealth.infowww.equalhealth.info415-922-6204 415-922-6204 [email protected]@gmail.com

mailto:[email protected]

September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network 22, , EQUAL Health NetworkEQUAL Health Network 22

The Truth About Health ReformThe Truth About Health ReformWhat It Means ToWhat It Means To

Women Seniors Women Seniors

September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network 3333

EQUAL Health Network EQUAL Health Network EEquitable, quitable, QQuality, uality, UUniversal, niversal, AAffordable ffordable

health carehealth care

Network for progressive policy and advocacyNetwork for progressive policy and advocacy– Links: Public health, women, seniors, faith Links: Public health, women, seniors, faith

groupsgroups– Policy-makersPolicy-makersCenter for Policy Analysis, anchorCenter for Policy Analysis, anchor


EQUAL’s Program:EQUAL’s Program:Making Health Reform WorkMaking Health Reform Work

EducateEducateHandout and website: summary of the lawHandout and website: summary of the law

ImplementImplement

Comment on regulationsComment on regulations

ImproveImproveNext steps toward EQUAL health careNext steps toward EQUAL health care


ACA: Historic Achievement ACA: Historic Achievement

Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act

Most substantial health reform since Most substantial health reform since Medicare and Medicaid in 1965Medicare and Medicaid in 1965

Expands coverage Expands coverage

Improves qualityImproves quality

Begins to control costsBegins to control costs

Complex, Complex, somesome misunderstandings misunderstandings


I. How We Got Here: The ProblemsI. How We Got Here: The Problems

II.II. Major ImprovementsMajor Improvements

III. Making it WorkIII. Making it Work

IV. Fixing the FutureIV. Fixing the Future


Does Everyone Deserve Health Does Everyone Deserve Health Care? Will it Hurt Me?Care? Will it Hurt Me?

I’ve worked hard, I’ve gotten what I’m I’ve worked hard, I’ve gotten what I’m supposed to get. I have what I need and if supposed to get. I have what I need and if the other people don’t, then that’s their the other people don’t, then that’s their problem. problem.

So your average person has fairly good So your average person has fairly good access. They’re happy with their physician access. They’re happy with their physician and they’re frightened that something’s and they’re frightened that something’s going to happen to that.going to happen to that.

Anna Deveare SmithAnna Deveare Smith


We’re All In This TogetherWe’re All In This Together

I am approaching retirement and worried I am approaching retirement and worried that I won't be able to afford drugs when that I won't be able to afford drugs when I'm ill. I'm ill. My daughter graduated from college My daughter graduated from college recently and is concerned about keeping a recently and is concerned about keeping a job. job. The costs of health insurance encourage The costs of health insurance encourage layoffs. We need to encourage job layoffs. We need to encourage job creation! creation!


A Doctor’s ViewA Doctor’s View

I believe it is essential to bring quality I believe it is essential to bring quality health care to this country. health care to this country.

How many people must get sick and die How many people must get sick and die before we adopt a before we adopt a reasonable working reasonable working affordableaffordable health care system not health care system not determined by the drug industry and determined by the drug industry and insurance companies? insurance companies?


Crisis in Costs, Access, QualityCrisis in Costs, Access, Quality

$2.5 trillion a year$2.5 trillion a year

Health care inflation growing faster than Health care inflation growing faster than economyeconomy

50 million uninsured50 million uninsured

Outcomes in U.S. worse than countries Outcomes in U.S. worse than countries with universal coveragewith universal coverage

U.S. companies and workers: constraint U.S. companies and workers: constraint on competitivenesson competitiveness


Employment-Based InsuranceEmployment-Based Insurance

Most people under age 65 get insurance through Most people under age 65 get insurance through work – but employers don’t have to provide itwork – but employers don’t have to provide it

Large employers: 96% offerLarge employers: 96% offer

Small employers: 43% offerSmall employers: 43% offer– (fewer than 50 employees)(fewer than 50 employees)


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 Decline in Employer CoverageThe Decline in Employer Coverage69.0%

54.9%

Over 15 percentage point decline

Source: Economic Policy Institute, State of Working America, 2006/2007


Women At RiskWomen At Risk

Lower incomeLower income

Less likely to get insurance through workLess likely to get insurance through work– More likely to be covered as dependentsMore likely to be covered as dependents

Caretakers for familiesCaretakers for families– Longer livesLonger lives

Gender discriminationGender discrimination

– Can charge higher rates for insuranceCan charge higher rates for insurance

– Reproductive health careReproductive health care


Medicare At RiskMedicare At Risk

Popular federal government program Popular federal government program covers entire population over age 65covers entire population over age 65

Due to go bankrupt in 2017Due to go bankrupt in 2017

More efficient than private sector health plansMore efficient than private sector health plans

But still affected by the problems of the overall But still affected by the problems of the overall health care systemhealth care system


Adjusted odds of mortality by race and insurance status


The Political Challenge:The Political Challenge:Controlling Costs = Reducing IncomeControlling Costs = Reducing Income

Effective cost control would improve Effective cost control would improve access and qualityaccess and quality

But it involves reducing payments to the But it involves reducing payments to the health care industryhealth care industry

Provokes political oppositionProvokes political opposition


$2.5 Trillion: $2.5 Trillion: SpendingSpending or or IncomeIncome??Industry Opposes Income ConstraintsIndustry Opposes Income Constraints

SpendingSpending IncomeIncome

IndividualsIndividuals Insurance IndustryInsurance Industry

EmployersEmployers Pharmaceutical Co.sPharmaceutical Co.s

GovernmentsGovernments Hospitals, PhysiciansHospitals, Physicians


What Do You Think?What Do You Think?

Great law – about time!Great law – about time!

Pretty good, wish it were single payerPretty good, wish it were single payer

All depends how it gets implemented…All depends how it gets implemented…


We Are All AmbassadorsWe Are All Ambassadors

If you’re here today, you stand to benefitIf you’re here today, you stand to benefit

Whether insured or not, employed or notWhether insured or not, employed or not

What you do – or don’t do – will make a What you do – or don’t do – will make a differencedifference


II.II. Major Improvements Major Improvements


Immediate Benefits +Immediate Benefits +Phased-In BenefitsPhased-In Benefits

Expanded CoverageExpanded Coverage

Better AffordabilityBetter Affordability

Curbing Insurance AbusesCurbing Insurance Abuses

Down payments on Cost Control: Down payments on Cost Control: – Quality Improvements, Primary care, Public Quality Improvements, Primary care, Public

Health and Prevention, Rate RegulationsHealth and Prevention, Rate Regulations

Protecting MedicareProtecting Medicare


TimelineTimeline: : ACA Benefits Phased In ACA Benefits Phased In

2010-20132010-2013– Consumer protections from insurance co. practicesConsumer protections from insurance co. practices– 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 Individual Mandate

– Subsidies to 400% of poverty ($88,000/yr family of 4)Subsidies to 400% of poverty ($88,000/yr family of 4)Employers contribute to Exchange if employees use Employers contribute to Exchange if employees use subsidysubsidy

– Medicaid ExpandedMedicaid ExpandedEveryone up to 133% of poverty levelEveryone up to 133% of poverty level

2020: “Donut hole” in Medicare drug coverage gone 2020: “Donut hole” in Medicare drug coverage gone


Immediate ImprovementsImmediate Improvementsin 2010in 2010

Coverage:Coverage:– New High Risk Pool for uninsuredNew High Risk Pool for uninsured– Coverage for Young Adults through Age 26 Coverage for Young Adults through Age 26

on parents’ planson parents’ plans

Affordability:Affordability:– Small business tax credits of up to 35%Small business tax credits of up to 35%– Rebates begin to close gaps in Medicare Rebates begin to close gaps in Medicare

coverage for drug costs – the “donut hole”coverage for drug costs – the “donut hole”– Reduces cost of early retiree coverageReduces cost of early retiree coverage


Immediate ImprovementsImmediate Improvements

Stops 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

Down payments on Cost Control: Down payments on Cost Control: – Quality Improvements, Primary care Quality Improvements, Primary care – Public Health and PreventionPublic Health and Prevention– Rate RegulationsRate Regulations


Insured Through Work?Insured Through Work?New Protections Benefit YouNew Protections Benefit You

Bankruptcy protection:Bankruptcy protection:Limits on out-of-pocket spendingLimits on out-of-pocket spending

Insurance abuse protection:Insurance abuse protection:No recissions: cannot withdraw coverage No recissions: cannot withdraw coverage

Workplace abuse protection:Workplace abuse protection:You don’t have to keep your job to keep your You don’t have to keep your job to keep your

health insurancehealth insurance


MedicareMedicare

Insolvency delayed almost 2 decadesInsolvency delayed almost 2 decades

Changes to Medicare AdvantageChanges to Medicare Advantage

Promising trials on quality improvementPromising trials on quality improvement


CoverageCoverage


CoverageCoverage

Currently 50 million uninsured

ACA Expands coverage to 32 million people currently without insurance


Coverage: MedicaidCoverage: Medicaid

Will cover everyone up to 133% of Will cover everyone up to 133% of poverty poverty

16 million would be newly covered16 million would be newly covered

Begins 2014Begins 2014

Maintenance of Effort til ThenMaintenance of Effort til Then

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Health Insurance Exchanges: WhoHealth Insurance Exchanges: Who

Offer guaranteed coverage to: Uninsured individuals Self-employed Small businesses Members of Congress and staff

Safety net if insured & lose a job.

NOT FOR MEDICARE BENEFICIARIES!


Parity for Mental HealthParity for Mental Health

Based on Wellstone-Domenici Act of 2008Based on Wellstone-Domenici Act of 2008– Mental illness covered at parity with physical Mental illness covered at parity with physical

illnessesillnessesJanuary 1, 2010- Employers with 50 or more January 1, 2010- Employers with 50 or more employeesemployees

– CaliforniaCaliforniaAB 1600 to cover employers with fewer than 50 AB 1600 to cover employers with fewer than 50 employees employees


AffordabilityAffordability


Affordability: Affordability: Insurance Exchange PlansInsurance Exchange Plans

Subsidies for insurance premiums for Subsidies for insurance premiums for incomes up to 400% of federal poverty incomes up to 400% of federal poverty limitlimit– $88,000 for family of 4$88,000 for family of 4Limits on out-of-pocket costs ($5,950 for Limits on out-of-pocket costs ($5,950 for individuals and $11,900 for families in ) to individuals and $11,900 for families in ) to prevent medical bankruptciesprevent medical bankruptcies


Premiums on the ExchangePremiums on the Exchange

Premium contributions limited based on income as Premium contributions limited based on income as a percent of Federal Poverty Level (FPL):a percent of Federal Poverty Level (FPL):

150% FPL ($16,245/yr): $ 68/month150% FPL ($16,245/yr): $ 68/month

200% FPL ($21,660/yr): $113200% FPL ($21,660/yr): $113

250% FPL ($27,075/yr): $191250% FPL ($27,075/yr): $191

300% FPL ($32,490/yr): $ 257300% FPL ($32,490/yr): $ 257

Hardship exemption: Available if lowest cost plan Hardship exemption: Available if lowest cost plan exceeds 8% of an individual’s incomeexceeds 8% of an individual’s income


Affordability: IndividualsAffordability: Individuals

Still a big concernStill a big concern– Can still be too expensive for someCan still be too expensive for some


New: Insurance Exchange New: Insurance Exchange

Example: 4-person family at 180% FPLExample: 4-person family at 180% FPL ($40,000)($40,000)

PremiumsPremiums $2178$2178

% Income% Income 5.4%5.4%

OOP CapOOP Cap $3867$3867

Max OOPMax OOP $6045$6045


New: Insurance Exchange New: Insurance Exchange

Example: 2-person family at 550% FPLExample: 2-person family at 550% FPL ($80,000)($80,000)No SubsidyNo Subsidy

PremiumsPremiums $ 9,316$ 9,316

% Income% Income NANA

OOP CapOOP Cap $11,600$11,600

Max OOPMax OOP $20,916$20,916


Early Retiree Reinsurance ProgramEarly Retiree Reinsurance Program

Reimburses plan sponsors for certain Reimburses plan sponsors for certain claims between $15,000 and $90,000 for claims between $15,000 and $90,000 for retirees age 55-64. retirees age 55-64.

http://healthreform.gov/affordablecareact.html


Insurance Reform: Insurance Reform: Limits on Limits on Insurance PremiumsInsurance Premiums

Cannot charge more if: You are sickYou are female (Gender-rating)You are female (Gender-rating)

Age-rating limited, 3:1Age-rating limited, 3:1

No more annual or lifetime limits

Administrative costs limitedAdministrative costs limitedNo underwritingNo underwriting

Easier to compare plansEasier to compare plans

September, 2010September, 2010 EQUAL Health NetworkEQUAL Health Network 4141, , EQUAL Health NetworkEQUAL Health Network

Cost Control: Cost Control: Regulating PremiumsRegulating Premiums

Expanding Public Health Expanding Public Health Protecting MedicareProtecting Medicare

Improving QualityImproving Quality


Regulating PremiumsRegulating Premiums

80-85% of premium 80-85% of premium must be spent on health must be spent on health care (vs. admin., profit)care (vs. admin., profit)

Exchanges: Secretary of Exchanges: Secretary of HHS can reject HHS can reject “unreasonable” rate “unreasonable” rate hikeshikes– CA: Stopped 39% CA: Stopped 39%

Wellpoint, 19% Aetna Wellpoint, 19% Aetna

State laws can expandState laws can expand


Public Health: OverviewPublic Health: Overview

95 cents of each care dollar is for treating illness95 cents of each care dollar is for treating illness

For the first time, an ongoing investment in For the first time, an ongoing investment in prevention and public healthprevention and public health

Moving from a “sick care” system to a wellness-Moving from a “sick care” system to a wellness-based system.based system.

Focus on prevention to improve the public’s Focus on prevention to improve the public’s health and help control costshealth and help control costs


Leading causes of preventable deathsLeading causes of preventable deaths

Tobacco SmokingOverweight and ObesityAlcohol consumptionInfectious diseasesToxicantsTraffic collisionsIncidents involving firearmsSexually transmitted diseasesDrug abuse


Prevention can make a Prevention can make a differencedifference

Tooth Decay is most common chronic disease in Tooth Decay is most common chronic disease in children children (fluoridation, sugar education)(fluoridation, sugar education)

Half the adults and 1 in 4 children are Half the adults and 1 in 4 children are overweight or obese overweight or obese (exercise, good nutrition)(exercise, good nutrition)

10% of adults and youth smoke regularly 10% of adults and youth smoke regularly (stronger tobacco policies, taxes)(stronger tobacco policies, taxes)

More than 1 in 4 adults have high blood More than 1 in 4 adults have high blood pressure or high cholesterol pressure or high cholesterol (diet and activity(diet and activity))

– Marty Fenstersheib, Sta Clara Cty Marty Fenstersheib, Sta Clara Cty


Public HealthPublic Health

““National Prevention, Health Promotion & National Prevention, Health Promotion & Public Health Council” - departmental Public Health Council” - departmental Secretaries across the federal government. Secretaries across the federal government. Fund HHS Office of the Secretary to expand and Fund HHS Office of the Secretary to expand and sustain a national investment in prevention and sustain a national investment in prevention and public health programs public health programs – $500 million/yr$500 million/yr– Starting 2015 - $2 billion/yrStarting 2015 - $2 billion/yr

Public health workforce loan repayment Public health workforce loan repayment Monitor minority healthMonitor minority health

Source: American Public Health AssociationSource: American Public Health Association


Public Health Grant ProgramsPublic Health Grant Programs

Public Education CampaignsPublic Education Campaigns

Centers on Excellence on DepressionCenters on Excellence on Depression

Education and Training Grants & Loan Education and Training Grants & Loan RepaymentRepayment

Community Health CentersCommunity Health Centers

School-based Health ClinicsSchool-based Health Clinics

Community Transformation GrantCommunity Transformation Grant

Early Childhood Home VisitationEarly Childhood Home Visitation


AccessAccess

$11 Billion to Community Health Centers$11 Billion to Community Health Centers

Important models of high quality primary Important models of high quality primary carecare

Adds access for newly insuredAdds access for newly insured


What Happens to Medicare?What Happens to Medicare?


3 Facts – The New Law Will:3 Facts – The New Law Will:

1.1. Improve many Medicare benefitsImprove many Medicare benefits Quality Improvement Programs set models Quality Improvement Programs set models

for health care systemfor health care system NO CUTS NO CUTS in basic Medicare benefitsin basic Medicare benefits

2.2. Extend Medicare’s solvency by 12 years Extend Medicare’s solvency by 12 years to 2029.to 2029.

3.3. Help people obtain long-term care at Help people obtain long-term care at home.home.

NCOANCOA


Medicare TodayMedicare TodayIndividuals entitled to Medicare without regard to Individuals entitled to Medicare without regard to medical history or incomemedical history or income

47 million beneficiaries47 million beneficiaries– 39 million seniors 39 million seniors – 8 million people under-65 receiving Social Security Disability Insurance8 million people under-65 receiving Social Security Disability Insurance

12% of federal spending12% of federal spending

23 percent of national personal health care spending23 percent of national personal health care spending

Exhibit 2


The A-B-C-D’s of MedicareThe A-B-C-D’s of Medicare


Part A –Part A –Hospital InsuranceHospital Insurance

• • Inpatient care, including skilled nursingInpatient care, including skilled nursing

• • Paid for by payroll taxesPaid for by payroll taxes

• • Concerns about future solvencyConcerns about future solvency

September, 2010 EQUAL Health Network 54

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


Part B - OutpatientPart B - OutpatientHealth InsuranceHealth Insurance

• • Pays for additional medical services (like Pays for additional medical services (like doctors doctors visits, diagnostic tests, and visits, diagnostic tests, and outpatient care)outpatient care)

• • Financed 75% by general revenues, 25% Financed 75% by general revenues, 25% by monthly premiumsby monthly premiums

($110.50)($110.50)


Part C - MedicarePart C - MedicareAdvantage (MA)Advantage (MA)

Private health plans (e.g. HMOs and Private health plans (e.g. HMOs and PPOs) that deliver Medicare servicesPPOs) that deliver Medicare services

24% of Medicare recipients are in MA24% of Medicare recipients are in MA


Reduced Payments to Medicare Reduced Payments to Medicare Advantage PlansAdvantage Plans

MA plans are paid about $1,100 more per MA plans are paid about $1,100 more per person than people in original Medicare person than people in original Medicare (13% higher)(13% higher)

Payments frozen in 2011Payments frozen in 2011

Beginning in 2012, these overpayments Beginning in 2012, these overpayments will be gradually reducedwill be gradually reduced


Changes in MedicareChanges in MedicareAdvantage (MA) Plans?Advantage (MA) Plans?

• • No one knows, but:No one knows, but:

• • Some plans may eventually reduceSome plans may eventually reduce

benefits or increase premiumsbenefits or increase premiums

• • New bonuses to reward high quality careNew bonuses to reward high quality care

• • New consumer protections to limit out-of-New consumer protections to limit out-of-pocket costspocket costs


Part D - PrescriptionPart D - PrescriptionDrug CoverageDrug Coverage

2003 law 2003 law

• • Paid for by general revenuesPaid for by general revenues

You choose your plan You choose your plan

Includes a coverage gap for “donut hole”Includes a coverage gap for “donut hole”

September, 2010 EQUAL Health Network 60, , EQUAL Health NetworkEQUAL Health Network 6060

Phasing out the doughnut hole

: $250 automatic rebate to seniors who hit the hole

2011: 50% discount on brand name drugs

Donut hole closes completely in 2020.

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Part D Donut HolePart D Donut Hole

In 2007, over 8 million seniors hit the In 2007, over 8 million seniors hit the “doughnut hole”“doughnut hole”

Costs discourage drug use by about 14% Costs discourage drug use by about 14% –threat to managing chronic diseases like –threat to managing chronic diseases like diabetes, high blood pressurediabetes, high blood pressure


Cost Containment and QualityCost Containment and QualityResearch Research comparative effectivenesscomparative effectiveness of of treatmentstreatments

Information TechnologyInformation Technology - electronic medical - electronic medical records, reduce medication errorsrecords, reduce medication errors

Payment Reforms Payment Reforms reward quality & better health reward quality & better health outcomes, including better care coordination and outcomes, including better care coordination and disease management. Pilot programs:disease management. Pilot programs:– ““Bundling:” pay for total care (by health Bundling:” pay for total care (by health

condition), rather than for every servicecondition), rather than for every service– Reduce hospital-acquired infections, hospital Reduce hospital-acquired infections, hospital

re-admissionsre-admissions


Cost Containment: Cost Containment: Protecting MedicareProtecting Medicare

Independent Payment Commission is Independent Payment Commission is established to make decisions on efficiency and established to make decisions on efficiency and reaching spending targetsreaching spending targets


Other Improvements forOther Improvements forSeniorsSeniors

New protections against elder abuse, neglect, New protections against elder abuse, neglect, financial exploitationfinancial exploitationBetter training for workers caring for seniorsBetter training for workers caring for seniorsNursing home quality improvementsNursing home quality improvementsHelp to keep premiums down for early retireesHelp to keep premiums down for early retireesBonuses for primary care doctors (other doctor Bonuses for primary care doctors (other doctor payment issues not addressed)payment issues not addressed)


Community Living Assistance Community Living Assistance Services and Support – CLASS ActServices and Support – CLASS Act

National, voluntary program for people National, voluntary program for people who require long-term services and who require long-term services and supports due to a functional disabilitysupports due to a functional disability

Cash benefit, Financed by premiumsCash benefit, Financed by premiums

Must pay in x 5 years, employed x 3 yearsMust pay in x 5 years, employed x 3 years– Part-time, self employed okPart-time, self employed ok

Contributions start Jan. 1, 2011, benefits Contributions start Jan. 1, 2011, benefits start 2016 start 2016


Integrated CareIntegrated CareHealth HomesHealth Homes– Support care coordination for chronically ill at Support care coordination for chronically ill at

high risk of being hospitalized. high risk of being hospitalized. – Community mental health centers can be Community mental health centers can be

designated as a health homedesignated as a health home

Health and Human Services GrantsHealth and Human Services Grants– Psychologists as members of interdisciplinary Psychologists as members of interdisciplinary

health teamshealth teamsLow income populationsLow income populations

Primary care settingsPrimary care settings


What is it going to cost?What is it going to cost?


What Must Be Paid ForWhat Must Be Paid For

New subsidies for health insurance New subsidies for health insurance exchangesexchanges

New coverage under MedicaidNew coverage under Medicaid

Better prevention, public health servicesBetter prevention, public health services


How Is It Paid For?How Is It Paid For?

Individual mandatesIndividual mandates

Employers offer coverage or pay $2,000 Employers offer coverage or pay $2,000 per full time employeeper full time employee

Increased penalties on over-payments in Increased penalties on over-payments in Health Savings AccountsHealth Savings Accounts

After 2017, tax on some health plansAfter 2017, tax on some health plans


Changes to Medicare FinancesChanges to Medicare Finances

Increased RevenuesIncreased Revenues• • Higher payroll taxes for wealthy workers ($200/$250,000)Higher payroll taxes for wealthy workers ($200/$250,000)• • Higher Part D premiums for 5% of wealthy Medicare Higher Part D premiums for 5% of wealthy Medicare

beneficiaries ($85/$170,000)beneficiaries ($85/$170,000)

Reduced SpendingReduced Spending• • Slower growth in payments to providers (not doctors)Slower growth in payments to providers (not doctors)• • Reduction in over-payments to Medicare Advantage plansReduction in over-payments to Medicare Advantage plans• • Average yearly Medicare spending increases down from Average yearly Medicare spending increases down from

6.8% to 5.5%6.8% to 5.5%


Affordability: Deficit ReductionAffordability: Deficit Reduction-2019 (CBO)-2019 (CBO)

$650Billion to $1.3 Trillion $650Billion to $1.3 Trillion

Spending per Medicare beneficiary: Spending per Medicare beneficiary:

Annual rate of increase (in real terms) cut Annual rate of increase (in real terms) cut in half, from 4% over last 2 decades to in half, from 4% over last 2 decades to 2% in the future. 2% in the future.


III. Making It Work:III. Making It Work:Implementing the LawImplementing the Law


Implementing the LawImplementing the Law

Comment on RegulationsComment on Regulations

Rate ControlRate Control

Medical Loss RatioMedical Loss Ratio

Determining Prevention Benefits - Determining Prevention Benefits - ContraceptionContraception


Implementing the Law: FederalImplementing the Law: Federal

HHSHHS** making progress making progressPublic commentsPublic commentsRegulate insurance premium increasesRegulate insurance premium increasesPay for care vs. insurance co. Pay for care vs. insurance co. administration (Medical Loss Ratio)administration (Medical Loss Ratio)– Center for Policy Analysis comments onlineCenter for Policy Analysis comments online

Determine if contraception covered under Determine if contraception covered under prevention – HRSAprevention – HRSA****

* Department of Health and Human Services ** Health Resources and Services Administration* Department of Health and Human Services ** Health Resources and Services Administration


Implementing the LawImplementing the Law Comment on Regulations to HHS Comment on Regulations to HHS

ISSUEISSUE VITAL IF YOU…VITAL IF YOU…

Rate ControlRate Control Care about costsCare about costs

Medical Loss RatioMedical Loss Ratio Care about costsCare about costs

Determining Determining Prevention Benefits Prevention Benefits - Contraception- Contraception

Use contraception, and/or Use contraception, and/or Consider it a preventive Consider it a preventive health servicehealth service


California Reforms PendingCalifornia Reforms Pending

Create an Insurance Exchange:Create an Insurance Exchange: AB 1602 AB 1602 (Bass) & SB 900 (Alquist). (Bass) & SB 900 (Alquist). To offer To offer transparent rates and benefits, available to transparent rates and benefits, available to buyers inside and outside the Exchangebuyers inside and outside the Exchange

Facilitate a public health insurance option: Facilitate a public health insurance option: SB 56 (Alquist). CSB 56 (Alquist). County-organized health ounty-organized health plans and other health benefits programs can plans and other health benefits programs can form joint ventures.form joint ventures.


California Reforms PendingCalifornia Reforms Pending

Reform individual insurance:Reform individual insurance: SB890 SB890 (Alquist). (Alquist). Specific plans with basic Specific plans with basic benefits so consumers can do “apples-to-benefits so consumers can do “apples-to-apples” comparisonsapples” comparisons

AB 1600 (Beall) Mental HealthAB 1600 (Beall) Mental Health


IV. Fixing the FutureIV. Fixing the Future


Policy Issues for the FuturePolicy Issues for the Future

Reproductive health careReproductive health care

Immigrants’ inclusionImmigrants’ inclusion

AffordabilityAffordability

State options for innovative approaches State options for innovative approaches – Single payerSingle payer


What To Do NowWhat To Do Now

Analyze/EducateAnalyze/Educate– Get the facts about the lawGet the facts about the law– Spread the wordSpread the word

Implement The LawImplement The Law– Make It WorkMake It Work

Improve The LawImprove The Law


Network with EQUAL toNetwork with EQUAL to Help Make History! Help Make History!

Join the EQUAL ListservJoin the EQUAL Listserv Send a blank message toSend a blank message to [email protected]@list.equalhealth.info

Website: Website: www.equalhealth.infowww.equalhealth.info

Thanks for contributions to this presentation to EQUAL partners including Thanks for contributions to this presentation to EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason, Keely Monroe (Lisa Kernan Social Justice Fellow), Jeoff Robert Mason, Keely Monroe (Lisa Kernan Social Justice Fellow), Jeoff Gordon, UULM-CA Gordon, UULM-CA Other source: Health Access CAOther source: Health Access CA

the truth about health reform: what it means to us

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