Transcript Slide 1

Implications of Obamacare for
Health Communicators
Amy Lischko, DSc
Susan Koch-Weser, ScD
Tufts University School of Medicine
Department of Public Health and Community
Medicine
Brief overview
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“Comprehensive” Health Reform
• Never happened in US health policy
• Four essential elements:
– Coverage and Access
• Coverage does not always equal access
– Delivery System Reform
• Quality, Efficiency, Effectiveness, Cost, Workforce,
Innovation, Fraud & Abuse, Liability, and much more
– Prevention, Wellness, Public Health
• Improving health status from within the health system
– Health In All Policies
• Improving health status and population health from
outside the health system
• National Prevention Strategy
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The ACA’s Ten Titles
I. Affordable and Available Coverage
II. Medicaid and CHIP
III. Delivery System Reform and Medicare
IV. Prevention and Wellness
V. Workforce Initiatives
VI. Fraud & Abuse, Transparency, Elder Justice Act +
VII. Biological Similars – (Pharmaceutical Innovation)
VIII.CLASS – Community Living Assistance Services &
Supports (repealed: January 2013)
IX. Revenue Measures
X. “Manager’s Amendment” (amendments to I-IX)
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Plus the Health Care and Education Reconciliation Act
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Key Questions
• How does the ACA health make health care
more affordable and accessible?
• What is the individual mandate and how
important is it to the law’s success?
• Will the U.S. maintain an employer-based
system?
• How will we pay for the coverage expansions?
• What are the recent ACA developments?
• What are the challenges and opportunities for
a health communications professional?
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How does the ACA make health care more
affordable?
• All people with incomes up to 133% FPL will be eligible
for Medicaid (SC ruled this feature optional for states)
• People earning between 133 and 400% FPL and not
offered an affordable plan through employer will be
eligible for sliding-scale subsidies and will pay 3 to 9.5%
of income towards premiums
• Cost sharing subsidies based on income and limits on
deductibles
• Donut hole in Medicare Part D gradually filled
• Many experiments to explore various ways to reduce
costs including payment and system reform,
malpractice reform and wellness incentives
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How does the ACA make health care
more accessible?
• Small group and Non-group markets:
– Guarantee issue and renewability
– No health underwriting: rating on age (3:1),
geography, family composition and tobacco
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No lifetime limits or rescinding coverage
Limit waiting periods to 90 days
Young people stay on parents’ plan until 26
Health Exchanges to coordinate eligibility and
purchase of health insurance
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What is the individual mandate and how
important is it to the law’s success?
• Requires U.S. citizens and legal residents to have
coverage by 2014
• Phased-in penalties, maxing out at 2.5% of income
• Exemptions for:
– Religion
– Hardship
– Affordability (No plan available </= 8% income)
• Require essential health benefits package (by state),
package will cover inpatient and outpatient care, mental
health, substance abuse, rx, preventive care with no costsharing
• Important component of law, why?
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Will the U.S. maintain an employer-based
system?
• Employers with 25 or fewer low-income (average wage
<50,000) can receive tax credit
• Employers with >50 employees who have at least 1
employee receiving tax credit may be fined
– Offering: $3000 per employee with credit or $2000
FT employee
– Non-Offering: $2000 per employee excluding first 30
employees
• Employers with >200 employees, auto-enroll
• In MA, no drop in coverage but ACA is different, some
estimate high drop rates for small employers...early
numbers suggest no movement yet
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How will we pay for health care reform?
• Tax on individuals who do not purchase coverage
• Penalties on larger employers whose employees
seek tax credits
• Tax on “Cadillac” plans
• Limit FSA amount and use & Increase threshold for
itemized deduction
• Increase Medicare Part A tax for higher income
wage earners
• Impose new fees on Rx, Medical device companies
and fully insured insurance products (maybe)
• Tax indoor tanning salon use
• Medicare payment reductions
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What are the Recent ACA Developments?
• ACA has survived 3 “near death” experiences
– January 2010 Massachusetts Senate Election
– US Supreme Court decision in June 2012
– November 6, 2012 federal elections
• Political furor abating
– Public polling more supportive, fewer want repeal
– Congress looking to modifications, not repeal
• Much action moves to states
– State Health Insurance Exchanges:
• 26 states established or partnered with HHS;
• 24 states default to federal exchange
– Medicaid Expansions:
• 28 expanded
• 21 did not expand
• 2 under discussion
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What are the Recent ACA Developments?
• Delivery System Innovation Is Accelerating
– 254 Accountable Care Organizations serving 4 million
Medicare enrollees
– New Medicare penalties on hospitals with high rates of
readmissions & infections
• Uninsured estimates are lower
– CDC estimates from first 3 months found estimates of
uninsured dropped from 14.4 to 13.1 (41 million)
• Medicare and overall rate of spending growth is
down
– 2000-2009 – 9.7% rate of growth
– 2009-2011 – ~4-4.9% rate of growth
– Private growth in 2011 at 3.9%, lower than overall
economic growth for first time in more than a decade
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Want to learn more?
• Bill Text and Section-by-Section Summary
– http://democrats.senate.gov/reform/patientprotection-affordable-care-act-as-passed.pdf
• Congressional Budget Office: cbo.gov
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Joint Tax Committee: jtc.gov
Obama Administration Site: healthcare.gov
Commonwealth Fund: cmwf.org
Kaiser Family Foundation: kff.org
Health Reform GPS: healthreformgps.org
Politico’s PULSE:
www.politico.com/politicopulse/
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Challenges and Opportunities
• Can we effectively convey health plan
information about health plans so that
consumers can make informed choices?
• Will the newly enrolled be able to use their
plan once enrolled?
• How do we achieve patient-centered
outcomes?
Selected research and practice areas
• Health Insurance Literacy
• Patient Engagement
• Patient Centered Outcomes Research Institute
Health Insurance Literacy
Health insurance literacy is the capacity to find
and evaluate information about health plans,
select the best plan given financial and health
circumstances, and use the plan once enrolled.
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Health Insurance Literacy Expert Roundtable, 2011
A collaboration between
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Consumers Union
University of Maryland College Park
American Institutes for Research (AIR)
Health Insurance Literacy (1)
Key Informant Interviews with Consumer Assistants
• Consumers don’t understand risk and personal
liability for care
“I’m not going to pay $300 a month because I am
not going to use $300 a month of anything”
• Can’t fully assess their needs or the services
the plans cover
• Fall back on brand and word of mouth
“People tend to assume that because you have a
particular policy from a particular carrier, you have good
insurance”
Health Insurance Literacy (2)
Key Informant Interviews with Consumer Assistants
Consumers do not understand
• Cost sharing terms necessary for assessing tradeoffs
between plans
• How to obtain care – Finding PCP
• Provider network restrictions, drug formularies, referral
and preauthorization
• How to verify or appeal billing statements (esp. preventive
vs. diagnostic tests)
“Often, for example, it’s a colonoscopy, which is technically
preventive, but it gets, more often than not, coded as diagnostic
because they find something”
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Navigate deductibles (in-network, out-of-network, and
drugs)
Health Insurance Literacy Problems
• Terminology e.g. coinsurance, annual benefit limit,
screening vs. diagnostic test (Quincy 2010, 2011)
• Stay on same plan even when there is a better choice
(Gruber 2009)
• As choices and complexity increase ability to choose
“optimal” plan decreases (Shaller 2005, Wood 2011)
• Self-efficacy – consumers dread shopping for insurance and
are not confident about their choices (Isaacs 1996, Quincy
2010, 2011)
• Numeracy affects comprehension of plans, use of data
tables (Kutner et. al. 2006, Greene et. al. 2008, Wood 2011)
Measuring Health Insurance Literacy: A Call to Action, Sponsored by Consumers Union in partnership
with University of Maryland College Park & American Institutes for Research (AIR), February 2012
Health Insurance Literacy (HIL) Measure
http://www.air.org/sites/default/files/downloads/report/Health_Insurance_Literacy_Issues_Brief_2.25.13_0.pdf
Patient Engagement
Patient Activation – knowledge, skills, ability, and
willingness to manage his or her own health care
Patient Engagement – broader concept that
combines patient activation with interventions
designed to increase activation and promote
positive patient behavior
“Health Policy Brief: Patient Engagement,” Health Affairs, February 14, 2013
Patient Activation Measure
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013.
http://www.healthaffairs.org/healthpolicybriefs/
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013.
http://www.healthaffairs.org/healthpolicybriefs/
Patient-Centered Outcomes Research
Institute
www.pcori.org
PCOR is a relatively new research field that
considers patients’ needs and preferences and
focuses on outcomes most important to them.
Selected PCORI Projects
When Kidneys Fail: Helping Patients Choose the Treatment Best for Them
The two main types of renal dialysis significantly alter patients’ lives in different ways. Michigan
researchers are developing a tool to guide patients toward a better-informed choice.
The PROMIS in Putting Patients’ Waiting Room Time to Good Use
Patients struggle to provide their full health perspective; a Baltimore team examines whether an
iPad questionnaire can improve patient-doctor communication.
What Do Patients and Caregivers Want In Mobile Health Apps? Ask Them
Julie Singer struggles to manage her husband’s health and treatments as he recovers from a
stroke; researchers are consulting with patients and caregivers as a first step in developing new
mobile tools for stroke survivors.
Improving Quality of Life for Latinas with Breast Cancer
Most Hispanic women with breast cancer face extra challenges in dealing with the disease. One
researcher aims to find out if culturally relevant group support can help such women and their
caregivers.
Transforming Community-Based Research on the High Plains
Research reports can be difficult to understand; a “Boot Camp Translation” project in Colorado
makes evidence-based recommendations accessible for diverse communities.
Questions?