Transcript Slide 1

National Health Reform Overview
Gray Panthers Annual Forum
Austin, Texas
August 23, 2009
Anne Dunkelberg, Assoc. Director, [email protected]
900 Lydia Street - Austin, Texas 78702
Phone (512) 320-0222 (X102) – www.cppp.org
www.texasvoiceforhealthreform.org
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Texas Voice for Health
Reform Principles
1. Affordable Access to Good Health Care Must be Available for All
Americans. It should:
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Be affordable for people at all income levels
Remain available and affordable when family and economic circumstances change
Establish both a responsibility for the public to contribute and an assurance of cost containment
for individuals and families
Eliminate health costs as the #1 cause of bankruptcy in America.
2. A Decent Standard of Comprehensive Care Must Be Established. It
should:
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Keep people healthy and treat them when they’re ill
Cover the whole person
Not be lost or reduced based on pre-existing conditions or pregnancy
• These first 2 steps will not happen by accident: Americans must
choose to do this and demand it.
3. To be effective, sustainable, equitable, and balanced with our other important
priorities as a nation, national health reform should also address safe and high
quality care; costs and cost-effectiveness of health care; consumer choice; and
eliminating non-financial barriers to care
• Just working on Step 3 will not make Steps 1 or 2 happen.
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Health Reform
Process
• Three bills being drafted: Senate Finance; Senate HELP
(Kennedy); House “Tri-Committee” (E&C, W&M, Ed & Labor)
– Finance: trimming back cost of 1st draft; no bill release before August recess,
concerns that they are cutting back by reducing affordability subsidies, protections.
– HELP: passed out of committee
• Original goal was to merge the two Senate bills before August recess; that
process can’t begin until Finance bill is laid out, voted out in September
– House: bill filed Tuesday July 14. Each of 3 committees made amendments which
must be reconciled in September before a full House vote can happen.
– Both chambers return from August recess on Tuesday 9/8.
• House-Senate compromise process starts as soon as
Chambers vote their bills.
• If successful, bill could be voted on and signed in October,
November.
• If no deal reached, large portions of (but not all of) reform
can/will be passed through “Budget Reconciliation,” but this is
less than ideal, both politically and from policy standpoint.
– Budget Reconciliation only requires 51 Senate votes, but limits what you can do.
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Health Reform
Basics
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Key elements BEING CONSIDERED:
– If you like what you have now, you can keep it.
– Medicaid expansion (e.g., cover all up to 133% FPL: $14,404 for one; $29,327 for 4).
– Reform Private Health Insurance: standardize benefits, limits on price variation,
no denial of coverage, no excluding pre-existing conditions. Changes focused on
individual and small employer coverage.
– Create health insurance exchanges where participating private options can be
compared and purchased.
• Will there be a Public or Non-profit plan option?
– Premium assistance up to 300% or 400% of FPL? ($66,150 to $88,200 for family of 4)
– Out-of-pocket caps, too, to ensure real affordability/end (reduce?) medical
bankruptcy
– Individual mandate to have coverage: but only if affordable coverage exists!
– Requirements for employers to contribute, with exemptions for smallest
employers; One idea is a requirement to help pay for only employees who use
Medicaid or get premium assistance (latter approach is opposed by advocates for
low-income Americans).
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Benefits, Costs of Health
Reform
Texas:
– About 1 million uninsured Texan adults would get Medicaid—up to 133% FPL
– about 2.3 million uninsured Texans would get premium assistance--above Medicaid and
below 400% of poverty ($88,200 for family of 4)
– Under Texas law today, small group insurers average high premium is $22,000 a year for
a single worker.
– CPPP CONSERVATIVELY estimates the Medicaid expansion alone will add $3.7
billion a year in new federal dollars to the Texas economy ($3.3 if 90% federal share);
with a multiplier effect of $10 to $12 billion a year, and
– could convert Texas from being a “donor state” that sends more to DC in taxes than
we get back by covering low-income adults in Medicaid.
– even more funding will flow to Texas from premium assistance to low-to-moderate
income families
– What share will Texas have to pay for required Medicaid expansions & increased Medicaid
provider payment rates?
• 100% federally-funded in House proposal; E&C amends to 90% from year 3 onward
• But Senate may push to “phase back” over time to a state-share formula
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Goal is to make the final bill 100% paid for (combo of cuts/savings and new revenues); if “payfors” are cut, expect to see loss of affordability and/or health benefits!
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Long list of provisions would reduce cost, improve quality of care, but MORE may be added
before a bill is passed.
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Policy: Some Top
Health Reform
Concerns
• Will enough be done to really help the middle class? (Needed
for broad support)
• Will a real affordability cap be created, so no one is at risk of
medical bankruptcy ever again?
– Every American (not only the poorest) must have both affordable
premiums, and caps on out-of-pocket spending.
• Will insurance reforms be strong enough to help all families?
– e.g., Senate Finance proposed allowing top premium rates to be 7.5
times the lowest price! If you pay $200 a month for the same policy I
have to pay $1,500 a month for, is that (a) affordable or (b) reform?
• Public plan is not more important than affordable access for all.
Public plan is one tool. Single payer is one tool. But Germany, the
Netherlands and Switzerland all have universal, secure coverage with no
public option.
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Consumer Voices:
Some Top Health
Reform Concerns
• Supporters of Health Reform are NOT being heard loudly in D.C.
• Who is being heard?
– Right-wing opponents of any reform, talk-radio disinformation:
euthanasia, taking hip replacements from seniors to pay for teenagers’
abortions.
– Single-payer advocates, who are well-organized!
• Texans should not “sit out” health reform
• Those who believe real reform is needed should tell our elected officials
and communicate that strong support FIRST, before your special issues
or concerns.
• OUR POSTIVE MESSAGE MUST BE REPEATED MORE OFTEN THAN
THEIR NEGATIVE ONE – and not just corrections to their lies!!
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Consumer Voices:
The Truth, and the
Big Fat Lies
Medicare
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NO CUTS to Medicare benefits
Changes to slow the growth rate of Medicare costs (shores up Medicare’s finances)
Ends subsidies to private health insurance companies that cost 14% more than regular
Medicare
Phases out Part D “donut hole.”
No rationing in Medicare based on age, life-expectancy, disability, etc.
End-of-Life-Care Planning (living wills, advance directives)
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NO provisions to encourage euthanasia
Will let doctors get reimbursed (for first time) for discussing end-of-life planning with patients
Planning is completely voluntary
Planning cannot presume the withdrawal of treatment of encourage hastening of death
These Provisions may end up removed from reform because of the disinformation campaign
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Senate Finance
Senate H.E.L.P.
Medicaid to 133% FPL for
Medicaid to 150% FPL
children and pregnant women;
100% FPL for parents, other adults.
House 3-Committee
Medicaid to 133% FPL (~2.5
million Texas adults, 1.5 million now
uninsured)
Reform Small Group 1-50;
Reform All Coverage
allow 7.5 to 1 premium range
(except large self-insured);
Max range 2:1 for age.
Health Insurance Exchange:
Health “Gateways”:
Health Insurance Exchange:
•Unclear if national, state, regional;
• state-based
• Public Option
•national
•Public Option
Individual Mandate:
exempt if
lowest premium >15% of your
income; income <100% FPL; other
“hardship”
No penalty under <150%
FPL; penalty = 50% of price
of least expensive qualifying
plan for others; IRS collects.
Penalty of 2% tax on income, not to
exceed average cost of a basic
health plan; hardship exemptions.
Premium Help: to 300% FPL
Out-of-Pocket limit: $5,800
Premiums: to 400% FPL,
Premiums: to 400% FPL, cap at
cap at 12.5% of income
10% of income
individual; $11,600 for a family, but
may end at 300% FPL?
OOP limit: X% family
OOP limit:
income (not set yet)
$5,000 individual;
$10,000 for a family
Employer Responsibility:
Cover, or pay $750/yr per
Cover, or pay 8% of payroll.
pay only for workers on Medicaid or
getting premium help. (MAY be 3
levels: >25, >100, >200.)
worker (exempt under 25
workers)
(Some small firms exempt, and
some tax credits for small
businesses)
•Co-op NFP instead of Public option?
* As of 7/7/09
Reform ALL private
insurance: Max range 2:1 for age.
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Major House Committee Amendments
E&C
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Public Option health plan will use rates negotiated by Secretary of HHS (not
Medicare rates); also will meet all insurance regs that commercial plans are
held to.
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No one is mandated to enroll in, or provide care in, the public option plan.
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Doubled the payroll size from $250,000 to $500,000 for non-insuring employers
exempted from “pay-or-play” assessments; reduced assessment for noninsuring employers between $550K and $750K.
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After two years of 100 percent federal funding of Medicaid, states would have to
pick up 10 percent of the cost (filed version tri-committee bill had 100 percent
federal funding indefinitely);
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Reducing slightly premium subsidies and out-of-pocket cost caps for Americans
from 150-400 percent of the federal poverty level (FPL), but the subsidies will
be increased if certain savings on medications, administration, and limits to
premium increases actually materialize.
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Energy & Commerce amendment prohibits the use of Comparative
Effectiveness research to delay, deny, or ration care or to make coverage
decisions in Medicare—squarely addressing one of the most egregious outright
lies being circulated about the bill.
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End-of-life counseling can’t promote suicide, can’t assume withdrawal of
treatment; and both en-of-life counseling AND advance directives are voluntary.
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Major House Committee Amendments
E&C, cont’d
• No discrimination for/against providers related to willingness/unwillingness to
provide abortions; no required inclusion of TAB in “essential” benefits, no
public subsidy of TAB beyond Hyde Amendment.
• “Accountable care” pilots in Medicaid (bundled payments, medical homes),
models to be expanded to system if proven
E&L
• Hardship exemptions for employers demonstrating high job loss risk
• Allow states to “waiver” federal ERISA law if they chose to establish state
single-payer system.
• Benefits for children must be comprehensive “EPSDT” package used in
Medicaid
W&M
• IOM study of geographical health cost variations, to recommend ways to
reduce variation, promote high-quality care.
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Other notable committee amendments helpfully laid out in the side-by-side at
www.kff.org
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Get Involved with
Texas Voice for
Health Reform
•Join our email list – Weekly update
•Web site: Fact Sheets, MythBusters, News and More
•Health reform Photo project!
•Have a group representative participate in weekly calls/meetings
•Communicate with your elected representatives using the tools in our
online Citizen Advocacy Center: calls, letters Congress and newspapers,
op-eds needed!
•Educate your community, congregation, friends and family
•Contribute to our Story Bank project
www.texasvoiceforhealthreform.org
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