www.drsforamerica.org What Is This? Skyrocketing Costs Health care for the average American family $16,771 per year = a second house payment Costs are rising.
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Transcript www.drsforamerica.org What Is This? Skyrocketing Costs Health care for the average American family $16,771 per year = a second house payment Costs are rising.
www.drsforamerica.org
What Is This?
Skyrocketing Costs
Health care for the average
American family $16,771 per
year = a second house payment
Costs are rising 200-300%
faster than wages or inflation
Uninsured/Underinsured
Americans
54,000,000 lives
49 million Americans
uninsured
14,000 more lose health
insurance coverage every
day
72 million Americans have
coverage too flimsy to
provide protection from
major expenses
47,000,000 lives
Economic Drag
5 businesses drop
health benefits for
employees every hour
50% of bankruptcies
related to medical
expenses
Looming Medicare
bankruptcy in 2019
Legislative Action - America Divided
by Fear and Politics
March 2009: Federal
legislators make health care
reform a top priority
August 2009: Raucous
legislative town halls,
divisive messaging begins
Spring 2009-Spring 2010:
Twisted legislative path in
the media/public spotlight
March 2010: Final health
care reform legislation
passes the US House and
Senate, signed into law
The Patient Protection and
Affordable Care Act of 2010
What’s Really In The New Law?
Expanded coverage
Improved affordability of insurance
Improved/increased insurance regulation
Shared responsibility
Efforts to control long-term costs
Emphasis on prevention/primary care
Efforts to improve effectiveness/value of medical care
delivered
Support to expand training for the medical professional
workforce we need
Expanding Coverage
30 million more Americans insured
Expansion of Medicaid eligibility to
133% of poverty – approx $29K for a
family of four
Financed 100% by federal money for first two
years, then 90% match for all states
Subsidies/Tax Credits for
individuals/small businesses to buy
insurance in a new “regulated
market-place” or “Exchange”
State Health Insurance Exchanges
Regulated Marketplaces
or
“Supermarkets for health insurance”
Private insurers offer plans to American
consumers – same as members of Congress
Insurance companies compete for business
on more level playing field - market principles
work better
Government regulates participating insurers,
sets up a “minimum benefit” package
Open to individuals without health
insurance/small business employees/some
employees who can’t afford insurance offered
by their employer
Begins in 2014 – or sooner in some states
Affordability
Exchange “affordability” subsidies
Sliding scale tax credits to help
make premiums more affordable
(max. approx. 2-9.5% of income)
Additional subsidies to lower outof-pocket spending
Eligibility up to 400% of Federal
Poverty Level ($43,320 for
individuals; $88,200 for family of
four)
Insurance Regulation
Prohibits pre-existing condition
exclusions/rescissions
Prohibits price discrimination based on
gender
Prohibits lifetime limits on $ amounts of
coverage, limits annual out-of-pocket
costs
Requires that at least 85% of premiums
go towards medical care (small
group/individual markets – 80%)
Full implementation by 2014
Real Stories, Real People: “Irene”
Middle-aged working mother with
husband and 3 children
Put off coming to see family doctor
despite concerning symptoms –
knew about “pre-existing condition
exclusions”
Thought she could wait the 6month “probation period” at her
new job
Her cancer caught her first
Shared Responsibility
What is the “Individual mandate?”
Financial penalty/tax, for not having health
insurance coverage
Is that fair?
Helps eliminate “hidden tax” insured pay
when uninsured seek their care in the ER
and can’t pay the bill
Difficult to incentivize young/healthy
people to buy insurance – like car insurance
mandates
“Everyone In” drives down the costs of
insurance through larger risk pool ”wholesale” approach
Subsidies should help Americans keep care
and coverage affordable when they need
that assistance.
Shared Responsibility
Employer responsibility
Employers not offering coverage pay
financial penalty if employees receive
public $ for Exchange subsidies or
Medicaid coverage
Small businesses have
exemptions/subsidies to pool purchasing
power – should help keep insurance for
owners and their workers more
affordable
Real Stories, Real People: “Gerald”
• Small business owner – 8 employees
• Offers health benefits - puts him at
competitive disadvantage
• Believes healthy employees are
essential, employers should play a role
• Has to cut benefits every year to turn a
profit
• Looks forward to this year’s tax credits
• Hopes further changes will let him
keep benefits affordable and help
keep employees healthy
Control Long Term Costs
Getting More Value For Our Dollar
Invest in Primary Care – the right care at the right time saves
lives and money
Pilot projects to innovate in payment/health care delivery reorient incentives to produce better care
We Are
Here
Better
Health
Patient-Centered Primary Care
Prevention
Lower
Costs
Prevention and Wellness
Incentivizing prevention and healthy choices
First dollar coverage for preventive care –
includes Medicare, all new plans
Insurance premium discounts for
participation in wellness programs
Requires chain restaurants to publish
calorie/RDA information so consumers can
make informed choices.
Breastfeeding accommodations for new
mothers
Expansion of Public Health
Will There Be A Doctor
or Nurse to See You?
More doctors in the places that need it
most
Increased funding for National Health Service
Corps
Community Health Centers funding expanded
Increased funding/space for primary
care training
Incentives for nursing
instructors/training
MORE NEEDED!
How Are We Paying For This?
New Income
High cost insurance plans (over $27K) will be taxed starting in 2018
Fees on tanning salons, certain device manufacturers, insurers
Tax on unearned income over $250K
Increased high income earners’ current Medicare tax/premium
Cutting payments to insurance companies
Restructures wasteful payments to Medicare Advantage HMOs
(saving ~$150 Billion)
Cost Analysis By The Non-partisan CBO
Reduce deficit $124 billion over 10
years
Average premiums unchanged for
majority of Americans who have
employer-based health insurance
Costs should go down for those who
buy in the Exchange and who qualify
for subsidies
Where Do We Go From Here?
Fixing the Root of the Problem:
COST ≠ VALUE
Our Journey Has Just Begun
We Hold Our Future In Our Hands
What You Can DO
Listen and Learn - Educate yourself
Advocate for affordable health care that prevents
illness and delivers better health
Pass it On - Talk with others in your family and
community
Become a Health Care Voter - Your voice and your
vote are important!
Please visit www.drsforamerica.org to get more information
For more information, visit:
www.drsforamerica.org
Many thanks to Dr. Evan Saulino who contributed
greatly to creating this presentation
Most of the photos in this presentation
were collected from 123rf.com