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