Health Policy in Kansas:

Transcription

1 Health Policy in Kansas: Where Are We? Where Are We Going? Sheldon Weisgrau WSU POWER Conference February 24, 2017

2 Takeaways The ACA has largely been a success. But Medicaid (KanCare) expansion is the most important health policy issue in Kansas. But Advocacy matters. Health Reform Resource Project 2

3 Kansas Grantmakers in Health Health Reform Resource Project 3

4 Why Health Reform? Health Care and Health Insurance (before the ACA) Health Reform Resource Project 4

5 Access Why health reform? 48 million uninsured (18% of pop < age 65) 350,000 uninsured in Kansas (13%) Millions more underinsured Employment-based health insurance declining Health Reform Resource Project 5

6 U.S. Uninsured Increasing ( ) 17.0% 16.0% 15.0% 14.0% 13.0% 12.0% Source: U.S. Census Bureau, Current Population Survey Health Reform Resource Project 6

7 Kansas Uninsured Increasing ( ) 14% 13% 12% 11% 10% 9% 2001/ / / / / / / / / /2011 Source: KHI, 2012 Health Reform Resource Project 7

8 What difference does health insurance make? The uninsured: Receive less preventive and prenatal care Go without care due to cost Diagnosed at later stage of illness Hospitalized for avoidable conditions Less healthy Earn less (and no financial protection) Have higher death rates Health Reform Resource Project 8

9 Access Quality Why health reform? Inconsistent Disparities Infections, medical errors, patient harm Health Reform Resource Project 9

10 Institute of Medicine...Serious and widespread quality problems exist throughout American medicine. These problems...occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a result... -IOM Roundtable, 2002 Health Reform Resource Project 10

11 Access Quality Cost Why health reform? Highest in the world (by far) Historically Increasing faster than wages and inflation Main driver of long-term federal budget deficits Health Reform Resource Project 11

12 Health Reform Resource Project 12

13 International rankings Source: Commonwealth Fund Health Reform Resource Project 13

14 Health Reform Resource Project 14

15 Vice President Joe Biden (March 23, 2010) This is a big f***ing deal! Health Reform Resource Project 15

16 ACA Linked Goals Make better health insurance coverage more available and affordable for legal residents Reform health care delivery and financing to provide better quality and outcomes, more cost effective care Health Reform Resource Project 16

17 The ACA s 3-Legged Stool 1. Insurers may not deny coverage to those with preexisting conditions (guaranteed issue) or charge them more (community rating) Health Reform Resource Project 17

18 The ACA s 3-Legged Stool 1. Insurers may not deny coverage to those with preexisting conditions (guaranteed issue) or charge them more (community rating) 2. Most people must maintain insurance coverage Health Reform Resource Project 18

19 The ACA s 3-Legged Stool 1. Insurers may not deny coverage to those with preexisting conditions (guaranteed issue) or charge them more (community rating) 2. Most people must maintain insurance coverage 3. Tax credits and subsidies are available to help individuals purchase private insurance Health Reform Resource Project 19

20 Health Reform Resource Project 20

21 Percentage of Uninsured is Lower than Ever 16% 15% 14% 13% 12% 11% U.S. Kansas 10% 9% 8% Source: U.S. Census Bureau American Community Survey Health Reform Resource Project 21

22 Quality: Errors & Harm Declining Source: HHS Agency for Health Care Research and Quality, Oct 2015 Health Reform Resource Project 22

23 Health Reform Resource Project 23

24 Cost: Health Inflation is Moderating Health Reform Resource Project 24

25 Cost: Financial Outlook Improving Long-term health care spending down Long-term cost of ACA down Solvency of Medicare program extended Health care share of federal deficit down But... Health Reform Resource Project 25

26 Cumulative Increases in Health Insurance Premiums, General Annual Deductibles, Inflation, and Workers Earnings, % Overall Inflation 63% 60% Workers Earnings Single Coverage Deductibles, all Workers Single Coverage Premiums 50% 40% 30% 20% 10% 0% 19% 11% 6% NOTE: Average general annual deductible is among all covered workers. Workers in plans without a general annual deductible for in-network services are assigned a value of zero. SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, (April to April).

27 What s Happening to the Marketplace? Adverse selection: healthy people not enrolling at anticipated levels Out-of-pocket costs increasing Congress defunded programs designed to protect insurers Uncertainty Health Reform Resource Project 27

28 Health Reform Resource Project 28

29 ACA: Where do we go from here? Repeal Repeal & Delay Repeal & Replace Repeal & Repair?? Health Reform Resource Project 29

30 Health Reform Resource Project 30

31 Health Reform Resource Project 31

32 Health Reform Resource Project 32

33 KanCare Expansion Health Reform Resource Project 33

34 In states that do not expand Medicaid, there is a gap in coverage available for adults. Health Reform Resource Project 34

35 Source: Kaiser Family Foundation, July 2016 Health Reform Resource Project 35

36 Benefits of KanCare Expansion Health Reform Resource Project 36

37 Budget Neutral Health Reform Resource Project 37

38 Brings Tax Dollars Back to Kansas Source: kha-net.org, Feb 23, 2017, 4:10 PM Health Reform Resource Project 38

39 Economic Stimulus Health Reform Resource Project 39

40 New Jobs Health Reform Resource Project 40

41 Support for Hospitals and Other Health Care Providers Health Reform Resource Project 41

42 Kansas-Specific Plan Health Reform Resource Project 42

43 Financial Security for Families Health Reform Resource Project 43

44 Healthy Kansans Health Reform Resource Project 44

45 Advocacy Health Reform Resource Project 45

46 Health Reform Resource Project 46

47 For more information, contact: Sheldon Weisgrau Health Reform Resource Project 700 SW Jackson Street, Suite 600 Topeka, KS (785) Blog: Health Reform Resource Project 47