The Perfect Storm - Putting America s Health Care in Peril American Health Care Act + President s Budget

Transcription

1 The Perfect Storm - Putting America s Health Care in Peril American Health Care Act + President s Budget May 24, 2017 CBO AHCA Analysis Daniel Derksen, M.D., Director University of Arizona Center for Rural Health

2 Arizona Center for Rural Health Mission: to improve the health & wellness of rural & underserved populations. AzCRH houses the: 1. State Office of Rural Health 2. Rural Hospital Flexibility Program 3. Small Hospital Improvement Program 4. Western Region Public Health Training Center 5. AzCRH Navigator Consortium

3 American Health Care Act CBO: AHCA over 10 years would: Cut $1.5 Trillion in federal funding Cut $830 Billion Medicaid funding to States Cut $665 B in fed subsidies for individuals Increase uninsured Americans by 23 million 1. American Health Care Act Accessed 05/24/2017 at: 2. CBO-JCT Cost and Coverage Estimates of the American Health Care Act, 05/24/2017: Dan Derksen MD

4 Over 10 years would cut $2 trillion: $610 billion in federal Medicaid funding $193 billion SNAP (food stamps) $72 billion SSI disability support $87 billion NIH funding $18 billion CDC funding 1. Accessed 05/24/2017 at: 2. NYT Accessed 05/24/2017: Dan Derksen MD

5 American Health Care Act Eliminates fed. min. 50% of total Medicaid costs Shifts FMAP to per capita amt. or block grant Bases cap/grant on 2016 state s total expenses Adjusts annually based on CPI-M Cuts $830B over 10 yrs Medicaid funding to states 1. CBO-JCT Cost and Coverage Estimates of the American Health Care Act, 05/24/2017: 2. American Health Care Act Accessed 05/24/2017 at: Dan Derksen MD

6 Rural, Elderly, & Disabled at Risk Nurse, Physician, Hospital, Clinic - Charity Care Taxes You don t save money throwing people off coverage that just shifts costs to individuals, families, & health providers - and it worsens health outcomes Dan Derksen MD

7 2015 U.S. Health Spending $3.2 Trillion Dental Nursing Home Other 10% Out of Pocket 11% Rx 26% Medicaid 17% 33% Private Insurance Physician & Clinic 20% Medicare 20% Accessed 03/10/2017 at:

8 Medicaid Cuts in AHCA: Medicaid Spending in 2015 was 1 : $545 billion = $200 state fed Federal Medicaid cuts : $830B (>$150B/yr by 2026) Medicaid Enrollment 2 : -14M Accessed 05/23/17:

9 Medicaid, CHIP, Medicare: One in $3 U.S. Health Spending in 2015 Medicaid: $545 billion Medicare: $646 billion Total US: $3.2 trillion Accessed 03/10/17 at: Martin: Health Affairs Jan 2017:

10 2016 Publicly Sponsored Insurance Medicaid + CHIP + Medicare 38% US pop (123M/323M) 75 Million=Medicaid 70M + CHIP 5M 57 Million on Medicare 9 M dual on both Medicaid + Medicare CHIP = Children s Health Insurance Program Accessed 05/24/17 at:

11 Medicaid + Marketplace Gain Post-ACA Enrollment Gain from Sept 2013 thru 2016 UNITED STATES Medicaid+CHIP Million Age <26 Parents Plan Million Marketplace Million Effectuated Enrollment (paid premiums) 91.4% Americans with health insurance Million Gained Coverage 2 since % or 27 Million Uninsured in Accessed 05/17/2017: 1. Medicaid + CHIP Report thru Mar 2017: Coverage gains due to the ACA US DHHS: 3. Effectuated Marketplace Enrollment:

12 é16.8m Medicaid/CHIP Enrollees States + DC Expanded Medicaid >Half (16) That Expanded Are in Republican Governor States: AZ, AR, IL, IA, IN, KY, MD, MA, MI, ND, NH, NJ, NM, NV, OH, VT

13 Medicaid FMAP: Federal Medical Assistance Percentage: FMAP is the federal share of Medicaid costs, based on a state s per capita income (PCI) compared to US PCI Accessed 03/10/17: FMAP by state: kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currenttimeframe=0&sortmodel=%7b%22colid%22:%22location%22,%22sort%22:%22asc%22%7d Congress Research Service Medicaid FMAP released 02/09/2016 at:

14 Medicaid FMAP 50% Statutory Minimum Federal Cost Share FMAP Share Averages 57% in the 50 States Example: Arizona 2018 FMAP = 69% 2018 FMAP by State:

15 Federal Per Capita Medicaid Enrollee Spending by State, ,000 0,000 8,000 6,000 4,000 Arizona would be punished by the proposed AHCA and the President s budget because Arizona expanded AHCCCS coverage, and is cost efficient Arizona #8 lowest 2,000 0 DC NY WV RI CT OR VT MO MS DE KY MN AR TN MT OH ND PA ME MA ID LA MD IA IN US AK NC UT NM KS SC AL WI CA WY WA OK TX MI NJ GA FL VA AZ NE SD HI CO NV IL NH Data: J. Holahan and M. Buettgens, Block Grants and Per Capita Caps: The Problem of Funding Disparities Among States, Urban Institute, Sept. 2016, available at Rosenbaum S Commonwealth Fund Mar 2017:

16 Governor Brewer Medicaid Expansion Weigh the evidence and do the math $2 billion per year 20,000 jobs 250,000 uninsured covered Governor Brewer restored Medicaid coverage to 100% FPL for childless adults in 2014, and expanded it from 100% to 138% FPL as the ACA allows Dan Derksen MD

17 Pre-ACA 2012 AZ Health Coverage Payer Source # Arizonans %AZ Pop Employer Sponsored Insurance 3,300, % Medicaid (AHCCCS)/CHIP (KidsCare) 1,200, % Medicare 800, % Uninsured 1,200, % Total Pop. Arizona 6,500, % Adapted by

18 How Arizona Cut Its Uninsured AHCCCS AZ Medicaid <138% FPL ($33,948 for a Family of 4) July-Sep 2013 to Oct 2016 Net Gain AZ MARKETPLACE % FPL ($33,948 - $98,400 Family of 4) OE-3 Effectuated Enrollment* Mar 31, ,000 AZ <26 Parents Plan +70, ,000 Arizona Total: +850,000 KidsCare/CHIP restored 09/2016: +15,000 Eligible Arizona Children Age <19 years with family incomes between % FPL *Effectuated enrollment are those enrolled and paying premiums. CHIP = Children s Health Insurance Program, called KidsCare in Arizona Accessed 04/26/17 at: 1. AZ KidsCare/CHIP: 2. AHCCCS/Medicaid: 3. Effectuated Enrollment (pd premium):

19 YES from Premiums Doubled (ex. 25 y.o. Non-Smoker, Silver Plan AZ) AZ County Avg. Monthly Rate Increase Average %Increase Maricopa $206 $386 $180 87% Pima $190 $274 $84 44% Gila, Pinal $219 $453 $ % Apache, Navajo, Coconino, Mohave $275 $501 $226 82% Yavapai $294 $586 $292 99% Yuma, La Paz $261 $593 $ % Santa Cruz $190 $395 $ % Cochise, Graham, Greenlee $238 $486 $ % 2016 AZ Marketplace Plan Rates: AZ Marketplace Plan Rates:

20 Total # Selected Market Plans Avg. Ttl Prem/Mo (Insurer Gets) Avg APTC Mo (Fed Subsidy Pays) Avg Prem Mo after APTC (Enrollee Pays) #Received APTC Subsidies (% of Ttl Enrollees) #Received APTC + CSR Subsidies (% Ttl Enrollees) # Paid Full Premium (% Total Enrollees) AZ 2016 AZ 2017 US 2016 US ,066 $324/mo $204/mo $120/mo 196,291 $611/mo $521/mo $104/mo 150,269 (74%) 155,754 (79%) 11,081,330 $397/mo $291/mo $106/mo 9,389,609 (85%) 12,216,000 $476/mo $383/mo $106/mo 10,101,808 (83%) 94,463 (47%) 100,316 (51%) 6,400,000 (57%) 7,500,000 (61%) 52,797 (26%) 40,537 (20%) 1,691,721 (15%) 2,114,192 (17%) But low-income Arizonans were shielded from total premium increases because of the ACA subsidies! APTC = Advance Premium Tax Credit Subsidy CSR = Cost Sharing Reduction Subsidy Dan Derksen MD

21 Low income Arizonans shielded from total premium increases because of the ACA subsidies 4% enrollment increase 2016 to 2017 in those getting APTC 6% enrollment increase for those getting APTC + CSR 23% enrollment decrease for those not receiving subsidies APTC = Advance Premium Tax Credit Subsidy CSR = Cost Sharing Reduction Subsidy Sharply cutting subsidies for the poor, by $1.5 trillion over 10 years as per the AHCA, will increase the uninsured, shift costs to individuals, families, & health providers, and worsen health outcomes Dan Derksen MD

22 If the American Health Care Act were enacted as is, it would End Medicaid/AHCCCS for 380,000 in AZ Cut $2.5 billion in federal funding to Arizona Shift $0.5 billion/yr federal costs to AZ to cover 300,000 childless adults (<100% FPL) Force 80,000 off AHCCCS ( % FPL) Increase Arizona uninsured to pre-aca levels (to 1.2 million uninsured from 750,000) 05/24/2017 Bob Christie AP, Arizona Daily Star published 03/18/17: Dan Derksen MD