NEW HAMPSHIRE HEALTH CARE PRESENT AND FUTURE
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- Annice Tate
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2 NEW HAMPSHIRE HEALTH CARE PRESENT AND FUTURE
3 DISCLOSURE Presented by the Granite State Chapter of Physicians for a National Health Program And New Hampshire Medical Society Single Payer Interest Group
4 Why is Health Care a Concern?
5 US Health Care Spending
6 Life Span Comparison Life Expectancy, 2005 (Data in Years) U.S. U.K. Germany France Canada Italy Sweden
7 Comparison of Outcomes Infant Mortality, 2005 (Deaths in first year of life per 10,000 live births) U.S. C an ad a A u stralia Italy G erm an y F ran ce Swed en
8 Insurance Agency Profits Graph
9 Insurance Company CEO Compensation
10 Administrative Cost Comparison Private insurers High Overhead
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13 70 The Epidemic of Underinsurance Number of people spending more than 10% of income on health care (Millions) Insured Uninsured Source: Too Great a Burden, Families USA, December 2007
14 Insurance Premiums Workers Earnings Inflation % 120% 100% Health'Insurance'Premiums Workers''Earnings Overall'Inflation 119% 80% 60% 40% 34% 20% 29% 0% Kaiser/HRET,Survey,of,Employer6Sponsored,Health, Benefits,, ,,Bureau,of,Labor,Statistics,, Consumer,Price,Index
15 State Total % Uninsured By State, 2005 Total Deaths By State Excess Deaths State Total # Uninsured by State, 2005 Total Deaths By State Excess Deaths AL 21.1% 13,219 1,031 MT 19.4% 2, AK 22.7% 1, NE 14.3% 3, AZ 24.7% 12,065 1,085 NV 21.2% 5, AR 23.0% 7, NH 13.1% 2, CA 23.9% 60,815 5,302 NJ 18.3% 15,884 1,084 CO 19.9% 8, NM 24.5% 4, CT 14.3% 5, NY 17.5% 34,496 2,254 DE 14.4% 1, NC 19.6% 20,085 1,461 DC 17.0% 1, ND 14.3% 1, FL 26.0% 41,739 3,925 OH 15.0% 25,911 1,463 GA 23.6% 21,387 1,841 OK 24.3% 9, HI 11.5% 2, OR 20.8% 7, ID 18.6% 2, PA 12.7% 27,620 1,344 IL 17.6% 24,694 1,626 RI 15.0% 1, IN 17.2% 14, SC 23.3% 11, IA 11.1% 5, SD 15.3% 1, KS 14.0% 5, TN 18.1% 15,344 1,033 KY 16.6% 10, TX 29.7% 44,056 4,675 LA 25.5% 11,940 1,104 UT 20.2% 3, ME 12.9% 2, VT 15.5% 1, MD 17.4% 12, VA 16.1% 15, MA 12.7% 11, WA 17.0% 11, MI 14.3% 22,570 1,218 WV 24.2% 5, MN 10.2% 7, WI 12.1% 9, MS 22.6% 8, WY 17.9% 1, MO 15.5% 13,
16 High Cost of Health Insurance Premiums: It s Even Too Expensive for the Middle Class Today National Average for Employer-provided Insurance Single Coverage Family Coverage $ 5,503 per year $15,073 per year Note: 31% high-deductible ($1,000-2,000) policies Source: Kaiser Family Foundation/HRET Survey of Employee Benefits, 9/27/2011
17 RISE IN PERSONAL BANKRUPTCIES 62% of personal bankruptcies are due to medical expenses and over 75% had health insurance at the outset of their bankrupting illness.* * Himmelstein, et.al. Am J Med, August, 2009
18 Bankruptcies Due to Uninsurance in the US
19 Bankruptcies Due to Uninsurance or Underinsurance in NH NH NH Medical Bankruptcies 2013 by Country Chapter 7 Percent due to medical Estimated Medical Bankruptcies BELKNAP-NH % 95.4 CARROLL-NH % 49.2 CHESHIRE-NH % 77.4 COOS-NH % 25.8 GRAFTON-NH % 56.4 HILLSBOROUGH-NH % 444 MERRIMACK-NH % ROCKINGHAM-NH % STRAFFORD-NH % SULLIVAN-NH % 42.6 Population ,408 1,321,000
20 CURRENT HEALTH CARE LAW AFFORDABLE CARE ACT Addresses Insurance Company Abuses Denial of Coverage for Preexisting Conditions Limits on Annual/Maximum Coverage Amounts Coverage for children under 26 years only if in college
21 10 Essential Benefits, but No Standard Benefit Package Eliminates Co-pays and Deductibles, but Only on Preventive Services Limits Insurers Overhead to 15-20%, but Lobbying Has Weakened Enforcement No Regulation of Premiums, Deductibles and CoPays
22 !! ACA!$!Subsidy!Availability!! Substantial!subsidies!are!available!through!the! Marketplace!for!those!at!100%$400%!of!federal! poverty!(fpl)!! Individuals:!$11,490!$!$45,960!! Family!of!4:!$23,550!$!$94,200!! Those!under!100%!FPL!are!not$eligible!for! subsidies!(assumed!to!be!covered!by!medicaid)!!
23 80 Millions Will Remain Uninsured (and Millions More Poorly Insured) Current law Millions PPACA Note: The uninsured include about 5 million undocumented immigrants. Source: Congressional Budget Office.
24 NH PHYSICIAN SURVEY 2007
25 NH PHYSICIAN SURVEY 2007
26 Affordable Care Act in NH Only one insurance company in the exchange (Anthem) Anthem does not cover all providers Traveling to providers may increase cost of obtaining medical care
27 WHY INSURANCE? Insurance is designed to compensate for an unlikely or unexpected event. Health insurance treats any illness or incident of health care as a loss. Insurance companies are profit making businesses and therefore to minimize losses there is an incentive to deny care.
28 Comparison of Health Care Options A system based on private insurance plans -- will not lead to universal coverage -- will not create affordable insurance A Medicare for All System -- can lead to universal, comprehensive coverage without costing more -- has the greatest potential to increase choice, improve quality and expand primary care -- can be financed fairly
29 Conyers HR 676 Expanded and improved MEDICARE-FOR-ALL Single Payer NH Care (55 Co-sponsors in House of Rep) Automatic enrollment Comprehensive benefits Free choice of doctor and hospital Doctors and hospitals remain independent Financed through progressive taxes Costs contained through capital planning, budgeting, quality reviews, primary care emphasis
30 Sanders (& McDermott): American Health Security Act S 915 (HR 1200) 1.Automatic enrollment 2.Comprehensive benefits 3.Operated by States using Federal standards 4.Free choice of doctor and hospital 5.Doctors and hospitals remain independent 6.Public agency processes and pays bills 7.Financed through payroll taxes
31 Essential Features of a Universal Health Care System Everyone Included Public Financing Public Stewardship Global Budget Public Accountability
32 SINGLE PAYER BENEFITS Comprehensive, universal system- covers all medically necessary services Costs consistent and controlled Simplified reimbursements one payment entity for health care providers; Hospitals guaranteed a secure, regular budget Payments according to ability to pay Not tied to employer and varying coverage
33 RESULTS OF SINGLE PAYER Improved health care- no delaying of care due to lack of insurance or underinsurance Improved health planning Public accountability for cost and quality Minimal bureaurocracy Uniform standards
34 VERMONT S PATHWAY TO SINGLE PAYER Elected Peter Shumlin governor: 11/6/2010 William Hsiao, Ph.D., Harvard economist, reports 3 options: 2/ Option 3: Public-private hybrid single payer Standard benefit package Uniform prices Administered by a public benefit corporation Pathway legislation passed: 5/25/11
35 A SINGLE PAYER PROGRAM FOR New Hampshire? Is possible within the Affordable Care Act Would provide coverage for all residents and providers Would require state legislation
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