The Patient Protection and Affordable Care Act

Transcription

1 The Patient Protection and Affordable Care Act Implications for those with Disabilities University Center of Excellence in Developmental Disabilities Rio Rico, AZ, April 13, 2013 Jonathan Weisbuch, MD, MPH ; cell

2 Agenda Why are we Here? Problems in US Health System How did we Get Here? History leading to ACA How Does our System Work? System of Care: Costs & Benefits; Implications for Disabilities Where Do We Go from Here? Does ACA Address the Problems? Does it Improve the SYSTEM for DDs? Is it a Bridge to the FUTURE?

3 Why are We Here? Problems Everyone is Frustrated: Docs, Pts,and Hospitals US ranks 37th among nations Quality Access 50 million Americans are Uninsured Cost Too much Service, not enough Benefit 150,000 unnecessary deaths a year Infant Mortality: High, especially among Minorities Life Expectancy: Below Japan, Europe, Canada $2.7 Trillion (18% of GNP) and rising

4 Before Discussing the Patient Protection & Affordable Care Act These Myths are not True!

5 ACA is NOT: Socialized Medicine or a takeover of Medical Care The Greatest Assault on Freedom in our Lifetime A way to Ration Medical Care A Death Panel Bill A plan to Reduce Medicare Services A Job Killing Bill Going to Increase State Medicaid Costs greatly Going to Degrade Clinical Care Going to Increase Medicare Premiums by 300% These are LIES and Propaganda! Created by those who wish to return to a Previous Age, or Worse

6 How Did We Get Here? A short History John Adams: Merchant Seaman Act, 1798 Dorothea Dix: Presidents Fillmore and Pierce Theodore Roosevelt: FDA, Bull Moose Party FDR: Soc. Sec. but no Health Care (1937) Harry Truman: Democratic Failure ( ) Lyndon Johnson: Medicare & Medicaid (1965) Barack Obama: Affordable Care Act, 2010

7 ACA Changes the System No Preconditions for kids, now; all in to 26 y.o.s now covered by Parent s Ins. No Caps on Coverage: Now Prevention Services for All: Now High Risk Pools: Now 80 to 85% of Premiums for Care: Now Insurance Exchanges: 2014 Expand Coverage for 20 to 30 million: 2014 Requires Insurance for All by 2014 Premium increases > 10%, are Challenged

8 Essential Elements (A) Ambulatory Patient Services. (B) Emergency Services. (C) Hospitalization. (D) Maternity and Newborn Care. (E) Mental Health & Substance Use Disorder Services, including Behavioral Health treatment. (F) Prescription Drugs. (G) Rehabilitative & Habilitative Services & Devices. (H) Laboratory Services. (I) Preventive & Wellness Services & Chronic Disease Management. (J) Pediatric services, including Oral and Vision Care.

9 Essential Elements for DD (A) Ambulatory Patient Services. (B) Emergency Services. (C) Hospitalization. (D) Maternity and Newborn Care. (E) Mental Health & Substance Use Disorder Services, including Behavioral Health treatment. (F) Prescription Drugs. (G) Rehabilitative & Habilitative Services & Devices. (H) Laboratory Services. (I) Preventive & Wellness Services & Chronic Disease Management. (J) Pediatric services, including Oral and Vision Care.

10 How does the System Work? Cost: $60 B $50 B $700 B $1,000 B $350 B $65 B Number: 315 million 15 million runs 1,200 million MD visits/yr 38 million Admits/ Yr 10 million Admits/Yr 3 million Patients C O M M U N I T Y PH & Prev EMS Prim Care Pharmaceuticals: Ambulatory Care Sec Care Hospital Care Tert Care ICU LTC Care --> $250 billion Administrative Overhead --> $650 billion (25%) Total Costs: --> $2,600 billion (18% GNP) Home Care

11 ACA Impact on Population Served Who Generates the Costs Population Distribution 16% 14% 14% 1.6% Healthy Insured 58% % Health Expenditure (2014) 4% -> 2% $550 billion 21% $1.5 trillion 60% $365 billion 15% > Insured (Healthy): 165 mil --> 180 Insured (Unhealthy): 42 mil --> 50 Medicare, Elderly: 42 mil --> 45+ Medicare, SSI: 4.8 mil --> decline Uninsured: 48 mil ---> 20 mil (±) Medicaid: 40± mil --> 50 mil (±) (15% --> 16% of population) 30% of 310 million (100 M) uses 85% of $2.7 T ($2.3 T) ACA Adds Preventive Services and Cost Controls

12 ACA Impact on Costs in 1 o Care & Hospital Sector? TIME Magazine Bitter Pill C O M M U N I T Y Ambulatory Prim Care Care Sec Care Hospital Care Tert Care (ICU) Steven Brill March 4, 2013 Community Hospitals: 4,973 Hospital Beds : 797, Admissions: 36,565,000 Expenditures: $773.5 Billion

13 Hospital Costs that can be Reduced (some Examples) Service United States First World Nations Avg MRI $ 1,121 $ 500 Appdix 13,851 4,000 C-Sx 15,041 5,000 Hip Rx 40,364 14,300 By-Pass 73,420 35,400 ACA may be unable to Reduce the Administrative Overhead of up to $650 B

14 What does the Future Hold? Health Care will continue to Evolve Merchant Seaman 1798 Dorothea Dix 1853 Medicare/ Medicaid 1965 Affordable Care Act 2010 After 2014?

15 The Future? Little Change this Session; but beyond 2014? If Congress stays split; NO Change Congress -> Red Congress -> Blue Republicans may Repeal ACA; Privatize Medicare or Eliminate Medicaid Democrats may Expand the ACA; or even push for Medicare for All; Eliminating Medicaid A Topic for Discussion

16 Problems Remain Many will Remain Uninsured Costs may Continue to Rise Insurance Industry has Power Individuals have Limited Control HHS Leadership is Essential To Promote Quality To Hold Costs Down To Expand Coverage To Empower Patients and Providers

17 Conclusions US History: Many Health Care Milestones US Health System Problems: Cost, Quality, Access Affordable Care Act: Deals with these Problem Services have Improved for Everyone, especially Disabled ACCESS to Care has expanded to the Uninsured & Disabled COSTS appear to be coming down The Future is Clear (maybe): Benefits will Remain; BUT Universal Coverage may still be far Ahead.

18 Questions? & Discussion

19 WHERE Do WE Want to BE? (Universal Coverage Goals) Access for 315 million Cost Reduction to 12% GDP Quality Improvement: Longer Life, Lower Infant Mortality, Lower Chronic Disease by Age Expanded Primary Care More Preventive Services

20 M EDI CAR E - FOR - A LL C OULD R ESOLVE THE M any Current ACA P roblem s No Mandate, Universal Coverage, No Medicaid Uniformity of Services, Nationwide No Debate over Contraception Services Uniform Payment Schedule: Admin Costs DOWN Uniform Quality Standards, Nationwide Uniform Access to Care, Nationwide Costs & Reimbursements Managed Regionally National Enforcement of Standards TRUST FUND Income from many sources: FICA, Wall Street, General Revenue

21 2015 is Where We Begin Medical Costs 1,000,000 $450 B $100 B $350 B $400 B 309,500,000 $300 B $20 B $250 B $30 B $250 B $70 B $2,000 B

22 If Medicare-for-All is Enacted In 2016 Population Uninsured Age Gps ,386,118 0% ,532,368 13% 6,179, ,884,743 18% 12,404, ,176,375 30% 13,512, ,100, ,211,683 0% ,887,656 0% Total Population: 312,078,943 Female Male Total Uninsured 27,996,950 % Uninsured 9.0% Annual Cost Billions $450 $ 16 $120 $686

23 In 2016 to 18: Add 50 to 65 yr olds 2015 Next to 2 yrs Population Uninsured Age Gps 2014 to ,386,118 0% ,532,368 0% ,884,743 18% 12,404, ,176,375 30% 17,612, ,211,683 0% ,887,656 0% Total Population: 312,078,943 Female Male Total Uninsured 30,017,742 % Uninsured 9.6% Total Reduction in Uninsured: 19,769,134 6,179,208 Annual Cost Billions $465 $330 $ 16 $120 Total $931

24 : Add 35 to 50 year olds 2017 to 2018 Years 5 & 6 Population Uninsured Age Gps 2016 to ,386,118 0% ,532,368 0% ,884,743 0% ,176,375 30% 17,612, ,211,683 0% ,887,656 0% Total Population: 312,078,943 Female Male Total Uninsured 17,612,912 % Uninsured 5.6% Total Reduction Reduction in in Uninsured Uninsured: 32,173,964 12,404,830 Annual Cost Billions $490 $332 $355 $ 16 $120 Total $1,186

25 In 2021: Add 20 to 35 year olds Final 2 years Population Uninsured Age Gps 2018 to ,386,118 0% ,532,368 0% ,884,743 0% ,176,375 0% ,211,683 0% ,887,656 0% Total Population: 312,078,943 Female Male Total Uninsured - % Uninsured 0.0% Annual Cost Billions $504+ ($300) $336 $355 $ 211 $120 Total $1,826 Total Reduction in Uninsured Uninsured: 12,404,830 49,786,876 17,612,912

26 Corp Payroll Tax: 7% Tax on ALL Income: 3% Premiums Input & Output to MTF (With Competition) $300 $550 Gov t Funds $2,300 Billion $330 $720 Medicare & Medicaid Other (WS) $450 Insurance Industry Providers $500 Drugs Other $250 $400 Hospitals $750 $ in Billions Admin 5%

27 Further Questions? or Discussion