Health Care Reform Implementation. August 4, 2013

Transcription

1 Health Care Reform Implementation August 4, 2013

2 How We Got Here Historical Perspective 1912 Former President Theodore Roosevelt campaigns on health care reform President Franklin Roosevelt opts to push for Social Security first, health care reform second 1945 President Harry Truman calls on Congress to create national insurance program for those who pay voluntary fees 1960 President John F. Kennedy makes health care a major campaign issue, but nothing happens 1965 President Lyndon Johnson convinces Congress to pass two landmark pieces of legislation Medicare and Medicaid

3 Historical Perspective - Highlights 1974 President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance 1976 President Carter pushes a mandatory national health plan 1986 President Ronald Regan signs COBRA 1993 President Bill Clinton attempts to develop a universal health care coverage plan 1997 President Clinton signs legislation creating the State Children s Health Insurance Program

4 2007 President George W. Bush adds prescription coverage to Medicare 2010 President Obama gets the Affordable Care Act passed without Republican support

5 Increasing costs Why Now?

6 Per Capita Spending - PPP Adjusted $8,000 $7,000 Total Health Expenditure Per Capita, U.S. and Selected Countries, 1970, 1980, 1990, 2000, 2008 $6,000 $5,000 $4,000 $3,000 $2, $1,000 $- Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: /data en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates figured for Belgium are OECD estimates. Numbers are PPP adjusted. Break in Series AUS (1998); AUSTRIA(1990); BEL(2003, 2005); CAN(1995); FRA(1995); GER(1992); JAP(1995); NET(1998, 2003); NOR(1999); SPA(1999, 2003); SWE(1993, 2001); SWI(1995); UK (1997. Starting in 1993 Belgium used a different methodology.

7 Why Now Increasing Number of Uninsured 2011 nationally decreased from 16.3% to 15.7% 47.9 million 2011 California increased from 19.4% to 19.7% 7.4 million residents 15% of all uninsured

8 Health Insurance Coverage in the U.S., 2010 Uninsured 16% Employer- Sponsored Insurance 49% Medicaid 17% Private Non- Group 5% Total = million Medicare 12% * Medicaid also includes other public programs: CHIP, other state programs, military-related coverage. Numbers may not add to 100 due to rounding. SOURCE: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.

9 Health Insurance Coverage of the Nonelderly Population, 2010 Private Nongroup 5.5% Million SOURCE: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.

10 Government Programs Medicaid Largest public insurance program in US A State and Federal partnership Covers more than 60 million low income individuals Families and children The elderly People with Disabilities Eligibility rules different for each state Benefits differ by state, but Certain benefits are available in every state ACA will expand options for community-based care as an option to nursing homes 10

11 Government Programs Medicare Health insurance for people aged 65 and older, people under the age of 65 with certain disabilities and people of all ages with End-Stage Renal disease Comprehensive coverage Four parts Part A inpatient care Part B doctors and preventative service Part C Usage of private companies for benefit coverage Part D prescription drugs

12 Affordable Care Act Overview: More than 90 provisions to be implemented between 2010 and 2018 Major Provisions focus on Expansion of coverage Controlling health care costs Improving health care delivery system Consumer protections Other provisions include Wellness and prevention Long-term care Workforce development 12

13 Who Won Short term Children with pre-existing conditions Young Adults who were able to remain on parents policy Uninsured Long Term All Americans Reduced costs Better outcomes All individuals with pre-existing conditions

14 Summary of Provisions Expansion of Public Programs State Health Insurance Exchanges Changes to Private Insurance Individual Mandates Employer Requirements Prevention and Wellness

15 Supreme Court Decision Two main provisions were at issue Individual mandate Medicaid Expansion Court decision Mandate was constitutional States could not lose existing Medicaid funds should they choose not to accept expansion funds/requirements

16 Consumer Protections Prohibiting discrimination due to pre-existing conditions or gender Eliminating annual limits on Insurance Coverage Ensuring Coverage for Individuals Participating in Clinical Trials

17 Other Benefits Improving integration between hospitals and physicians Increasing access to affordable care Paying physicians based on value not volume Moving Care to outpatient setting

18 Health Exchanges Quasi-governmental organization marketplace Contract with Plans Standardized benefits cost-sharing Subsidies available based on income In California 3 tiers of plans

19 Resources Kaiser Family Foundation California Healthcare Foundation

20 Questions and contact information Sherri Sager Chief Government Relations Officer Lucile Packard Children s Hospital ssager@lpch.org