Health Policy in Kansas:

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

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

Kansas Grantmakers in Health Health Reform Resource Project 3

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

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

U.S. Uninsured Increasing (1999-2010) 17.0% 16.0% 15.0% 14.0% 13.0% 12.0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: U.S. Census Bureau, Current Population Survey Health Reform Resource Project 6

Kansas Uninsured Increasing (2001-2011) 14% 13% 12% 11% 10% 9% 2001/2002 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011 Source: KHI, 2012 Health Reform Resource Project 7

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

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

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

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

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International rankings Source: Commonwealth Fund Health Reform Resource Project 13

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

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

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

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

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

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Percentage of Uninsured is Lower than Ever 16% 15% 14% 13% 12% 11% U.S. Kansas 10% 9% 8% 2011 2012 2013 2014 2015 Source: U.S. Census Bureau American Community Survey Health Reform Resource Project 21

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

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Cost: Health Inflation is Moderating Health Reform Resource Project 24

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

Cumulative Increases in Health Insurance Premiums, General Annual Deductibles, Inflation, and Workers Earnings, 2011-2016 70% Overall Inflation 63% 60% Workers Earnings Single Coverage Deductibles, all Workers Single Coverage Premiums 50% 40% 30% 20% 10% 0% 19% 11% 6% 2011 2012 2013 2014 2015 2016 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, 2011-2016. Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 2011-2016; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2011-2016 (April to April).

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

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

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KanCare Expansion Health Reform Resource Project 33

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

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

Benefits of KanCare Expansion Health Reform Resource Project 36

Budget Neutral Health Reform Resource Project 37

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

Economic Stimulus Health Reform Resource Project 39

New Jobs Health Reform Resource Project 40

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

Kansas-Specific Plan Health Reform Resource Project 42

Financial Security for Families Health Reform Resource Project 43

Healthy Kansans Health Reform Resource Project 44

Advocacy Health Reform Resource Project 45

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For more information, contact: Sheldon Weisgrau Health Reform Resource Project 700 SW Jackson Street, Suite 600 Topeka, KS 66603 (785) 408-8008 HealthReformResource@gmail.com Twitter: @ACAResource Blog: http://healthpolicyrx.blogspot.com/ Health Reform Resource Project 47