DRC Oct 2012 Without Cartoons

7/31/2019 DRC Oct 2012 Without Cartoons

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Health Care Issues and Legislation

Impacting Businesses Today Susan R. Bailey MD

October 17, 2012


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Percent Distribution of National Health Expenditures, by Sourceof Funds, 1960-2010

Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National HealthStatistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and sourceof funds, CY 1960-2010; file nhe2010.zip).

Notes: Medicare and Medicaid were enacted in 1965; by January 1970, all states but two were participating in Medicaid. Starting with 2009 NHE data, CMSrevised the Source of Funds measure from a classification that was either public or private to one that is more program -based. CMSs rational was that

financing arrangements have become more complex and the lines between public and private payers have become blurred as a sin gle program may havefederal, state, local, and private funding. As a result, the category Other Third Party Payers includes both public and priv ate programs and also someprograms that receive funds from both public and private sources, such as Workers Compensation, Worksite Health Care, and Sc hool Health. Other Pub. Ins.Programs includes CHIP, the Department of Defense, and the Department of Veterans Affairs.
http://www.cms.hhs.gov/NationalHealthExpendData/http://www.cms.hhs.gov/NationalHealthExpendData/


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Health Insurance Coverage of the Nonelderly Population, 2010

266.0 Million

SOURCE: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.

Private Non-group 5.5%


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Average Annual Worker and Employer Contributions toPremiums and Total Premiums for Family Coverage,

1999-2011

* Estimate is statistically different from estimate for the previous year shown (p


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Distribution of Health Coverage Costs as a Percentage of Payroll for Employees with Access to Coverage, 1999-2010

Source: Kaiser Family Foundation calculations based on data from the National Compensation Survey, 1999-2010,conducted by the Bureau of Labor Statistics.


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Uninsured Rate by Worker Characteristics, 2010

10%

11%

6%

13%

26%

34%

20%

30%

Based on workers ages 18 to 64. White collar includes all professionals and managers; all otherworkers classified as blue collar. Industry groups are not inclusive of all industry types.Source: KCMU/Urban Institute analysis of 2011 ASEC Supplement to the CPS.

Smaller Firms(< 100 workers)

Larger Firms(> 100 workers)

Firm Size

Not in unionIn union

UnionMembership

White collar

Blue collarOccupation

Education/Finance/Social

Service & Admin

Construction/Agriculture/Service

Industry


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The Number of Uninsured Adults Has Increasedin the Past Decade

27.833.3 34.9

41.2

8.58.0

8.6

8.0

2000 2004 2007 2010

Adults ChildrenIn Millions:

NOTE: Numbers may not sum to totals due to rounding.Source: Urban Institute analysis for KCMU, 2011. Based on data from the 2001-2011 ASECSupplement to the CPS.

41.343.4

49.1


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Expanding Health Coverage Under ACA

Medicaid Coverage(up to 138% FPL)

Employer-Sponsored Coverage

Exchanges(subsidies 139-400% FPL)Individual

Mandate

Health InsuranceMarket Reforms

Universal Coverage

Note: In 2012, 138% , FPL for family of 4 is $31,809 and 400% FPL is $92,200


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ACA is Expected to Substantially Reduce the Numberof Uninsured by 2019

57% 56%

11% 17%

12%

18%20%

8%

Without Health Reform With Health Reform

UninsuredUninsured

Employer-SponsoredInsurance

Medicaid/CHIP

Medicaid/CHIP

PrivateNon-group/Other

Employer-SponsoredInsurance

Exchanges/

Private Non-group/Other

Source: Congressional Budget Office, March 18, 2011

Total Nonelderly Population in 2019 = 282 million


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By 2014 all must purchase insurance or face a fine2014 1% of taxable income or $95.00

2015 2% of taxable income or $325.00

2016 3% of taxable income or $695.00/$2085.00 max

Companies with more than 200 workers mustautomatically enroll employees

Companies with more than 50 employees fined up to$3,000 per employee if not enrolled

Companies with fewer than 50 employees receivesome subsidies and tax breaks

Families earning less than $92,200/year receivesubsidies for health insurance

Effects of the Mandates


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Premium increase if dont qualify for subsidies Family of 4 earning more than $92K a year premiums and required coverage may increase

Tax increase0.9% Medicare tax hike on earnings over $200K

3.8% tax on investment income

40% tax on non-union, high-cost health plans

FSA contributions limited to $2,500/year

Fees passed on from pharma and insurancecompanies

Effects on the Currently Insured


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Effects on employers play or pay?Towers Watson/National Business Group for Health Survey Sept 2012

Play Continueas plan sponsor

for all employees

Play and redirect Change

contributions solow-paid

employees qualifyfor federalsubsidies

Selective play Limit eligibility to

employer planand direct others

to Exchanges

Pay and redeploy Discontinue

plan and providefinancial top-upfor employees

Pay Discontinueplan with no

accommodations


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Requirements for All Plans

The plan will be required to meet minimum (80% or 85%)loss ratio standards.

No waiting periods for coverage of more than 90 days

No lifetime coverage limitsRestrictions and phase-out (by 2014) of annual limits

No rescissions

Provide coverage for adult children up to age 26 (if noother coverage)


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Uniform explanation of coverage documentsand standardized definitions

Must contain:

No more than 4 pages At least 12-pt font

Disclosures in plainlanguage

Copay, deductible, etc listed Limitations and exceptions

listed Coverage fact labels for

common conditions


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Accountable Care Organizations

Common key elements:

Cost control Assumption of risk Data Collection

Managed patient care New payment models


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Medicare Shared Savings ACO Goal: Improve quality while lowering costfor specific patient population

Who can create an ACO?Physicians, network of physicians,partnership or joint venture with ahospital, or hospital-employed physiciansNew law bans physician-owned hospitals

Accountable Care Organizations


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How Many Could be Affected by theIndividual Mandate in 2016?

Projected Non-Elderly in 2016= 275 million

Source: Kaiser Family Foundation analysis; Congressional Budget Office; Jonathan Gruber

32 million previously uninsured affected by the mandate

24 million qualify for exemptions from the mandate

219 million insured by employers, Medicaid,Medicares disability coverage, or individualinsurance and not affected by the mandate


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What is theIPAB? Independent Payment

Advisory Board 15-member body

appointed by President

Have the authority todecrease Medicarereimbursement withoutCongressional OK

Physicians: 2015 Hospitals and nursing

homes: 2020


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Medicare Crisis

The Gap Continues to GrowMedicare Physician Payment Vs. Practice Costs


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Health Reform Competing ForAttention/Resources In a Crowded National

Agenda

Jobs and economy

Deficit reduction pressures Another debt ceiling event Rising energy costs Tax reform Entitlement reform Foreign policy challenges (Iran, Afghanistan, North

Korea)


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Resources for More Information

Kaiser Family Foundationhttp://www.kff.org

U.S. Census Bureauhttp://www.census.gov/hhes/www/hlthins/

American Medical Associationhttp://www.ama-assn.org

Texas Medical Associationhttp://www.texmed.org

The Commonwealth Fundhttp://commonwealthfund.org
http://www.kff.org/http://www.census.gov/hhes/www/hlthins/http://www.ama-assn.org/http://www.texmed.org/http://commonwealthfund.org/http://commonwealthfund.org/http://www.texmed.org/http://www.ama-assn.org/http://www.ama-assn.org/http://www.ama-assn.org/http://www.census.gov/hhes/www/hlthins/http://www.kff.org/

DRC Oct 2012 Without Cartoons

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