Health Care Costs and the Long-Term Fiscal Imbalance
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Health Care Costs and the Long-Term Fiscal Imbalance Colorado Human Services Directors Association June 6, 2012
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Health Care Costs and the Long-Term Fiscal Imbalance. Colorado Human Services Directors Association June 6, 2012. Overview. The Federal Budget and Healthcare Costs The Affordable Care Act Reform Proposals What’s Coming Up. Growth of Government. - PowerPoint PPT Presentation
Transcript of Health Care Costs and the Long-Term Fiscal Imbalance
Health Care Costs and the Long-Term Fiscal Imbalance
Colorado Human Services Directors Association
June 6, 2012
Overview
The Federal Budget and Healthcare Costs
The Affordable Care Act Reform Proposals What’s Coming Up
2
Growth of Government
Federal Spending & the Political Party in Power
1945
1947
1949
1951
1953
1955
1957
1959
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500Democratic Controlled Congress Republican Controlled CongressSplit Congress Republican President Democratic President
Fiscal Years
Bill
ions
of C
onst
ant 2
005
Dol
lars
Source: OMB, Budget, Historical Tables, Table 1.3—Summary of Receipts, Outlays, and Surpluses or Deficits (−) in Current Dollars, Constant (FY 2005) Dollars, and as Percentages of GDP: 1940–2016
Social Security Act of 1965(Medicare)
Medicare Prescription Drug, Improvement, and Modernization Actof 2003and the Invasion of Iraq
America Recovery and Reinvestment Act of 2009
Patient Protection and Affordable Care Act of 2010
Gramm-Rudman-Hollings Balanced Budget and Emergency Deficit Control Act of 1985
Budget EnforcementAct of 1990
Deficit Reduction Act of 1993 2001 Invasion
of Afghanistan
Vietnam Conflict1960-75
Korean Conflict1950-53
End of WWII
End of Statutory Budget Controls 2002
20%
19%
23%
20%
12%
6%
42%
20%
4%
15%
12%
7%
Defense Other Discretionary Medicare and Medicaid Social Security Other MandatoryNet Interest
2010Source: CBO, Budget and Economic Outlook: Fiscal Years 2011 Through 2021, Historical Tables
Composition of Federal Spending(% of Total Outlays)
1970
Our Fiscal Future
Source: The Dartmouth Atlas of Health Care. (2009). The Policy Implications of Variations in Medicare Spending Growth. Link: http://www.dartmouthatlas.org/atlases/Policy_Implications_Brief_022709.pdf. Note: Data adjusted for age, race, and sex but not price. Category definitions as in source document.
Chart 1: Medicare Spending per Beneficiary, by Hospital Referral Region, 2006
National Average = $8,304
$7,500 – $8,000
$8,000 – $9,000
> $9,000
$7,000 – $7,500< $7,000
Not populated
Variations in Healthcare Spending
The ACA Dominos …
GI and Community
Rating
Mandates
SubsidiesExchanges
Cost cuts, Prevention,
Workforce, etc.
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Impact of ACA on Insurance Coverage
Pre-ACA 2016 2022Pre-ACA Medicaid/CHIP 34 32 32
Employer 153 159 162
Non-group 24 28 30
Uninsured 53 56 54
Total 267 273 282
Post-ACA (+/-) Medicaid/CHIP 17 17
Employer -4 -3
Non-group -2 -3
Exchanges 20 22
Uninsured -30 -33
# of Uninsured 55m 26m 27m
% of Eligible 81% 93% 93%
Comparison of Pre and Post ACA Premium Contributions*
$10,0
00
$15,0
00
$20,0
00
$25,0
00
$30,0
00
$35,0
00
$40,0
00
$45,0
00
$50,0
00
$55,0
00
$60,0
000.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Pre-ACAPost-ACA
10*As % of Income for Single Adult
Status of ACA Implementation
Immediate Benefits
2010
Delivery Reforms
2011-2014
Coverage Expansions2014-2017
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Simpson-Bowles Plan
Discretionary Spending Caps
Tax Reform to Reduce Rates
& Raise Revenue
Long-term Medicare “Doc
Fix” & IPAB
Additional Mandatory
Savings
Social Security Solvency
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The Ryan Budget
• Medicare Premium Support
• Medicaid Block Grants
• Individual Tax Credits
Healthcare
• Eliminate Corporate Tax
• Eliminate Deductions
• Lower Rates
Taxes • Social Security Reforms
• Discretionary Spending Caps
Other
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Key Medicaid Reform Proposals
Proposal Simpson-Bowles
WhiteHouse
Rep. Ryan
CBO Options
Global cap on Medicaid spending growth/Block Grants
√ √
Reform/reduce FMAP formula √ √
Reduce cap on State Medicaid provider fees
√ √
Increase reliance on managed care in Medicaid
√ √
Permit reductions in Medicaid eligibility thresholds
√
Expedite Medicaid waiver process √
The “Fiscal Cliff”
$221
$95$65
$65$26$11
$123
-$607 Billion in 2013
Bush Tax Cuts & AMT
Payroll Tax
Other Tax Ex-tenders
Sequester
Unemployment Benefits
Medicare Payments
Other
15
The Next Six Months
25 Day Lame Duck Session
Debt Limit Vote
Expiring Tax Cuts,
etc.
Sequester
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