Health Reform:Why, What, How …

Liz BaxterMay 18, 2013liz@wecandobetter.org

Total Expenditure of Health as Share of U.S. GDP

Current Projected

Source: Organization for Economic Co-Operation and Development, OECD Health Data, Feb 2011;U.S. Congressional Budget Office, The Long-Term Budget Outlook, June 2010, p. 42

%

Medicare & Medicaid Spending

Medicare & Medicaid Spending

U.S. Nondefense Discretionary Spending

Bill

ion

s

What Influences Overall Lifetime Health Status?

Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83

Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83

Lifestyle & Behavior 40%Lifestyle & Behavior 40%

Human Biology 30%Human Biology 30%

Medical Care 10%Medical Care 10%

EnvironmentalFactors 5%EnvironmentalFactors 5%

Social Factors 15%

Social Factors 15%

IJFALTIJ CABF RFFQPM

IJFALTIJ CABF RFFQPM

The Triple Aim①Improved Health②Lower Cost③Better Experience of Care

Traditional Approach to Balancing Budgets

• Cut reimbursement• Cut services• Cut people

Major Elements of Reform

• Expansion of Medicaid eligibility

• Delivery System Reform• Health Insurance Exchange

Medicaid Expansion

• Traditional Medicaid• State and federal

partnership• Oregon Health Plan• Raising Income Eligibility

Oregon Health Plan

50% of babies born in Oregon

16% of Oregonians

85% of Oregon providers

11% percent of total state budget

40% are people of color

23

OR: Changing How Care is Delivered

Coordinated Care Organizations (CCOs)

• Reduce waste• Accountable for health

outcomes• Local decision-making• Align financial incentives• Create fiscal sustainability• Reduce disparities• Better coordination of care

Health Insurance Exchange

• Created by OR Legislature in 2011

• Public Corporation• 9 member board of directors• State option under

Affordable Care Act• Cover Oregon

(coveroregon.com)

Mission of Cover Oregon

Improving the health of all Oregonians by providing health coverage options, increasing access to information, and fostering quality and value in the health care system

ONE HOUSE ONE DOOR

IndividualsandFamilies

SmallEmployers

PORTAL

INFORMED DECISIONS ABOUT PREMIUMS VS. COPAYS

• No one can be denied, no lifetime limits

• Carriers must spend 80% of premiums on care

• Health plans held accountable for quality

• Essential health benefits: Ambulatory patient services

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

NEW HEALTH COVERAGE RULES

Prescription drugs

Rehabilitative and habilitative services and devices

Laboratory services

Preventive and wellness services, and chronic disease management

Pediatric services, including oral and vision care

HOW WILL COVER OREGONAFFECT ME?

ELIGIBILITY FORFINANCIAL ASSISTANCE

Carrier A

Carrier B

Carrier C

Carrier D

Platinum $400 $395 $450 $420

Gold $375 $375 $400 $380

Silver $350 $330 $380 $340

Bronze $325 $300 $340 $320

Carrier A

Carrier B

Carrier C

Carrier D

Platinum $400 $395 $450 $420

Gold $375 $375 $400 $380

Silver $350 $330 $380 $340

Bronze $325 $300 $340 $320

Carrier A

Carrier B

Carrier C

Carrier D

Platinum $400 $395 $450 $420

Gold $375 $375 $400 $380

Silver $350 $330 $380 $340

Bronze $325 $300 $340 $320

Carrier A

Carrier B

Carrier C

Carrier D

Platinum $400 $395 $450 $420

Gold $375 $375 $400 $380

Silver $350 $330 $380 $340

Bronze $325 $300 $340 $320

Traditional Choice Carrier Choice

Metal Tier Choice Broad Choice

LONG-TERMVISION

• Larger employers

• Additional products

• Coordinated care models

• Quality and value

• Buying power

The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.

--Thomas Alva Edison

Thank You

• Liz@wecandobetter.org• Healthreform.kff.org• Health.Oregon.gov• Oregon.gov/oha/oei/• CoverOregon.com