Loss of super majority in the SenateSupreme Court challengePresidential election

Exchanges: Who will run them? Will they open on time?Individual mandate: Will it work?Employer mandate: Will they hang in there?Medicaid expansion: How many states opt out?Lawsuits: contraception, employer mandate, subsidies

It became health “insurance” reformWhat it does not do: Address the problems of cost and access (Price x Units = Costs)

What we’re up against

State’s reluctance to expand MedicaidLow-tax, low-service political culture: 47th in tax expenditures per capitaBudgetary pressures

Uninsured rate of 23.7% cut in half10% in rural counties; 11% in urban counties; 9.5% in suburban countiesIf Medicaid is not expanded, uninsured rate would be cut by one-quarter

Fact: Law was shaped and largely paid for by the health-care industry Prediction: Health-care lobbyists won’t let the law die

Feds to the statesStates to hospital districts (especially on ACAInsurance companies (and providers) to employersEmployers to employees

High-deductible health plansAccountable care

Overuse of technologyMarket powerHigh prices

Proton therapy: Average $63,511Radiation therapy: Average $36,808

It’s the pricesIt’s the prices

Fewer businesses offer health insuranceHigh poverty: 1 out of 3 counties has at least 20% below the federal poverty line

25% of Texans have unmet medical needs, which leads the nation

Health Care Cost Growth Affects Living Health Care Cost Growth Affects Living StandardsStandards Family of four with employer

coverage—income increased from $76,000-$99,000 (1999-2009)Health care spending costs consumed almost all

Premiums $490-$1,115/mo.Out of pockets $135-$235/mo.

If health care costs had increased at rate of inflation, family would have had additional $545/mo. (vs. $95)Even $95 was “artificial”—tax collections insufficient to cover increases in Federal health care spending

1 out of 4 are 60 years or older

Primary care increase, 21%; overall increase, 36%

16,830 primary care physicians in active practice in 2009

68 per 100,000 pop81:100 K is national average118 of 254 counties are full HPSAs26 counties had no primary care physicians in 2009

…until the 82nd legislature gutted the programs

Texas MDs: 202/100K; U.S. 257/100KShortages in 36 out of 40 medical specialties

45% of med students leave state38% of THOSE preferred not toMost who leave do not return$168,000 state investment in each is lost

Hospitals: 8% Medicaid cut in 2011, 2% in 2009Hospitals: DSH payments going away, but state refuses to expand MedicaidHospitals: $19 billion in Medicare cuts over the next 10 years; Baylor takes $900 million hitPhysicians: 2% cut in Medicaid in 2011Physicians: SGR is up again in December 2012

$52 billion in federal funding this decadeEach $1 generates an additional $2Will cost Texas hospitals $25 billionPenalties for Texas businesses: $299-$448 million annuallyNet of $900 million per biennium savings from state-funded programsExpansion = 231,000 new jobs by 2016

Number of insured grows 50%, if Perry relentsWaits for new patients could be 90 days

AHRQ: Texas is dead last among the 50 states

The report is “fake and false," and "this federal government ... doesn't like Texas to begin with."

Uninsured population, and children specificallyNumber of executionsAmount of carbon dioxide emissionsToxic chemicals released into waterPopulation with food insecurity (2nd) Population – and children – below FPL (4th)Among U.S. metro areas: 4 of the 5 worst poverty rates; 12 out of 20 worst uninsured rates

Per capita spending on mental healthPercent of adults with a high school diplomaPercent of non-elderly women with health insuranceWorker’s compensation coveragePercent of women getting prenatal carePercent of poor covered by Medicaid (49th)Average credit score (49th)Percent with employer health insurance (48th)

2020: 97% of population growth in Texas will be non-white 5 million more residents50% of public-school enrollment is HispanicHispanics will exceed whites by 2020 and exceed 50% by 2040Hispanic average age: 26. Whites: 40

Nearly half say cost burden is “very serious”1 out of 3 uninsured; 1 out of 4 forego care Half are on Medicaid or eligible for itNearly half say care was poorly managedMore likely to wait for test results or have access to latest technologyElderly less likely to be on MedicareUndocumented ineligible for public insuranceCommunication and cultural gaps

NPR/Harvard/RWJF, Sick in America, May 2012

steve@unitedstatesofhealth.com(817) 605-0931Speech based on the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking UsBack of your business card: “eBook” means you want a free copy of How Health Reform Affects Texas; “Speak” means you would like to talk to me about addressing another group