The Truth About Health Reform: What It Means To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL...

October, 2010October, 2010 EQUAL Health NetworkEQUAL Health Network 11

The Truth About Health Reform:What It Means To Us

Ellen R. Shaffer PhD MPHJoe Brenner MA

EQUAL Health Networkwww.equalhealth.info

415-922-6204 [email protected]

October, 2010


EQUAL

EEquitable, quitable, QQuality, uality, UUniversal, niversal, AAffordabffordablle health caree health care

Center for Policy Analysis, anchor Center for Policy Analysis, anchor Network for progressive policy and advocacyNetwork for progressive policy and advocacy– Links: Labor, Public health, women, seniors, faith Links: Labor, Public health, women, seniors, faith

groupsgroups– Policy-makersPolicy-makers

ForumsForumsPolicy StatementsPolicy Statements


EQUAL’s Program:Making Health Reform Work

EducateEducate

ImplementImplement

ImproveImprove


How We Got Here:The Problems

The Affordable Care Act:What It Does

Making it Work

Building for the Future


How We Got Here:Historic Achievement

Congress has passed the most substantial Congress has passed the most substantial health reform since Medicare and Medicaid in health reform since Medicare and Medicaid in 19651965

Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act (ACA)(ACA)

The new law takes important steps to expand The new law takes important steps to expand coverage and improve quality, and begins to coverage and improve quality, and begins to control costscontrol costs


The Problems


People Are Suffering

50 million in U.S. uninsured

6.7 million uninsured in California

44,000 deaths each year due to lack of health

insurance– 1 person died every 12 minutes

60% of U.S. bankruptcies due to health costs– 75% of medical bankruptcies happen to people with

health insurance


52%

56%

60%

64%

68%

72%

1979 1985 1991 1997 2003Per

cen

t co

vere

d b

y o

wn

em

plo

yer

insu

ran

ce

Private employer-provided health

insurance

The Great Risk Shift in Health Care69.0%

54.9%

Over 15 percentage point decline

Source: Economic Policy Institute, State of Working America, 2006/2007


Insurance, Access, Costs – Costs Increase, Coverage Decreases

Private for-profit insurance companies Private for-profit insurance companies face incentives to avoid spending face incentives to avoid spending premiumspremiums– Identify and avoid “risky” patientsIdentify and avoid “risky” patients– Exclude pre-existing conditionsExclude pre-existing conditions

Insurance companies run up Insurance companies run up administrative costs to avoid “expensive” administrative costs to avoid “expensive” enrollees (sick people)enrollees (sick people)


ACA: The Gains Expanded Coverage and Access

Improving Quality

Consumer Protections

ALL = Lower CostsHow Will We Benefit?How Will We Benefit?


ACA Benefits Phased In 2010-2020

2010-20132010-2013– Consumer protectionsConsumer protections– Affordability and quality improvementsAffordability and quality improvements

2014: Major coverage expansions2014: Major coverage expansions– Health Insurance ExchangesHealth Insurance Exchanges

For individuals, small business employeesFor individuals, small business employeesIndividual Mandate, Employer contributionsIndividual Mandate, Employer contributions

– Medicaid ExpandedMedicaid ExpandedEveryone up to 133% of poverty levelEveryone up to 133% of poverty level

2020: Medicare drug price “doughnut hole” gone 2020: Medicare drug price “doughnut hole” gone


Immediate Improvementsin 2010

Coverage:Coverage:– New High Risk PoolNew High Risk Pool– Covers Young Adults through Age 26 on Covers Young Adults through Age 26 on

parentsparents’’ coverage coverageQualityQuality– First dollar coverage of preventive careFirst dollar coverage of preventive care– Increased funding for Community ClinicsIncreased funding for Community ClinicsStops Insurance Abuses:Stops Insurance Abuses:– Discrimination against children with pre-Discrimination against children with pre-

existing conditions prohibitedexisting conditions prohibited– Rescissions Illegal (withdrawal of care)Rescissions Illegal (withdrawal of care)– Bans lifetime limits on coverage Bans lifetime limits on coverage


Immediate Improvements

(cont.)

Affordability:Affordability:– Small business tax credits of up to 35%Small business tax credits of up to 35%– Rebates begin to close the Medicare Part D Rebates begin to close the Medicare Part D

Doughnut HoleDoughnut Hole– Reduces cost of early retiree coverageReduces cost of early retiree coverage


Insurance Exchanges: WhoState-based Exchanges begin in 2014

Uninsured individuals, self-employed and small businesses can buy coverage

NOT FOR MEDICARE!!

Workers can opt-out of employer-based coverage and seek a voucher if cost is between 8% and 9.8% of income

Safety net for insured who lose a job

Est. 2.4 million eligible in CA

Applies to Members of Congress

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Cost Control: Regulating Premiums

Expanding Public Health Protecting Medicare

Improving Quality

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What Happens to Medicare?


3 Facts – The New Law Will:

1. Improve many Medicare benefits Quality Improvement Programs set models

for health care system NO CUTS in basic Medicare benefits

2. Extend Medicare’s solvency by 12 years to 2029.

3. Help people obtain long-term care at home.

NCOA


The A-B-C-D’s of Medicare

October, 2010 EQUAL Health Network 20

Medicare Part A Trust Fund

Pre-health reform: 2017 projected insolvency date

Assets as a share of annual spending:

Post-health reform: 2029 projected insolvency date

Projection: Health reform legislation will extend the life of the Medicare Part A Trust Fund from 2017 to 2029

Exhibit 14

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Part D Donut Hole

In 2007, over 8 million seniors hit the “doughnut hole”

Costs discourage drug use by about 14% –threat to managing chronic diseases like diabetes, high blood pressure


Other Improvements forSeniors

New protections against elder abuse, neglect, financial exploitationBetter training for workers caring for seniorsNursing home quality improvementsHelp to keep premiums down for early retireesBonuses for primary care doctors (other doctor payment issues not addressed)


How Will It Be Paid For?


ACA: The Gains Expanded Coverage and Access

Improving Quality

Consumer Protections = Lower Costs


Making It Work:Implementing the Law


California ReformsCreate a Transparent Insurance Market

Create an Insurance Exchange:Create an Insurance Exchange: transparent, transparent, consumer-friendly, easy-to-use, fairly governed, consumer-friendly, easy-to-use, fairly governed, negotiates to provide the best value to negotiates to provide the best value to consumers:consumers: – AB 1602 (Bass) & AB 1602 (Bass) & SB 900 (Alquist)SB 900 (Alquist)



Reproductive Health – Retreat from Reproductive Health – Retreat from current lawcurrent law

Immigrants’ inclusion: Allow to purchase Immigrants’ inclusion: Allow to purchase thru Exchangethru Exchange

AffordabilityAffordability

State options for innovative approaches State options for innovative approaches – Single payerSingle payer


Single Payer: What it Is and Why It Is Still on the Table

A government-sponsored system like MedicareA government-sponsored system like Medicare

Everyone automatically covered, most cost Everyone automatically covered, most cost efficient, contributes to social & economic equity, efficient, contributes to social & economic equity, good outcomes…good outcomes…

Gives government the authority to constrain Gives government the authority to constrain health care spendinghealth care spending


What To Do Now

Get the facts about the lawGet the facts about the law

Spread the work: tell Union Spread the work: tell Union members, friends and familymembers, friends and family

Make It WorkMake It Work

Build for the futureBuild for the future


Work with EQUAL

Join the EQUAL ListservJoin the EQUAL Listserv– Send a blank message toSend a blank message to

[email protected]@list.equalhealth.info

See our website:See our website:– www.centerforpolicyanalysis.orgwww.centerforpolicyanalysis.org

Thanks for contributions to this presentation to: Keely Thanks for contributions to this presentation to: Keely Monroe, Lisa Kernan Social Justice Fellow; EQUAL partners Monroe, Lisa Kernan Social Justice Fellow; EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason; and Jacob HackerAdelson, Lee Lawrence, Robert Mason; and Jacob Hacker


Thank YouFor Making History!

The Truth About Health Reform: What It Means To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL...

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