Health Policy Elective Healthcare Reform

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Health Policy ElectiveHealthcare Reform

• Tom Norton

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Well Recognized Points

• Employers are tired of the rising costs of
  providing healthcare
• Employees are tired of having to pay out of
  pocket for shrinking coverage
• Federal and State governments are tired of seeing
  their own health bills go up as costs seem to be
  spiraling out of control
• There are too many people that fall through the
  cracks due to
• Lack of health insurance
• Inadequate health insurance
• Limited access to healthcare

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Health Care for All?

• There is a national consensus that healthcare
  reform is needed, but one major hindrance has
  been finding a middle ground that both the left
  and the right could agree upon

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The State of the Union for Health Care

• Highlights
• A conversation with Senators Bob Bennett (R-Utah)
  and Ron Wyden (D-Oregon)
• Panel 1 Innovation of the Future of Health Care
  (CEO of Johns Hopkins, Chief Medical Officer for
  Philips Healthcare, Former Commissioner USFDA)
• Panel 2 What Should Reform Look Like? (President
  of The Joint Commission, Executive VP of Social
  Impact, AARP, Chief of Medical Affairs, United
  Health Group)
• Remarks by Representative Frank Pallone

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Healthy Americans Act

• Originally introduced by Senator Rob Wyden
  (D-Oregon) as a step toward healthcare
  legislation
• It has since attracted bipartisan attention and
  is currently being spearheaded by a group of
  senators, most notably the aforementioned Senator
  Ron Wyden and Senator Bob Bennett (R-Utah)
• Its most prominent objective is provide
  affordable, high quality health coverage for all
  Americans

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Crossing party lines

• In addition to Senators Wyden and Robert F.
  Bennett, the Act is sponsored by Senators
• Lamar Alexander (R-Tenn.)
• Maria Cantwell (D-Wash.)
• Thomas R. Carper (D-Del.)
• Norm Coleman (R-Minn.)
• Bob Corker (R-Tenn.)
• Mike Crapo (R-Idaho)
• Judd Gregg (R-N.H.)
• Daniel Inouye (D-Hawaii)
• Mary Landrieu (D-La.)
• Joe Lieberman (I-Conn.)
• Bill Nelson (D-Fla.)
• Arlen Specter (R-Pa.)
• Debbie Stabenow (D-Mich.).

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Letter to President-Elect Obama

• The group sent a letter to Obama recommending
  seven goals for health care legislation
• Ensure that all Americans have health care
  coverage
• Make sure health care coverage is affordable and
  portable
• Implement strong private insurance market
  reforms
• Modernize federal tax rules for health coverage
• Promote improved disease prevention and wellness
  activities, as well as better management of
  chronic illnesses
• Make health care prices and choices more
  transparent so that consumers and providers can
  make the best choices for their health and health
  care dollars and
• Improve the quality and value of health care
  services.

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Healthy Americans Act Objectives

• guarantee private health care coverage for all
  Americans and allow them to choose the health
  insurance that is right for them
• provide health benefits equal to those that
  Members of Congress now enjoy
• modernize the employer-employee relationship
  regarding health care benefits making health care
  portable from job to job and even allow Americans
  to keep it between jobs
• provide incentives for individuals and insurers
  to focus on prevention, wellness and disease
  management rewarding Americans for maintaining
  healthy lifestyles
• establish tough cost containment measures that
  save 1.48 trillion over 10 years

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Basic Structure

• Reform by building on what works and improving
  what doesn't
• Individuals and families will continue to have
  private insurance policies that they can purchase
  from either their employer or one of their
  state's approved insurers.
• If you currently receive health coverage from
  your employer, you will still be able to do so,
  but your employer will no longer be in control of
  your health care decisions and if you lose your
  job, under the Healthy Americans Act, you won't
  lose your health insurance.
• The way it works, is that your employer will give
  you a raise equal to the amount he/she is
  currently paying for your health care coverage
  and the federal government will give you the tax
  deduction that your employer currently gets for
  providing you coverage.
• You will then have the option of choosing to
  either stay with your current employer-provided
  plan or selecting a different plan that makes
  better sense for you and your family.
• Insurance companies will be required to charge
  subscribers a standard rate and will no longer be
  allowed to deny coverage based on prior illnesses
  or anything else.
• In the end, the Healthy Americans Act will
  require that insurance companies to compete to
  keep you healthy and if you aren't satisfied with
  what your insurance company is providing, you
  will have the option of taking your business
  elsewhere.

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What if your company doesnt offer health
insurance?

• Employers who don't currently offer health
  benefits would have to make phased-in "Employer
  Shared Responsibility Payments," which would be
  used to provide financial assistance to
  individuals and families of modest income. After
  two years, all employers would make "Employer
  Shared Responsibility Payments." These payments
  would reflect the relative ability of small and
  large employers and low- and high-wage industries
  to make such payments, and would have no direct
  impact ON the coverage that is available to their
  employees.

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Affordable Quality Healthcare

• Those people earning between 100 percent and 400
  percent of the federal poverty line (10,400
  annually per person) would also receive subsidies
  on a sliding scale to help pay their premiums.
  The bill also creates a generous standard
  deduction to help Americans pay for health
  coverage regardless of whether they get coverage
  on their own or through their employers.

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Reform the Private Insurance market

• The Healthy Americans Act stipulates that
  insurance companies be required to cover every
  individual who chooses to enroll and that they be
  prohibited from raising prices or denying
  coverage if individuals are sick or are at risk
  of becoming sick.
• Previous and existing health problems,
  occupation, genetic information, gender and age
  could no longer be used to determine eligibility
  or the price paid for insurance.

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Focus on Preventative Care

• The Healthy Americans Act focuses on preventive
  care and provides insurance companies with an
  incentive to keep their subscribers healthy.
• Individuals would not be charged co-pays for
  preventive services or chronic disease
  management.
• Insurers would be able to offer discounts and
  other incentives based on participation in
  wellness programs, like nutrition counseling,
  tobacco cessation and exercise.
• Doctors will be reimbursed under the Healthy
  Americans Act for investing time in chronic
  disease management and prevention

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Safety Net

• The government, for its part, would make sure
  that every American has, and can afford, health
  insurance. Every time an individual interacts
  with local, state or federal government, they
  could be required to verify their enrollment in a
  private health insurance plan.

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State Based Health Help Agencies

• Agencies instituted to help guide individuals
  through the enrollment process so they my choose
  from a variety of private plans offered by their
  state
• These agencies would also provide consumers with
  unbiased information about competing private
  health plans and determine premium reductions
  that will ensure every American can afford their
  health plan.
• HHAs would ultimately lower administrative costs
  by coordinating payments from employers,
  individuals and the government.

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How is it funded?

• The plan would pay for itself once the act is up
  and running by eliminating administrative costs
  and changing the outdated tax code that gives
  businesses write-offs for even the most lavish
  designer health plans
• It would return surpluses to the government after
  the first two years of implementation.

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Financial Analysis

• The CBO which analyzed the bill with the
  Congressional Joint Committee on Taxation. showed
  that, under the Healthy Americans Act, it will be
  possible to not only to cover all Americans for
  the same amount of money the nation is currently
  spending on health care but to reduce the
  increase in health care costs over time.

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The Basic Principles of the Healthy Americans Act

• CHOICE - Gives Americans choice in what type of
  coverage best suits their individual and family's
  needs and a choice in where they receive health
  care services.
• PORTABILITY - Because the individual will now own
  their health policy, insurance becomes portable
  from job to job and individuals will no longer
  feel tied to their job because of health
  benefits.
• TAX REFORM - Breaks the link between employment
  and insurance, giving employees instead of
  employers the tax benefit, which will strengthen
  incentives to shop for lower cost plans, as well
  as improve health care quality.
• HEALTHY BEHAVIOR - Promotes personal
  responsibility and preventative medicine by
  creating incentives for individuals to engage in
  healthy behavior.
• MARKET FORCES - Provides for patient-driven
  health care through market forces by allowing
  more transparency and competition, thereby
  forcing insurance companies to compete on price,
  benefits, and quality.

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Recent News

• Article in the Wall Street Journal on April 10th,
  2009 A Health-Care Plan that could Bridge the
  Divide by Gerald Seib
• Describes the public option obstacle

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References

• The State of the Union for Health Care, sponsored
  by the Atlantic A Conversation with Senators Bob
  Bennett and Ron Wyden
• http//www.wyden.senate.gov
• http//bennett.senate.gov