Health Reform: An Overview

1
Health Reform An Overview
Figure 1
The Patient Protection Affordable Care
Act Donna Willis, MD MPH Faculty Department of
Internal Medicine Center for Health
Promotion Johns Hopkins School of
Medicine February 2011
2
Figure 2
Goals for Health Reform

• Expand health insurance coverage
• Improve coverage for those with health insurance
• Improve access to and quality of care
• Control rising health care costs

3
Promoting Health Coverage
Figure 3
Universal Coverage
Exchanges (subsidies 133-400 FPL)
Medicaid Coverage (up to 133 FPL)
Individual Mandate
Health Insurance Market Reforms
Employer-Sponsored Coverage
4
Expanding Health Insurance CoverageEarly Actions
Figure 4

• Create temporary Pre-existing Condition Insurance
  Plan for people with medical conditions who are
  uninsured
• To qualify, individuals must be uninsured for six
  months
• Federally funded
• Available in each state until 2014
• Allow adult children to remain on their parents
  health insurance policy until age 26
• Children do not have to live with parents, nor be
  students
• May be married, but spouses and children not
  eligible

5
Expanding Health Insurance Coveragein 2014
Figure 5

• Expand Medicaid to all individuals under age 65
  with incomes up to 133 of the poverty level
  (14,400/individual or 29,300/family of 4)
• Create new Health Insurance Exchanges where
  individuals and small employers can purchase
  coverage
• Provide premium subsidies to eligible individuals
  and families with incomes up to 400 of the
  poverty level (43,300/individual or
  88,200/family of 4) through the Exchanges

6
Estimated Health Insurance Coverage in 2019
Figure 6
Total Nonelderly Population 282 Million
SOURCE Congressional Budget Office, March 20,
2010
7
Improving Health Insurance
Figure 7

• Reform the health insurance market
• Prohibit insurers from denying coverage or
  charging people more because they are sick
• Prohibit insurers from rescinding coverage or
  placing annual or lifetime limits on coverage
• Improve benefits for those with insurance
• Ensure coverage of preventive services with no
  cost-sharing
• Establish minimum benefit standards
• Limit out-of-pocket spending for consumers

8
Employer Requirements and Incentives
Figure 8

• Larger employers that dont offer affordable
  coverage will face penalties of up to 2,000 per
  full-time worker per year beginning in 2014
• Small employers with up to 50 employees will be
  exempt from penalties
• Tax credits available for some small businesses
  that offer health benefits

9
Individual Mandate
Figure 9

• Individuals will be required to have health
  coverage that meets minimum standards in 2014
• Individual mandate spreads costs among whole
  population
• Mandate enforced through the tax system
• Penalty for not having insurance greater of
  695 (up to 2085 for family) or 2.5 of family
  income
• Exemptions for certain groups and if people
  cannot find affordable health insurance

10
Some Uninsured Will Remain
Figure 10

• Congressional Budget Office (CBO) estimates 23
  million uninsured in 2019
• Who are they?
• Immigrants who are not legal residents
• Eligible for Medicaid but unenrolled
• Exempt from the mandate (most because cant find
  affordable coverage)
• Choose to pay penalty in lieu of getting coverage
• Many remaining uninsured will be low-income

11
Health Reform and Delivery System Changes
Figure 11

• Promoting primary care and prevention
• Improving provider supply
• Developing new models for coordinating and
  delivering care
• Making use of information technology
• Reforming provider payments to promote quality

12
Promoting Primary and Preventive Care
Figure 12

• Increased Medicare and Medicaid payments for
  primary care providers
• Incentives for new doctors and other health
  professionals to practice primary care
• No cost-sharing in Medicare and new private plans
  for certain preventive services and incentives
  for states to do same in Medicaid
• Funding for population-based prevention
  activities

13
Improving Health Care Quality
Figure 13

• Development of a national quality strategy
• Coordinated care through medical homes and other
  models
• Quality-based payments for health care providers
  and improved information on provider quality
• Comparative effectiveness research to identify
  most effective treatments and interventions
• Enhanced data collection to address health care
  disparities

14
Improving Health Care Quality
Figure 13

• Shortages in Primary Care Physicians
• Pediatrics, internal medicine and family
  medicine.
• Decreased access to geriatricians and
  gynecologists.

15
Containing Health Care Costs
Figure 14

• Greater oversight of health insurance premiums
  and insurer practices
• Increased competition and price transparency
  through Exchanges
• Provider payment reforms in Medicare
• Testing of new, more efficient delivery system
  models in Medicare and Medicaid

16
Financing Health Reform, 2010-2019
Figure 15
Federal savings
New revenues
Total Cost 938 Billion
Savings to Federal Deficit 124 Billion
Source Congressional Budget Office, 2010
17
Health Reform Implementation Timeline
Figure 16
18
Future of Health Reform Legislation Is Just
the Beginning
Figure 17

• Implementation will be challenging
• Guidance and federal oversight needed
• Resources for infrastructure and capacity
  building
• Policy and political challenges
• Health reform provides opportunities to improve
  our health care system
• Reduce the number of people who are uninsured
• Make the health insurance system work better for
  all consumers
• Transform delivery and payment systems to get
  better value
• Reorient health care to focus on prevention and
  primary care

19
Health Reform Baby Boomers
Figure 18

• First wave are at the retirement age
• Spend more on health care and visit the doctor
  more than their parents.
• 7 trillion in collective wealth for quality of
  life services.
• The aging population contributes to the
  healthcare crisis, but it is NOT the cause.
• The cause costly new drugs, diagnostics,
  treatments and medical technologies.
• Everyone spends more at every age whether youre
  50 or 2, and that will continue.

20
Health Reform Top Concerns of the Baby Boomers
Figure 19

• About 60 have at least 1 chronic medical
  condition.
• i.e. arthritis, diabetes, heart disease and
  hypertension.
• Require regular health care check-ups,
• Prescription medications and lifestyle changes.

21
Health Reform Baby Boomers Benefit the Most
Figure 20

• Some of those gains will come right away
• The elimination of restrictions on people with
  preexisting conditions
• 2014 provisions of the Affordable Care Act
  include
• Lifetime limits on health insurance
• Subsidized coverage through health insurance
  exchanges

22
Health Reform Assurance Maladie
Figure 21

• France covers everyone, and provides high-quality
  care.
• France spends 11 of national output on health
  services, compared with 17 in the U.S
• Assurance Maladie deficit since 1989, 15 billion
  in 2010, or roughly 10 of its budget.
• System's fragile solvency is evidence of the
  difficulty to provide universal coverage while
  controlling costs
• Agressive public health and prevention programs
  are essential

23
Health Reform Why Prevention is Essential
Figure 22

• Research validates that lifestyle changes are
  proven to save lives and prevent disease.
• Prevention accounts for only 2 to 3 of spending
  on health care.
• Intel Corporations Health for Life saves 3 for
  every dollar spent
• Kaiser Permanentes tertiary prevention program
  for high-risk diabetics saves as much as 38
  million annually and avoid 8,000 hospitalizations

24
Resources
Figure 23

• Kaiser Family Foundation http//healthreform.kff.
  org/
• DHHSHealth Care Reform Explained
  http//healthcare.gov/
• Alliance for Health Reform http//www.allhealth.o
  rg/
• National Association of Insurance Commissioners
  http//www.naic.org
• National Governors Association
  http//www.nga.org
• CSM http//www.csmonitor.com/USA/Politics/2010/032
  0/Health-care-reform-bill-101-Who-gets-subsidized-
  insurance
• Johns Hopkins Perspective http//www.hopkinsmedici
  ne.org/news/stories/hopkins_on_health_care/index.h
  tml