The%20Truth%20About%20Health%20Reform:%20What%20It%20Means%20To%20Us

1
The Truth About Health ReformWhat It Means To Us

• Ellen R. Shaffer PhD MPH
• Joe Brenner MA
• EQUAL Health Network
• www.equalhealth.info
• 415-922-6204 ershaffer_at_gmail.com
• October, 2010

2
EQUAL

• Equitable, Quality, Universal, Affordable health
  care
• Center for Policy Analysis, anchor
• Network for progressive policy and advocacy
• Links Labor, Public health, women, seniors,
  faith groups
• Policy-makers
• Forums
• Policy Statements

3
EQUALs ProgramMaking Health Reform Work

• Educate
• Implement
• Improve

4
How We Got HereThe ProblemsThe Affordable
Care ActWhat It DoesMaking it WorkBuilding
for the Future
5
How We Got HereHistoric Achievement

• Congress has passed the most substantial health
  reform since Medicare and Medicaid in 1965
• Patient Protection and Affordable Care Act (ACA)
• The new law takes important steps to expand
  coverage and improve quality, and begins to
  control costs

6
The Problems
7
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

8
The Great Risk Shift in Health Care
69.0
Private employer-provided health insurance
Over 15 percentage point decline
Percent covered by own employer insurance
54.9
Source Economic Policy Institute, State of
Working America, 2006/2007
9
(No Transcript)
10
Insurance, Access, Costs Costs Increase,
Coverage Decreases

• Private for-profit insurance companies face
  incentives to avoid spending premiums
• Identify and avoid risky patients
• Exclude pre-existing conditions
• Insurance companies run up administrative costs
  to avoid expensive enrollees (sick people)

10
11
ACA The Gains

• Expanded Coverage and Access
• Improving Quality
• Consumer Protections
• ALL Lower Costs
• How Will We Benefit?

12
ACA Benefits Phased In 2010-2020

• 2010-2013
• Consumer protections
• Affordability and quality improvements
• 2014 Major coverage expansions
• Health Insurance Exchanges
• For individuals, small business employees
• Individual Mandate, Employer contributions
• Medicaid Expanded
• Everyone up to 133 of poverty level
• 2020 Medicare drug price doughnut hole gone

13
Immediate Improvementsin 2010

• Coverage
• New High Risk Pool
• Covers Young Adults through Age 26 on parents
  coverage
• Quality
• First dollar coverage of preventive care
• Increased funding for Community Clinics
• Stops Insurance Abuses
• Discrimination against children with pre-existing
  conditions prohibited
• Rescissions Illegal (withdrawal of care)
• Bans lifetime limits on coverage

13
14
Immediate Improvements(cont.)

• Affordability
• Small business tax credits of up to 35
• Rebates begin to close the Medicare Part D
  Doughnut Hole
• Reduces cost of early retiree coverage

14
15
Insurance Exchanges Who
State-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
15
16
Cost Control Regulating Premiums Expanding
Public Health Protecting MedicareImproving
Quality
,
EQUAL Health Network
17
What Happens to Medicare?
,
17
EQUAL Health Network
18
3 Facts The New Law Will

• Improve many Medicare benefits
• Quality Improvement Programs set models for
  health care system
• NO CUTS in basic Medicare benefits
• Extend Medicares solvency by 12 years to 2029.
• Help people obtain long-term care at home.
• NCOA

19
The A-B-C-Ds of Medicare
20
Medicare Part A Trust Fund
Exhibit 14
Projection Health reform legislation will
extend the life of the Medicare Part A Trust Fund
from 2017 to 2029
Assets as a share of annual spending
Post-health reform 2029 projected insolvency
date
Pre-health reform 2017 projected insolvency date
21
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

,
21
22
Other Improvements forSeniors

• New protections against elder abuse, neglect,
  financial exploitation
• Better training for workers caring for seniors
• Nursing home quality improvements
• Help to keep premiums down for early retirees
• Bonuses for primary care doctors (other doctor
  payment issues not addressed)

23
How Will It Be Paid For?
24
ACA The Gains

• Expanded Coverage and Access
• Improving Quality
• Consumer Protections
• Lower Costs

24
25
Making It WorkImplementing the Law
26
California ReformsCreate a Transparent Insurance
Market

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

27
Building for the Future
28
Building for the Future

• Reproductive Health Retreat from current law
• Immigrants inclusion Allow to purchase thru
  Exchange
• Affordability
• State options for innovative approaches
• Single payer

29
Single Payer What it Is and Why It Is Still on
the Table

• A government-sponsored system like Medicare
• Everyone automatically covered, most cost
  efficient, contributes to social economic
  equity, good outcomes
• Gives government the authority to constrain
  health care spending

30
What To Do Now

• Get the facts about the law
• Spread the work tell Union members, friends and
  family
• Make It Work
• Build for the future

30
31
Work with EQUAL

• Join the EQUAL Listserv
• Send a blank message to
• join-equal_at_list.equalhealth.info
• See our website
• www.centerforpolicyanalysis.org
• Thanks for contributions to this presentation to
  Keely Monroe, Lisa Kernan Social Justice Fellow
  EQUAL partners including Deborah LeVeen, Elinor
  Blake, Karl Keener, Joel Adelson, Lee Lawrence,
  Robert Mason and Jacob Hacker

32
Thank YouFor Making History!