Bloomberg Small Business Payroll Loan by wjr21472

VIEWS: 4 PAGES: 129

More Info
									Health Care Reform:
Access, Cost and Quality

William P. Moran MD MS
Director, General Internal Medicine
   and Geriatrics
Chair, SGIM Health Policy Committee
Agenda

    Cost, access and quality of care
    Battle lines are drawn
    Proposals move through in Congress
     and a surprise for the Senate
    The Bill and the Second Bill
    What‘s in OUR future?

                                          2
2/2/2011
           3
2/2/2011
We spend twice as much as other
industrialized nations...
            Per capita health care
            spending of select OECD
            nations, 2003
            Source: The Commonwealth Fund




                                            4
 2/2/2011
US Health care expenditures as percentage of GDP:
Unsustainable cost growth

                                                                        18%




                                                                        2009




Source: CMS. Office of the Actuary, National Health Statistics Group.
If US health care was a
country, it would be the 12th
largest economy in the world…
Insurance premiums are too high




                              7
   2/2/2011
Then there is the
uninsured…
    ~ 47 million uninsured
    >80 million under-insured
    44,800 excess deaths annually due to
     lack of insurance
    8,000 Americans loose their health
     insurance every day


                                            8
2/2/2011
The Young Invincibles
They’re young and healthy, and insurance is expensive. As long as
they don’t catch the flu, slip on the ice, crash a bike, snowboard into a
tree, rupture an appendix, or get hit by a bus, everything will be fine.
Right?




                                                                       9
     2/2/2011
The challenge of
quality….
    Safe
    Patient centered
    Timely
    Effective
    Efficient
    Equitable

                        10
2/2/2011
     Although US costs are highest …the
     quality of care is far from optimal

   RAND: Americans get
    evidence-based care
    only 55% of the time
   IOM: Up to 98,000 Americans
    die each year due to
    avoidable medical errors
   CDC: 2 million acquire
    nosocomial infections
    annually; 90,000 die
   WHO: US is 32nd in the world
        2/2/2011
                                     11
Remember this couple?
Battle lines are drawn….
Early Skirmish
The American Recovery and Reinvestment Act
AKA the Stimulus Bill
 Ruin Your Health With the Obama Stimulus Plan:


Commentary by Betsy McCaughey

Elderly Hardest Hit
Daschle says health-care reform ―will not be pain free.‖ Seniors
should be more accepting of the conditions that come with age
instead of treating them. That means the elderly will bear the
brunt.

Medicare now pays for treatments deemed safe and effective. The
stimulus bill would change that and apply a cost- effectiveness
standard set by the Federal Council (464).
First, insurers must thoroughly cover everyone who wants,
and will pay for, insurance, regardless of health, age or pre-
existing conditions (this is known as ―guarantee issue‖).
Second, insurers would be required to charge customers the
same regardless of health (called ―community rating‖).
For their part, insurance companies want a third mandate,
called the individual mandate, under which the federal
government forces people to buy and maintain health
insurance...so that risk is spread.
             Health Care Reform Effort
             Draws Opposition
             AP Saturday, March 07, 2009
The flashpoint is a proposal that would give Americans the option of buying medical coverage through a
government plan. President Obama and many Democrats have endorsed it, as one part of a broader health
overhaul. On Saturday, Republicans laid down a challenge.



"I'm concerned that if the government steps in, it
will eventually push out the private health care
plans millions of Americans enjoy today,"
Republican Rep. Roy Blunt (MO) said in the
Republican weekly radio address.
Blunt, who will play a leading role in the debate, warned: "This could cause your employer to simply stop
offering coverage, hoping the government will pick up the slack."
Mark E. Miller, Ph.D., executive director of the Medicare
Payment Advisory Commission, suggested that
changes in the Medicare payment system were
essential to both increasing the nation's physician
supply and streamlining health care delivery.
  Drugmakers Boost Lobbying
  to Police Drug Comparisons

Jonathan D. Salant And Aliza Marcus – Fri Apr 17, 4:49 pm ET

April 17 (Bloomberg) -- U.S. drugmakers are working to ensure that
President Barack Obama’s move to encourage cheaper medical care
doesn’t end up dictating treatments to doctors and insurers.
Already the biggest spender on influencing policy, the drug industry,
including Merck & Co. and Eisai Co., is relying on well-known
individuals, some with stories of personal battles against disease, to
promote its views. They include Tony Coelho, a former U.S. House
Democratic leader who has epilepsy; Andrea LaRue, counsel to Tom
Daschle when he was Senate Democratic leader; and the firm of
Democratic fundraiser Tony Podesta, brother of Obama adviser John
Podesta.
  Drugmakers Boost Lobbying
  to Police Drug Comparisons
  (cont’d)
Makers of drugs and other health-care products say they support side-
by-side studies of medical products as a tool for doctors and patients,
not as a way to stop medical professionals from prescribing a more
expensive drug if they’re convinced it will work better.

The industry has already recorded one victory,
supporting the removal of language concerning
costs from a $1.1 billion funding provision for
such studies included in the ARRA passed in
February.
Party Politics
THE LANGUAGE OF HEALTHCARE
2009 (April 2009)

THE 10 RULES FOR STOPPING
THE
―WASHINGTON TAKEOVER‖
OF HEALTHCARE

         Frank Luntz
Luntz - Language
(1)   Humanize your approach. ―Individualize.
  Personalize. Humanize.‖
(2) Acknowledge the ―crisis‖ or suffer the
  consequences. ―If you have to wait weeks
  for tests and months for treatment, that‘s a
  healthcare crisis.‖
(3) ―Time‖ is the government healthcare
  killer. ―Waiting to buy a car or even a
  house won‘t kill you. But waiting for the
  healthcare you need – could. Delayed care
  is denied care.‖
 Luntz - Language
(4)     The arguments against the Democrats‘ healthcare
   plan must center around ―politicians,‖ ―bureaucrats,‖ and
   ―Washington‖ … not the free market, tax incentives, or
   competition.
(5)     The healthcare denial horror stories from Canada &
   Co. do resonate, but you have to humanize them.
   ―government takeover‖
(6)     Healthcare quality = ―getting the treatment you
   need, when you need it.‖ ―The plan put forward by the
   Democrats will deny people treatments they need and
   make them wait to get the treatments they are allowed
   to receive.‖
(7)     ―One-size-does-NOT-fit-all.‖ ―committee of
   Washington bureaucrats‖ ―protection of the personalized
   doctor-patient relationship.‖
Luntz - Language

 (8)     WASTE, FRAUD, and ABUSE are your best
    targets for how to bring down costs.
 (9)     Americans will expect the government to look
    out for those who truly can‘t afford healthcare. ―A
    balanced, common sense approach that provides
    assistance to those who truly need it and keeps
    healthcare patient-centered rather than
    government-centered for everyone.‖
 (10) It‘s not enough to just say what you‘re against.
    You have to tell them what you‘re for ―more access
    to more treatments and more doctors…with less
    interference from insurance companies and
    Washington politicians and special interests.‖
 Politicizing Health Care
 Reform
"If we're able to stop Obama
on [health care reform], it
will be his Waterloo. It will
break him and we will show
that we can, along with the
American people, begin to
push those freedom
solutions...‖
                                41
 2/2/2011
           42
2/2/2011
           Transformative Change
              Equitable Access to Care
              Insurance Reform
              Comparative effectiveness research
              Workforce changes
              Physician payment reform and
              delivery system redesign
                                                   43
2/2/2011
           44
2/2/2011
           Transformative Change
              Equitable Access to Care
              Insurance Reform
              Comparative effectiveness research
              Workforce changes
              Physician payment reform and
              delivery system redesign
                                                   45
2/2/2011
Health Care Committees
of Jurisdiction
   Senate
      – Health, Education, Labor & Pensions
        (HELP) – Sen. Harkin (IA) (Kennedy)
      – Finance – Sen. Baucus (MT)
   House
      – Energy & Commerce – Rep. Waxman (CA)
      – Ways & Means – Rep. Levin (MI) (Rangel)
      – Education & Labor – Rep. Miller (CA)
                                              46
2/2/2011
―Laws are like sausages.
It's better not to see them
being made.‖

Otto von Bismarck
German Prussian politician
(1815 - 1898)

                             47
2/2/2011
Understanding the game:
This is how our laws are made




                                48
  2/2/2011
And this is how sausage is
made…
Understanding The Game:
How Our Laws Are Made




                          50
  2/2/2011
Understanding The Game:
How Our Laws Are Made




                          51
  2/2/2011
Understanding The Game:
How Our Laws Are Made




                          52
  2/2/2011
Understanding The Game:
How Our Laws Are Made




                          53
  2/2/2011
―Patient-centered Outcomes Research
Act of 2009‖
(Comparative Effectiveness Research):
House Ways and Means and Senate Finance



                                      54
  2/2/2011
―Preserving Patient Access
to Primary Care Act‖




                             55
2/2/2011
HELP ―Affordable Health Choices Act‖




                                 56
   2/2/2011
HELP ―Affordable Health Choices Act‖




                                 57
   2/2/2011
House Tri-Committee bill




                           58
2/2/2011
House Tri-Committee bill

           Access to Coverage and Choice
           Affordability
           Shared Responsibility
           Controlling Costs
           Prevention and Wellness
           Workforce Investments

           Reforming SGR and the
           Physician Payment System:
           Rewarding Primary Care,
2/2/2011
           Coordination, and Efficiency    59
Understanding The Game:
How Our Laws Are Made

             HR 3962




                          61
  2/2/2011
           62
2/2/2011
Understanding The Game:
How Our Laws Are Made

             HR 3962




              HR 3590
                        But then…

                               63
  2/2/2011
Senator Kennedy’s death
precipitated a special senate
election in MA




    Scott Brown (R) v Martha Coakley (D)
Republican Scott Brown
elected to senate from MA
Understanding The Game:
How Our Laws Are Made

             HR 3962




              HR 3590


                        Senate 59-41
                                  66
  2/2/2011
The NEW Game: Senate Rs can
now filibuster! Reconciliation?

                 HR 3962




                  X
                  HR 3590


                            Senate 59-41
                                      67
   2/2/2011
A new path for HR 3590: Trust
the Senate?




               HR 3590

                                68
  2/2/2011
―The Republicans are
the opposition – the
Senate is the enemy.‖


The Honorable Thomas P.
‗Tip‘ O‘Neil Jr. D-MA
Speaker of the House from
1977-1987
                            69
2/2/2011
           70
2/2/2011
CBO revised estimates that the bill would
reduce projected federal budget deficits by
$138 billion over the next decade, and more
than $1 trillion over the subsequent decade
H.R. 3590
H.R. 3590
The House strikes back:
Reconciliation H.R. 4872




                           76
  2/2/2011
Senate Rules for
Reconciliation

   Must be limited to budget changes
   Requires a simple majority 51-49
   Cannot change substantive non-
    budget items
   Issues off the table
    – Government option
    – Abortion restrictions or language change
WASHINGTON, March 23 (UPI) -- U.S. President
 Barack Obama will sign the sweeping healthcare
 reform bill into law Tuesday in the East Room, the
 White HOUSE said.
So what is in H.R. 3590 signed
today by the President?
   Market Reform
   Insurance Reform
   State insurance exchanges
   Coverage choices
   Changes to improve the quality and
    efficiency of health care
MARKET REFORM

PART A—INDIVIDUAL AND GROUP MARKET REFORMS
SUBPART II—IMPROVING COVERAGE
Sec. 2711. No lifetime or annual limits.
Sec. 2712. Prohibition on rescissions.
Sec. 2713. Coverage of preventive health services.
Sec. 2714. Extension of dependent coverage.
Sec. 2715. Development and utilization of uniform
  explanation of coverage documents and standardized
  definitions.
Sec. 2716. Prohibition of discrimination based on salary.
Sec. 2717. Ensuring the quality of care.
Sec. 2718. Bringing down the cost of health care coverage.
Sec. 2719. Appeals process.
INSURANCE REFORM

Sec. 2704. Prohibition of preexisting condition
  exclusions or other discrimination based on health
  status.
Sec. 2701. Fair health insurance premiums.
Sec. 2702. Guaranteed availability of coverage.
Sec. 2703. Guaranteed renewability of coverage.
Sec. 2705. Prohibiting discrimination against individual
  participants and beneficiaries based on health
  status.
Sec. 2706. Non-discrimination in health care.
Sec. 2707. Comprehensive health insurance coverage.
Sec. 2708. Prohibition on excessive waiting periods.
STATE INSURANCE EXCHANGES

Sec. 1321. State flexibility in operation and enforcement of
  Exchanges and related requirements.
Sec. 1322. Federal program to assist establishment and
  operation of nonprofit, member-run health insurance
  issuers.
Sec. 1323. Community health insurance option.
Sec. 1324. Level playing field.

PART IV—STATE FLEXIBILITY TO ESTABLISH
  ALTERNATIVE PROGRAMS
Sec. 1331. State flexibility to establish basic health
  programs for low-income individuals not eligible for
  Medicaid.
Sec. 1332. Waiver for State innovation.
E—Affordable Coverage
Choices for All Americans
PART I—PREMIUM TAX CREDITS AND COST-
  SHARING REDUCTIONS

Sec. 1401. Refundable tax credit providing premium
  assistance for coverage under a qualified health
  plan.

Sec. 1402. Reduced cost-sharing for individuals
  enrolling in qualified health plans.
Small business and
employees
PART II—SMALL BUSINESS TAX CREDIT
Sec. 1421. Credit for employee health insurance expenses
  of small businesses.

PART I—INDIVIDUAL RESPONSIBILITY
Sec. 1501. Requirement to maintain minimum essential
  coverage.

PART II—EMPLOYER RESPONSIBILITIES
Sec. 1511. Automatic enrollment for employees of large
  employers.
Sec. 1512. Employer requirement to inform employees of
  coverage options.
Sec. 1513. Shared responsibility for employers.
TITLE II—ROLE OF PUBLIC
PROGRAMS
Improved Access to Medicaid
Sec. 2001. Medicaid coverage for the lowest income
  populations.

Subtitle B—Enhanced Support for the Children‘s
  Health Insurance Program
Sec. 2101. Additional federal financial participation for
  CHIP.

Subtitle C—Medicaid and CHIP Enrollment
  Simplification
Sec. 2201. Enrollment Simplification and coordination
  with State Health Insurance Exchanges.
TITLE II—ROLE OF PUBLIC
PROGRAMS
Improved Access to Medicaid

Subtitle E—New Options for States to Provide Long-
  Term Services and Supports
Sec. 2401. Community First Choice Option.
Sec. 2402. Removal of barriers to providing home and
  community-based services.
Sec. 2403. Money Follows the Person Rebalancing
  Demonstration.
Sec. 2404. Protection for recipients of home and
  community-based services against spousal
  impoverishment.
Sec. 2405. Funding to expand State Aging and
  Disability Resource Centers.
Improved Access to Medicaid

   Subtitle F—Medicaid Prescription Drug Coverage
   Sec. 2501. Prescription drug rebates.
   Sec. 2502. Elimination of exclusion of coverage of
    certain drugs.
   Sec. 2503. Providing adequate pharmacy
    reimbursement.

   Subtitle G—Medicaid Disproportionate Share
    Hospital (DSH) Payments
   Sec. 2551. Disproportionate share hospital
    payments.
IMPROVING THE QUALITY AND
EFFICIENCY OF HEALTH CARE




 Subtitle A—Transforming the
 Health Care Delivery System
Part I – LINKING PAYMENT TO
QUALITY OUTCOMES IN MEDICARE


• Extends through 2014 payments under the
PQRI program, which provide incentives to
physicians who report quality data to Medicare.
• Creates appeals and feedback processes for
participating in PQRI.
• Establishes a participation pathway for
physicians completing Maintenance of
Certification program
• In 2014, physicians who do not submit to PQRI
                                            93
will have their Medicare payments reduced.
2/2/2011
Sec. 3003. Improvements to the
physician feedback program.


• Expands Medicare’s physician resource use
feedback program to develop of individualized
reports by 2012.
• Reports will compare the per capita utilization
of physicians to other physicians who see
similar patients.
• Reports will be risk-adjusted and standardized


                                              94
2/2/2011
Sec. 3007. Value-based payment
modifier under the physician fee
schedule.

• Directs the Secretary of HHS to develop and
implement a budget-neutral payment system
that will adjust Medicare physician payments
based on the quality and cost of the care they
deliver.
• Quality and cost measures will be risk-
adjusted and geographically standardized.
•The Secretary will phase-in the new payment
system over a 2-year period beginning in         95
2/2/2011
2015.
 Sec. 3008. Payment adjustment for
 conditions acquired in hospitals

• Starting in FY2015, hospitals in the top 25th percentile
of rates of hospital acquired conditions for certain high-
cost and common conditions would be subject to a
payment penalty under Medicare.
• Report to Congress by January 1, 2012 on the
appropriateness of establishing a healthcare acquired
condition policy related to other providers participating in
Medicare, including nursing homes, inpatient
rehabilitation facilities, long-term care hospitals,
outpatient hospital departments, ambulatory surgical
centers, and health clinics.                              96
 2/2/2011
PART II--NATIONAL STRATEGY TO
IMPROVE HEALTH CARE QUALITY

    SEC. 3011. NATIONAL STRATEGY
    SEC. 3012. INTERAGENCY WORKING GROUP
     ON HEALTH CARE QUALITY
    SEC. 3013. QUALITY MEASURE DEVELOPMENT
    SEC. 3014. QUALITY MEASUREMENT
    SEC. 3015. DATA COLLECTION; PUBLIC
     REPORTING




                                          97
2/2/2011
Part III – Encouraging Development of
New Patient Care Models
Sec. 3021. Establishment of Center for
Medicare and Medicaid Innovation within CMS.

    Establishes within the Centers for Medicare and
     Medicaid Services (CMS) a Center for Medicare &
     Medicaid Innovation.
      – research, develop, test, and expand innovative payment
        and delivery arrangements to improve the quality and
        reduce the cost of care provided to patients in each
        program.
      – Dedicated funding is provided to allow for testing of
        models that require benefits not currently covered by
        Medicare.
      – Successful models can be expanded nationally.

                                                                 98
2/2/2011
Sec. 3022. Medicare shared savings
program.

     Rewards Accountable Care Organizations
      (ACOs) that take responsibility for the costs
      and quality of care received by their patient
      panel over time.
     ACOs can include groups of health care
      providers (including physician groups,
      hospitals, nurse practitioners and physician
      assistants, and others).
     ACOs that meet quality-of-care targets and
      reduce the costs of their patients relative to
      a spending benchmark are rewarded with a
      share of the savings they achieve for the
      Medicare program.
 2/2/2011
                                                       99
Part III – Encouraging Development of
New Patient Care Models
Sec. 3023. National pilot program on payment
bundling.
    Direct the Secretary to develop a national,
     voluntary pilot program encouraging
     hospitals, doctors, and post-acute care
     providers to improve patient care and
     achieve savings for the Medicare
    Requires the Secretary to establish this
     program by January 1, 2013 for a period of
     five years.
    Before January 1, 2016, required to submit
     a plan to Congress to expand the pilot
     program if doing so will improve patient      100

     care and reduce spending.
2/2/2011
Sec. 3025. Hospital readmissions
reduction program.

    Beginning in FY2012, adjusts payments for
     hospitals paid under DRG payment system based
     on the dollar value of each hospital‘s percentage of
     potentially preventable Medicare readmissions
       – three conditions and risk adjusted readmission measures
         that are currently endorsed by the National Quality Forum.
    Secretary has authority to expand the policy to
     additional conditions in future years
    Directs the Secretary to calculate and make publicly
     available information on all patient hospital
     readmission rates for certain conditions.

                                                                 101
2/2/2011
Subtitle B – Improving Medicare for
Patients and Providers
Part I – Ensuring Beneficiary Access to
Physician Care and Other Services
Sec. 3101. Increase in the physician payment
update.



   Replaces the scheduled 21 percent
    payment reduction to the Medicare
    physician fee schedule for 2010 with a
    0.5 percent positive update.

                                             102
2/2/2011
           103
2/2/2011
Part III – Improving Payment Accuracy
Sec. 3134. Misvalued codes under the
physician fee schedule.

    Directs the Secretary to regularly
     review fee schedule rates for physician
     services paid for by Medicare,
     including services that have
     experienced high growth rates.
    Strengthens the Secretary’s authority
     to adjust fees schedule rates that are
     found to be misvalued or inaccurate.
                                           104
2/2/2011
Subtitle E – Ensuring Medicare
Sustainability
Sec. 3403. Independent Medicare
Advisory Board.
    Creates an independent, 15-member Medicare
     Advisory Board tasked with presenting Congress
     with comprehensive proposals to reduce excess
     cost growth and improve quality of care.
    When Medicare costs are projected to be
     unsustainable, the Board‘s proposals will take effect
     unless Congress passes an alternative measure that
     achieves the same savings.
    The Board would be prohibited from making
     proposals that ration care, raise taxes or Part B
     premiums, or change Medicare benefit, eligibility, or
     cost-sharing standards.                            105
2/2/2011
MedPAC March 2008

    ― ‗medical home‘ programs… if
     designed carefully, may be a way to
     improve the value of physician and
     other health care services.‖




                                           106
2/2/2011
Subtitle F—Health Care Quality
Improvements Sec. 3502. Grants or
contracts to establish community health
teams to support the patient-centered
medical home.

     Creates a program to establish and fund the
      development of community health teams to
      support the development of medical homes
      by increasing access to comprehensive,
      community based, coordinated care.




                                               107
2/2/2011
           108
2/2/2011
TITLE V—HEALTH CARE WORKFORCE
Subtitle B—Innovations in the Health Care
Workforce


    Sec. 5101. National health care
     workforce commission.
    Sec. 5102. State health care workforce
     development grants.
    Sec. 5103. Health care workforce
     assessment.
                                         109
2/2/2011
Subtitle C—Increasing the Supply of the
Health Care Workforce (inducements)

Sec. 5201. Federally supported student loan funds.
Sec. 5202. Nursing student loan program.
Sec. 5203. Health care workforce loan repayment
     programs.
Sec. 5204. Public health workforce recruitment and
     retention programs.
Sec. 5205. Allied health workforce recruitment and
     retention programs.
Sec. 5206. Grants for State and local programs.
Sec. 5207. Funding for National Health Service Corps.
Sec. 5208. Nurse-managed health clinics.
Sec. 5209. Elimination of cap on commissioned corps.
Sec. 5210. Establishing a Ready Reserve Corps.
 2/2/2011
                                                      110
Subtitle D—Enhancing Health Care
Workforce Education and Training

Sec. 5301. Training in family medicine,
  general internal medicine, general
  pediatrics, and physician assistantship.
Sec. 5302. Training opportunities for direct
  care workers.
Sec. 5303. Training in general, pediatric, and
  public health dentistry.
Sec. 5304. Alternative dental health care
  providers demonstration project.
Sec. 5305. Geriatric education and training;
  career awards; comprehensive geriatric
  education.                                     111
2/2/2011
Subtitle F – Strengthening Primary Care and Other
Workforce Improvements
Sec. 5501. Expanding access to primary care
services and general surgery services.

    Beginning in 2011, provides primary care
     practitioners, as well as general surgeons
     practicing in health professional shortage
     areas, with a 10 percent Medicare payment
     bonus for five years.

    Half of the cost of the bonuses would be
     offset through an across-the-board
     reduction in all other services.
                                                    112
2/2/2011
Coverage and individual
mandates
   Senate Bill                        Reconciliation
   Makes insurance available          Makes insurance available
    to an estimated 94% of              to an estimated 95% of
    non-elderly citizens by             non-elderly citizens.
    dramatically expanding              Adopts the Senate
    Medicaid and offering tax           approach but lowers the
    credits to Americans who            assessment and raises the
    would otherwise find it             percent of income that
    difficult to afford coverage.       individuals would pay if
   Individuals must purchase           they chose not to become
    insurance or pay a penalty          insured. Individuals must
    that would be the greater of        purchase insurance or pay a
    $750 or 2% of income by             penalty that would be the
    2016.                               greater of $695 or 2.5% of
                                        income.
Employer Mandate
   Senate Bill                Reconciliation
   The Senate bill does        Also penalizes
    not include an              companies with 50 or
    employer mandate, but       more employees, but
    requires companies          helps mid-size
    with 50 or more             businesses by
    employees to help           exempting the first 30
    defray the cost if          workers when
    taxpayers are footing       calculating the tax
    the bill for their          ($2000 annually per
    workers.                    non-exempted
                                employee).
How it’s is paid for
   Senate Bill                  Reconciliation
   Would be financed            Scales back the tax on
    through billions in           high-end Cadillac plans
    Medicare cuts and new         and delays its
    taxes, including a tax        imposition to 2018, but
    on insurance plans that       increases the tax's
    are worth more than           impact in the years
    $23,000 for a family of       following. The 2.9
    four. Couples making          percent Medicare
    more than $250,000            payroll tax would
    would pay additional          extend to unearned
    Medicare payroll taxes.       income for couples
                                  making more than
                                  $250,000 a year.
Abortion Coverage
   Senate                         Reconciliation
   The new insurance              No change
    exchanges can offer
    plans that cover
    abortion, but people
    who choose those
    plans must pay for
    their coverage with
    separate checks — one
    for abortion coverage,
    one for the rest of their
    health care services.
Exchanges/Subsidies
   Senate                    Reconciliation
   Sets up 50 different      The subsidies to help
    exchanges,                 low and middle-income
    administered by the        families buy coverage
    states, where people       are larger than in the
    without employer-          Senate bill, but the
    based coverage will        rate at which they will
    buy insurance.             increase over time is
                               lower, meaning that
                               coverage may become
                               somewhat less
                               affordable.
Medicare Drug Coverage
   Senate                       Reconciliation
   The Medicare drug            Closes the hole in drug
    benefit would expand          coverage over a decade,
    to include coverage for       starting with a $250
    retirees.                     rebate this year, half
                                  what was in the Senate
                                  bill. After that, the gap
                                  would gradually shrink,
                                  with drug companies
                                  giving 50 percent
                                  discounts on brand name
                                  drugs and the
                                  government increasingly
                                  paying the rest until
                                  patients, by 2020, have
                                  to pay just 25 percent of
                                  the costs.
Medicaid Expansion
   Senate                      Reconciliation
   Medicaid would be           Seeks to address
    expanded to cover            states' concerns about
    everyone earning             the cost of expanding
    under 133% of Federal        Medicaid by increasing
    Poverty Level ($29,327       the Federal share of
    for a family of four).       covering newly eligible
                                 people. It also
                                 jettisons the speacial
                                 deal that Sen. Ben
                                 Nelson (D-Neb.)
                                 secured for his home
                                 state.
           121
2/2/2011
Timing of provisions: First
year
    Donut hole rebates of $250
    Small business tax credits
    Establish high-risk pool for people with
     pre-existing conditions
    Ban excluding children with pre-
     existing conditions, recision and
     lifetime caps
    Dependants can stay on parents         122

     insurance until age 26
2/2/2011
Timing
   2011
    – requires Insurance companies to spend 80-
      85% of premiums on care
   2013
    – increase Medicare payroll taxes for
      individuals>$200k investment income,
      $250k couples income
   2014
    – Subsidies for families at <400% FPL
    – Most employers and people must offer/be
      insured
2/2/2011
                                                123
Timing

    2015 – Part of expanded Medicaid
     costs shift to state




                                        124
2/2/2011
Historic Health Care
Reform: What now?
   Senate will pass reconciliation bill?
   Efforts at repeal?
   Agencies will write rules for
    implementation
   Challenge of some provisions in court
    including insurance mandates and
    Medicaid cost transfers to states
   Insurers and health care organizations
    will reposition themselves
Health Care Reform:
Access, Cost and Quality

Comments? Questions?

                           129
2/2/2011
ransfers to states
   Insurers and health care organizations
    will reposition themselves
Health Care Reform:
Access, Cost and Quality

Comments? Questions?

                           129
11/17/2010

								
To top