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Health Care Reform: Challenges and Opportunities. Marian Mulkey, MPP, MPH California HealthCare Foundation www.chcf.org State Association of County Retirement Systems Spring Conference May 15, 2009. The Problems. Rising health care costs Growing population of uninsured

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Health care reform challenges and opportunities

Health Care Reform: Challenges and Opportunities

Marian Mulkey, MPP, MPH

California HealthCare Foundation

www.chcf.org

State Association of County Retirement Systems

Spring Conference

May 15, 2009


The problems
The Problems

  • Rising health care costs

  • Growing population of uninsured

  • Declining rate of employer-sponsored insurance

  • Ongoing concerns with health care quality


Health spending represents a growing share of the us economy
Health spending represents a growing share of the US economy.

Slide #3 of HC Costs 101, 2008



Most non-elderly Californians receive health coverage through employment…

Subsitute Slide 4, Unins snapshot 2008

Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008.


Yet employer based coverage is steadily declining and more are uninsured
Yet employer-based coverage is steadily declining, and more are uninsured.

Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. www.chcf.org/documents/insurance/CAUninsured08.pdf


The uninsured are less likely to get the care they need
The uninsured are less likely to get the care they need. are uninsured.

Source: Kaiser Family Foundation, The Uninsured: A Primer, October 2006


Nationwide on average adults receive recommended care less than half the time
Nationwide, on average adults receive recommended care less than half the time.

Percentage of Adults Receiving Recommended Care, by Type

54.9% = Overall care

54.9% = Preventive care

53.5% = Acute care

56.1% = Chronic care

Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645





Some policy approaches and ideas
Some policy approaches and ideas than half the time.

  • Broad coverage expansion

    • Employers required to provide coverage (“pay or play”)

    • Individuals mandated to buy, insurers required to sell

    • Single payer (all participate, broad tax-based financing)

  • Other proposals

    • Reduce insurance and/or employer regulation

    • Make consumers more aware of prices

    • Reduce health care provider administrative burden

    • Use health information technology to better manage care

    • Change provider payments to reward “performance” rather than volume

    • Directly regulate new technology, and/or prices

    • And on, and on…


Many groups have a stake in the health reform debate
Many groups have a stake in the health reform debate than half the time.

  • Hospitals, doctors, and other health care providers

  • Employers

  • Labor unions

  • Insurance companies

  • Government agencies: federal, state, local

  • Consumer advocates

  • Citizens

    It’s much easier to agree that current system needs reform, than to agree on who should pay more or be obligated to behave differently to change it.


Health reform key issues and challenges
Health Reform: Key Issues and Challenges than half the time.

  • Coverage expansion addresses one aspect of larger set of problems

  • Who should pay? Who should be subject to mandates or other new requirements?

  • How should “affordability” be defined for:

    • Employers

    • Employees/ Individuals

    • Government

  • How should “quality” be defined and monitored?

  • How can costs be contained and quality improved, now and in future?


What s next
What’s next? than half the time.


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