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Understanding Health Reform

Understanding Health Reform. Health Care Foundation of Greater Kansas City. History of HCF Our Mission Target Population Area Served. HCF’s Grantmaking. $18 million in 2011 Funding Areas Safety Net Healthcare Healthy Lifestyles Mental Health Applicant Defined Grants Initiatives.

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Understanding Health Reform

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  1. Understanding Health Reform

  2. Health Care Foundation of Greater Kansas City • History of HCF • Our Mission • Target Population • Area Served

  3. HCF’s Grantmaking • $18 million in 2011 • Funding Areas • Safety Net Healthcare • Healthy Lifestyles • Mental Health • Applicant Defined Grants • Initiatives

  4. Grantmaking • Kansas City Free Health Clinic • PE 4 Life • Rose Brooks • Gordon Parks Academy • MOCSA • Harvesters

  5. Community Survey on Health Reform • Phone Survey • 403 registered voters in the Kansas City metropolitan area • Fielded in July 2010

  6. The Status Quo is Not Acceptable • Only 7% saw no need for change in the health care system.

  7. Initial Impressions of “Health Reform”

  8. But… • Many respondents were supportive of specific elements

  9. Change in Opinions After Brief Education • After being exposed to these elements of health reforms, respondents were again asked their opinion • Beginning of survey: 34% favorable • End of survey: 45% favorable • This is a 32% increase

  10. What is health insurance?

  11. Before Insurance • Medical care was purchased on an as-needed basis • Fees were based on services provided

  12. Started as a Way to Protect Workers • A firm arose in 1850 to offer accident protection to workers in particularly dangerous professions

  13. Workers Began Organizing Themselves • In 1887, African-American workers at a coal plant in Iowa create a mutual protection society • $.50 per month for an individual or $1.00 per family

  14. A Marketplace is Born! • In the late 1800s, commercial insurance companies are born

  15. World War II • Strict wage and price controls • Employer-sponsored insurance expanded dramatically • Benefits were taxable until 1954

  16. What do we think of this “system”? Pre-paid plans HMOs Companies provide insurance Uninsured Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

  17. We don’t have a health system • No logical connection between components • No central manager, but also no true marketplace • No one is making sure we get our money’s worth • People aren’t getting the right care at the right time at the right place

  18. We spend a lot of money. Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP

  19. Health Care Expenditure per Capita by Source of Funding, 2007Adjusted for Differences in Cost of Living

  20. We spend a lot of money.

  21. We spend a lot of money.

  22. Mortality Amenable to Health Care And we don’t get enough in return. Deaths per 100,000 population*

  23. Life Expectancy at Birth, 2007

  24. We Need a Bargain Shopper • Without someone wrapping their arms around this “system,” we don’t get what we pay for. • Nothing is free

  25. U.S. Health System

  26. High Performance Health System

  27. Patient Protection and Affordable Care Act • A platform for change • Seeks to move us toward a system • We can pay less and get more

  28. Current Source of Coverage, U.S. Medicare (12%) Employer Sponsored Insurance (49%) Individual (5%) Uninsured (17%) Medicaid (16%)

  29. Why do we care if people are uninsured? • Receive less preventive care • Enter the health care system sicker • Lack needed medical care • Have worse health outcomes

  30. Who are the uninsured? • Young • Sick • Working Poor

  31. The Young • 30% of the uninsured are between 18 and 26 • Relatively healthy • Not settled in the job market • Can stay on parents’ insurance through age 26

  32. The Sick • People with pre-existing conditions are oftentimes denied insurance. • Or, they are charged exorbitantly high premiums. • ACA requires guaranteed issue.

  33. Guaranteed Issue • Requires insurers to offer coverage to anyone, even if they have pre-existing conditions • Allows price-setting based on age, geographic area, family composition, and tobacco use • Not gender • Being a woman is not a pre-existing condition • Imagine guaranteed issue without a mandate

  34. Need an Individual Mandate • Guaranteed issue and the individual mandate go hand in hand.

  35. The Working Poor • 64% of the uninsured are in households with at least one full-time worker. • Only 41% of small businesses (less than 50 employees) offer health insurance. • 96% of firms with more than 50 employees

  36. The Working Poor • Small business tax credits • Big employers will be required to provide insurance or pay a fine. • Those who are still not covered will be eligible for Medicaid or the health exchange.

  37. $375/month

  38. Health Insurance Exchanges • Creates state or regional exchanges • Individuals and Small Businesses (<100) • Large employers beginning in 2017 • Creates four benefit plans, plus a catastrophic plan • Clearinghouse for information

  39. What the Exchange Could Look Like

  40. Premium Subsidies to Individuals • Accessible through the health insurance exchange

  41. Controlling Costs

  42. Medicare • Medicare Advantage • Changes in provider rates • Reduces annual increases in reimbursement • Adjusts payments based on productivity • Reduces payments for hospital readmissions

  43. Bending the Cost Curve • Prevention and Wellness • No cost-sharing for preventive care • Employee wellness grants for small businesses • Value-Based Purchasing

  44. Medicare/Seniors • Prescription drug doughnut hole closes • CLASS Act • Creates a national, voluntary program for buying community living assistance services and supports • Voluntary payroll deductions • Five-year vesting period • Provides cash benefits of at least $50 per day to purchase non-medical services and supports

  45. This is Incremental

  46. ACA will be Revisited • Social Security’s many large holes filled over 40 years • Originally excluded women, minorities, agricultural labor, government employees, teachers, and nurses. • Medicare is revised nearly every year • Enactment closes one chapter and opens a new one

  47. Call to Action • Stay informed!! • Be part of a constructive dialogue on this issue.

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