Fixing what ails healthcare in America today

1. People Over Politics Frequently Asked Questions Supplement to “People Over Politics” presentation. Last updated 1/26/2012. Fixing what ails healthcare in America today

2. FAQ slides • Who is paying for this? • Details for business • Details for individuals • Why pay for people who are unhealthy? • Why no single payer system? • Is this socialized medicine? • What about primary care? • What about hospitals? • What about lawsuits? • Who is Doctors for America? • How is Doctors for America funded? • Will Doctors for America endorse candidates?

3. Who is paying for this? If you make more than $200,000 (or you and your spouse make more than $250,000), for every extra $1,000 you pay $9 more in Medicare taxes.

4. Who is paying for this? A single person who makes $250,000 a year in wages will pay $450on the extra $50,000

5. Who is paying for this? A couple that makes $1,000,000 a year in wages, will pay $6,750 on the extra $750,000.

6. Who is paying for this? If you make more than $200,000 and you make money from investments, you pay 18.8% instead of 15% on the investment income.

7. Who is paying for this? If your health insurance from your employer is worth more than $27,500 you pay your regular tax rate for the extra cost (starts in 2018).

8. Who is paying for this? Bottom Line: People who make more than $200,000 (or families that make more than $250,000) will pay extra taxes.

9. Who is paying for this? Bottom Line: If you make less than $200,000 (or your family makes less than $250,000) no increase in taxes

10. Who is paying for this? . . . unless you have really expensive insurance or you like tanning salons (10% tax increase)

11. Who is paying for this? If you are a health care corporation, you pay extra fees and taxes: Insurance companies: $60 billion Drug companies: $27 billion Some medical devices: $20 billion

12. Details for Businesses 60% of businesses offer insurance 40% of businesses do not If everyone offers insurance, it will level the playing field.

13. Small Businesses 50% subsidy for insurance bought on the exchange starting 2014 35% subsidy for insurance now

14. Small Businesses To qualify, a business must: Have fewer than 25 full-time employees (FTE’s) Pay average annual wages below $50,000 per FTE Contribute at least 50% of each employee's premium

15. Small Businesses For more information, visit smallbusinessmajority.org

16. Small Businesses

17. Small Businesses

18. Small Businesses

19. Small Businesses

20. Large Businesses Any company with more than 50 employees: • If any employee needs public assistance to afford insurance (Medicaid or insurance exchange subsidies), the company will be fined $2000 per person. Note: in Massachusetts, employers insurance went up because of the individual mandate.

21. Details for Individuals Note: These are the 2011 numbers and will be slightly higher for 2014. Lowest income = 133% of the federal poverty level Below this, people qualify for Medicaid. Highest income = 400% of the federal poverty level

22. Details for Individuals

23. Details for Individuals

24. Details for Individuals Pre-existing Condition Insurance Plans • For individuals who have been uninsured for at least 6 months due to pre-existing conditions • Temporary insurance through 2014 • Rates similar to health individuals of the same age PCIP.gov (or healthcare.gov)

25. Details for Individuals

26. Why should I pay for people who don’t take care of themselves? Photo courtesy of http://www.flickr.com/photos/yourdon/3855923910/

27. Why should I pay for people who don’t take care of themselves? You already do. Insurance: The lucky many (the healthy) pay for the unlucky few (the unhealthy).

28. Why should I pay for people who don’t take care of themselves? If we decide to only cover those who behave in a “healthy” way, there might not be anyone left to insure.

29. Why should I pay for people who don’t take care of themselves? We need to focus on prevention so we all live healthier lives.

30. Why no single-payer system? Large differences in public opinion on: • free market solutions • government solutions Strong advocates on both sides, from public, physicians, health care industry, other industry, legislators.

31. Why no single-payer system? Laws are passed by votes in Congress. Need 218 Members of the House and 60 Senators to pass a law. There have never been enough members of Congress to vote for single payer.

32. Why no single-payer system? Affordable Care Act is a law that combined approaches to pass a solution in 2010: • Government solutions • Market-based solutions • Public-private partnerships

33. Why no single-payer system? States can experiment with single-payer and other systems as long as they: • Get to the same coverage and affordability • For the same cost to the federal government. Vermont is working on a single-payer system.

34. Is this socialized medicine? Affordable Care Act is a law that combined approaches to pass a solution in 2010: • Government solutions • Market-based solutions • Public-private partnerships

35. Is this socialized medicine? It expands the private insurance market. The government is not taking over any hospitals, doctor offices, doctors, etc. The law focuses on making fair and better rules for everyone.

36. What’s happening with Primary Care? The Affordable Care Act creates 16,000 more primary care providers by 2015. We need 25,000-30,000 more. And we need 125,000 more physicians across specialties by 2025.

37. What’s happening with Primary Care? Adding just 1 primary care physician for every 10,000 Americans could save 127,617 deaths every year.

38. What’s happening with Primary Care? Payment to Primary Care • Medicare: 10% payment bonus for physicians who bill >60% primary care codes (2011-2015)

39. What’s happening with Primary Care? Payment to Primary Care • Medicaid: family medicine, general internal medicine, and pediatrics are reimbursed at 100% of Medicare levels (2013-2014)

40. What’s happening with Primary Care? National Health Service Corps • Loan repayment for physicians who work in underserved areas • Expanded from previous program, and allows some teaching time to qualify for full-time clinical work • $1.5 billion more funding for thousands of additional spots

41. What’s happening with Primary Care? Training • Increased primary care residency slots • Teaching Health Centers for clinic-based residency training

42. What about lawsuits? Problems: Medical errors happen. Many people are suing for bad reasons. Most people who are harmed by true medical errors don’t get any compensation. The decision on two identical cases often is different depending on the lawyers and jury. Many doctors are doing more to patients because they are afraid of getting sued. Doctors in some specialties pay very high malpractice insurance, and some are dropping high-risk areas entirely (like obstetrics). Current malpractice system does not improve patient safety.

43. What about lawsuits? The Affordable Care Act set up a $50 million fund for states and local groups to figure out better solutions.

44. What about lawsuits? Comprehensive malpractice reform: 2nd wave of national reforms or State-by-state reforms

45. What happens to hospital payments? Changing Payments to Improve Quality Decrease Medicare payments to hospitals by 1%. If hospitals meet or exceed national average, get incentive payments.

46. What happens to hospital payments? Changing Payments to Improve Quality Hospitals that do not meet the average get help improving their quality.

47. What happens to hospital payments? Changing Payments to Improve Quality Improve Care Quality Hospital Value-Based Purchasing Program (VBP) Multiple quality measures Decrease 30-day Hospital Readmissions For 2012: CHF, Acute MI, Pneumonia Decrease Healthcare-Associated Conditions For 2012: Decubitus ulcers, falls, line infections