The Health Care Landscape Before and After the ACA. Bill Evans University of Notre Dame. Two Goals. What are the issues that any health reform proposal must address? How did the ACA deal with these issues? . What must health care reform address?. Access
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University of Notre Dame
What are the issues that any health reform proposal must address?
How did the ACA deal with these issues?
Cost (both the level and rate of change)
143% more than UK
ARVs reduced AIDS mortality by 70%
NICU’s reduce neonatal mortality among very low birth weights infants by 42%
Lipitor reduces LDL by 39-60%, reduces all cause mortality by 12%
30-day survival rates for heart attack patients admitted to the hospital fell 17% 1995-2006
Will equal 2% of
Receive $19,047 in income
Pay 37% or $7,047 in taxes
$12,000 left over for health insurance
Net benefit of tax deduction is $7,047
An outline and some likely outcomes
Individual mandate (tax of 2.5% of AGI)
Pay or play -- employer mandates
Expand Medicaid to include higher income groups
Provide tax credits for the low income in individual market
Tax credits for small firms to provide insurance
Establish health insurance exchange where people can purchase group insurance
Reduce uninsured by 32 mil. in 2019 (60%↓)
Leaves another 23 mil. uninsured
Hispanics will be over-represented in the uninsured
In Billions of $
“It is important to note that the actual future costs of Medicare are likely to exceed those shown by the current law projections…We recommend that the projections be interpreted as an illustration of the very favorable financial outcomes that would be experienced if the productivity adjustments can be sustained in the long run.”
It was necessary to do something about the future costs of Medicare
ACA did attack these costs – but – the savings were then paid out in benefits
If the concern is the overall fiscal health – we have not improved
Firms w/ >50 employees must offer qualified health insurance or pay $2000 tax/employee
Tax incentives/credits for small firms to provide insurance
Language is that firms must pay “fair share”
Economists believe workers pay for insurance in the form of lower wages
Will firms pay or play?
Small firms not subject to pay/play mandate
Face extremely high cost of providing HI
Workers face much lower wages if they receive HI from firm
Gov’t now provides high subsidy rate for low-income uninsured
As a result….