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Health Care Reform: How we got here and where we need go

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Health Care Reform: How we got here and where we need go

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  1. Health Care Reform:How we got here and where we need go BIAOH Annual Conference November 2, 2010 Jerry Friedman, JD Advisor for Health Policy Director External Relations & Advocacy

  2. True or false? • Government takeover of health care • Ends of Life: • Abortion on demand • Death Panels • Illegal immigrants will get free coverage • Care will be rationed

  3. “Everyone has the right to their own opinion, but not the right to their own facts.” - Senator Daniel Patrick Moynihan

  4. The Simple Facts on our Health Care “Situation” • We have no health care “system” • The current situation is unaffordable for individuals & unsustainable for our nation • The definition of “vulnerable” reaches the middle class • Health care is business: the business of medicine, and the business of insurance • Negatively impacts our competiveness in a global economy, innovation & individual prosperity

  5. Total Healthcare Expenditures (in billions)

  6. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  7. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  8. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  9. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  10. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  11. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  12. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  13. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  14. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  15. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  16. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  17. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  18. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  19. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  20. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  21. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  22. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  23. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  24. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  25. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  26. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  27. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  28. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  29. Obesity Trends* Among U.S. AdultsBRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  30. Obesity Trends* Among U.S. AdultsBRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  31. How does our spending align with influences of health status? Where our nation spends its health care dollars (~$2 Trillion) What influences our health status How do we shift more resources to address health behaviors? 10% 20% 20% 88% 8% 50% 4% Source: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future

  32. How did we get here? • YOYO or WITT • Several major policy decisions rather than one, unified health care policy. • Employer-based coverage • Government-sponsored coverage • Emergency Medical Treatment & Active Labor Act (EMTALA)

  33. The President’s Health Care Reform Principles • Guarantee Choice • Make Health Coverage Affordable • Protect Families Financial Health • Invest in Prevention and Wellness • Provide Portability of Coverage • Aim for Universality • Improve Patient Safety and Quality Care • Maintain Long-Term Fiscal Sustainability

  34. Desired Outcomes • More and better access • Sick care and Health care • Evidence based medicine • Reduce fragmentation • Caring and curing • Effective use of workforce • Flatten the cost curve

  35. How does the legislation do this? • Coverage expansion & reform • Payment reform • Delivery system transformation

  36. How does the legislation do this? • Coverage • Individual coverage mandate • Medicaid expansion • 138% of poverty level • Subsidies for low income individuals • To 400% of poverty level • Credits/subsidies for business • Penalties for non compliance

  37. 32 million gain coverage, split between Medicaid/SCHIP and Exchanges *Insurance coverage for population < 65 years Employer-sponsored Medicaid/SCHIP Uninsured Non-group/Other Exchanges

  38. Coverage • Health Insurance Exchanges • Essential benefits + buy-up • Bronze, Silver, Gold, Platinum • Federal multi-state plans (FEHBP-like) • Consumer Operated & Oriented Plans

  39. Coverage • Insurance market reforms • Guaranteed issue/ prohibit rescissions • Premium rate restrictions • Eliminates annual & lifetime limit • Expands family coverage to age 26

  40. Coverage Reforms • Essential Benefits • Preventive Services, 100% covered • Care planning & coordination • Chronic Illness care • Recognition of added need • Includes mental health

  41. How does the legislation do this? • Coverage expansion & reform • Payment reform • Delivery system transformation

  42. Payment Reform • Flatten the Cost Curve • Reduce the growth in hospital payments • Eliminate subsidies for uncompensated care • Reduce or eliminate certain payments • Preventable Readmissions • Hospital Acquired Conditions • Pay for Performance

  43. Why hospitals ? When Willie Sutton was asked why he robbed banks, he is said to have responded: “ Because that’s where the money is.”