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Health Care Reform: Facts, Figures, and Imperatives

Delve into the complex landscape of healthcare reform, from rising expenditures to health behavior influences. Gain insights to navigate the system's challenges. Learn where we stand and what lies ahead for the industry.

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Health Care Reform: Facts, Figures, and Imperatives

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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.”

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