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Major Health Issues

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The Affordable Healthcare ... Excellence Mayo s Cleveland Clinic The Affordable Healthcare Act Battle over ... Regulatory Reform Accept all ... – PowerPoint PPT presentation

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Title: Major Health Issues


1
Major Health Issues
  • The Affordable Healthcare Act

2
Introduction
  • Costs- US per capita is 2x costs in other
    industrialized nations
  • Recent years increasing 6-9 per year
  • Approximately 20 of US economy

3
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4
Can the average Mississippi family afford
healthcare?
  • Family of four in Mississippi estimated cost is
    15,000
  • What drives the cost?
  • Technology - excessive use
  • Aging population
  • Overutilization duplication of services
  • Excess Administrative costs

5
Can the average Mississippi family afford
healthcare?
  • Driving Cost contd
  • Waste and Fraud Overuse of Emergency Rooms
  • Defensive Medicine
  • Fee for Service System Over utilization
  • Insurance Coverage

6
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7
Milliman Milliman State Federal Federal State
Moderate Participation Moderate Participation Moderate Participation 13,901 12,635 1,267
320,000 Enrollees 320,000 Enrollees

Kaiser
320,000 Enrollees 320,000 Enrollees 10,294 9,865 429
Reflects State savings for Reflects State savings for Reflects State savings for
several groups under ACA several groups under ACA several groups under ACA

Urban Institute Urban Institute
15,832 14,805 1,027
State Spending increases 13 State Spending increases 13 State Spending increases 13 State Spending increases 13
over a 9 year span versus over a 9 year span versus over a 9 year span versus
existing program. existing program.
(Most of the Increase is in years 2016-2020) (Most of the Increase is in years 2016-2020) (Most of the Increase is in years 2016-2020) (Most of the Increase is in years 2016-2020)
8
Access
  • The UNinsured
  • 40-50 Million in the US
  • 500,000 in Mississippi
  • The UNDERinsured

9
Access
  • Other Factors
  • Knowledge
  • Culture
  • Poverty
  • Disparity Racial Economic

10
Quality
  • Significant variability
  • Process Issues
  • Many preventable and avoidable errors
  • 80-100,000 Excessive deaths per year
  • Evidence Based Medicine
  • Centers of Excellence
  • Mayos
  • Cleveland Clinic

11
The Affordable Healthcare Act
  • Battle over Single Payer vs. Multiple Payer
    System
  • Builds on Existing System
  • Government Plans Healthcare Insurance Plan
  • Strengthens Health Insurance
  • Regulation Consumer Protection- Placed on States

12
The Affordable Healthcare Act
  • Emphasis on Prevention Wellness
  • Goal of Universal Coverage
  • Improve Access
  • Lower overall costs
  • Reduce Misuse of Emergency Rooms
  • Promote the Medical Home

13
Major Provisions
  • Phased in over Several Years

14
Access
  • Medicaid Expansion
  • Covers all under 133 of the Federal Poverty Line
  • Estimates for Mississippi are an additional
    200-300,000
  • Who are largely adults without children
  • Why not covered now
  • State and Federal Funding

15
Access
  • Medicaid Expansion contd
  • Funding
  • No Match for 3 years
  • 5 to 10 for years 2017-2020
  • 10 Capped after 2020
  • Very Attractive to Mississippi
  • Economically Important

16
Premium Support
  • Tax Credits for individuals to purchase health
    insurance
  • Above 133 of the poverty line for individual
    health insurance
  • Estimates 200,000 in Mississippi

17
Premium Support
  • Will enable uninsured individuals 133 to 400
    above the poverty income level to afford
    insurance no premium gt 10 annual income
  • Economic Impact No state match the average
    subsidy will be lt 5,000

18
Regulatory Reform
  • Accept all applications
  • No rejections for preexisting conditions
  • Increase payment for primary care
  • Under the age of 26 may continue on parents plan
    if no other access to a group plan
  • Remove Annual Caps -Rescissions

19
Mandates Coverage For All
  • Individual or group plans
  • Penalty if not offered or purchased
  • Mandates all large employer groups must provide
    coverage or pay penalty
  • Small employers are provided tax credits for
    employee coverage
  • Employers of early retirees age 55-64 may reduce
    premium costs through reinsurance

20
Costs
  • Medical Effectiveness Studies
  • Support for Health Information Systems
  • Computerized health records
  • Standardized health insurance claim forms
  • Standardized definitions for procedures
  • Systems for providers to exchange information
  • Health Insurance Exchanges
  • A marketplace in each state for the uninsured and
    small employers to compare health insurance plans
    and prices as well as purchase coverage
  • Also determines eligibility for Medicaid and
    Premium Support programs

21
Costs
  • Sets minimum medical loss ratios for health
    insurance plans
  • Expansion of Community Health Centers
  • Expansion of preventative services
  • Includes governmental plans and private health
    insurance
  • Sets limits on amount insurance companies can
    deduct as expense items for executive salaries
  • Independent Payment and Advisory Board (IPAB)
  • Sets limits on fees and payments to keep Medicare
    growth in control
  • Congress cannot change, if it rejects must
    substitute to equal cost reductions of (IPAB)
  • Accountable Care Organizations
  • Supports projects to change Medicare payments for
    primary care services somewhat like DRGs for
    hospitals

22
Funding HCR
  • Individuals with earned income greater than
    200,000 per year (250,000 joint filers) will
    have a .9 increase in Medicare tax
  • Same individuals or joint filers as above an
    additional 3.8 Medicare tax on investment
    income, dividends, capital gains, rents, and
    passive income
  • Excise tax on high cost employer sponsored plans
  • Premiums gt 10,200 for individuals and 27,500
    for families
  • Increased taxes on drug companies, health
    insurance companies and other health related
    companies
  • Estimated cost through 2020 800 Billion

23
Questions?
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