Title: Health Reform and the Delivery System: A Discussion of the Policymaking Process Jack O. Lanier, DrPH, MHA, FACHE CEO Richmond Behavioral Health Authority
1 Health Reform and the Delivery System
A Discussion of the Policymaking ProcessJack O.
Lanier, DrPH, MHA, FACHECEORichmond Behavioral
Health Authority
2Class Learning Objectives
- Describe and discuss components of PPACA.
- Describe key components of health economics and
social choice. - Explain the role of public opinion in the
policymaking process. - Describe a model for policymaking in the U.S.
- Assess students opinion of Governments role in
access to health care. -
3 Health Care For AmericansThe Patient
Protection and Affordable Care Act(P.L.
111-148) 2010-2018
4Five Key Components of PPACA
- Health Insurance Reform
- Coverage Reform parity
- Quality Reform
- Payment Reform
- Information Technology
5Behavioral Health Reform Three Notable
Publications
6- http//link.brightcove.com/services/player/bcpid18
75349721?bctid608833805001
7Significant Provisions of PPACAImpact on
Individual Population Groups
- Young Adults
- 26 and younger may remain on parents policy
- Insurance may be costly, but must stay covered
- The Elderly
- Receive free preventive services under Medicare
- Medicare Advantage Plan - insurer may cut extra
benefits or increase co-payments - Small-Business Owners
- 25 workers or less - may be eligible for tax
credit to help buy coverage - After 2010, may be eligible for only 2 years of
tax credits to help purchase coverage
8Impact of New Insurance Coverage on Americans
- 32 mil more adults nationwide covered.
- In Virginia, 300,000 individuals predicted to
receive new benefits. - Of the 32 mil, 10.5 mil have mental health or
substance use conditions 60 qualify for
Medicaid. - Approx. 8 of individuals may have sub-stance use
issues and never been served.
9Virginias Response to Mandatory Coverage
State-run Insurance Exchanges
- In March, VA AG Cuccinelli sued U.S. Govt.
- Claim U.S. Constitution Commerce Clause cant
compel people to buy insurance. - 2010, Va. GA passed law not to compel residents
to purchase health insurance. - Gov. Bob McDonnell has endorsed lawsuit, saying
the federal law could cost Va. in excess of 1.5
bil in health costs between 2017 and 2022. - Va. Medicaid enrollees estimated to increase from
270,000 to 425,000 between 2017 and 2022.
10Doctors Urge Cuccinelli to Drop Health-Reform
Lawsuit (RTD 06-18-2010)
- Washington-based Doctors for America sent
letter to AG Cuccinelli to drop suit. - Letter argues that litigation (successful or not)
would harm patients by delaying funding
appropriated to medical schools and community
health centers, and medical care to underserved
populations. - Obama administration lawyers filed motion to
dismiss Virginias lawsuit.
11Doctors Urge Cuccinelli to Drop Health-Reform
Lawsuit By the numbers (contd)
- 155 Virginia physicians of Doctors for America
group signed letter to AG Cuccinelli opposing
Virginias lawsuit. - Doctors for America has 16,000 members.
- Virginia has 30,000 physicians.
12Health Spending vs. Results
Americans see doctors less, do not live longer,
and are not healthier.
12
13Health Care ReformComplaints are Never-ending
14Added Benefits To Some States
- A health-care windfall
- D.C. officials are expecting an infusion of
cash. a reward for their push to offer - nearly universal access to insurance for
residents. - 6.2 percent of District residents are uninsured,
less than half the national average.
SOURCE Urban Institute the Henry J. Kaiser
Family Foundation The Washington Post - April
14, 2010
14
15A Case to Reform the SystemCosts, Quality, and
Coverage
16A New Approach for Medicare A Plan to Reward
Quality
- Todays Payment System
- Is Riddled with perverse incentives
- Rewards volume and high profit margin services
regardless of value, outcomes or appropriateness - PPACA will reward hospitals for high-quality
care a first step to transform the way the
federal government pays for health care
17Financial Fiscal Realities For State
Governments
18Fiscal Realities POLICY MAKING AT THE STATE LEVEL
19Public Opinion
20Public Trust in Government 1958 to 2010An
Impediment to Policy Making
- People who say they trust government just about
always or most of the time
20
21Special InterestsIts All About Money
22Americans Dependency on Federal Aid Continues to
Increase
- In 2010
- A record 18.3 of total personal income was
payment from government for Social Security,
Medicare, Food Stamps, unemployment benefits and
other programs - Wages accounted for the lowest share of income
51.0 - Wages declined to a low of 50.5 of personal
income in Feb. 2011
23Suicidal Politics Government Promises More Than
It Can Deliver
- Americans Dependency on Government 2009
- 46.2 received at least one federal benefit
- 46.5 mil Social Security
- 42.6 mil Medicare
- 42.4 mil Medicaid
- 36.1 mil Food Stamps
- 3.2 mil - Veterans benefits
- 12.4 mil - Housing subsidies
- National Opinion Research Center University of
Chicago 2011
24How Americans Spend 35,083 per
HouseholdSource The Portland Mercury with
Exotic Magazine (2009)
- Shopping - 8,668
- Health Family - 8,026
- Food Drink - 6,514
- Home Related Expenses - 6,398
- Getting Around - 5,477
25National Opinion Research Center
SurveyUniversity of Chicago - 2011
- Americans Consistently Want More Spending For
- Education 74 percent
- Health Care 60 percent
- Social Security 57 percent
- Taxes too high Between half and two-thirds
- 2010 Only 2 thought taxes too low
26Government On The Brink With Suicidal
PoliticsNational Opinion Research Center
Chicago 2011
- Government
- Consistently promises more than it can
realistically deliver - Repeatedly disappoints by providing less than
people expect - Governments very expansion brings it into
disrepute, results in paralyzed politics and
impedes it from acting in the national interest
27Big Government on the Brink American Dependency
on Federal Benefits
Samuelson (WP), 2010
28Behavioral Health Reform Three Notable
Publications
29The Legislative Policy Making Process
30Is access to health insurance for all Americans a
right or a privilege?
- A right
- A privilege
31Given the known tension between federal and state
governments, which legislative body should
prevail in the health care reform debate?
- Federal
- State
32Will provisions of the health reform law likely
bend (reduce) the cost curve over time?
- Yes
- No
33Which of the four population groups described
provides the greatest opportunity to reduce
health care cost and improve quality?
- Medicaid and CHIP
- Employers with fewer than 50 employees
- Medicare recipients
- Midsized and larger employers
34A Thought To Ponder
- All history is only one long story to the
effect Men have struggled for power over their
fellow men in order that they might win the joys
of earth at the expense of others, and might
shift the burdens of life from their own
shoulders upon those of others. William Graham
Sumner - (1840-1910). An American academic and professor
at Yale College
35Thank You