Health Reform and the Delivery System: A Discussion of the Policymaking Process Jack O. Lanier, DrPH, MHA, FACHE CEO Richmond Behavioral Health Authority - PowerPoint PPT Presentation

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Health Reform and the Delivery System: A Discussion of the Policymaking Process Jack O. Lanier, DrPH, MHA, FACHE CEO Richmond Behavioral Health Authority

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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
2
Class 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
4
Five Key Components of PPACA
  • Health Insurance Reform
  • Coverage Reform parity
  • Quality Reform
  • Payment Reform
  • Information Technology

5
Behavioral Health Reform Three Notable
Publications
6
  • http//link.brightcove.com/services/player/bcpid18
    75349721?bctid608833805001

7
Significant 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

8
Impact 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.

9
Virginias 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.

10
Doctors 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.

11
Doctors 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.

12
Health Spending vs. Results
Americans see doctors less, do not live longer,
and are not healthier.
12
13
Health Care ReformComplaints are Never-ending
14
Added 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
15
A Case to Reform the SystemCosts, Quality, and
Coverage
16
A 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

17
Financial Fiscal Realities For State
Governments
18
Fiscal Realities POLICY MAKING AT THE STATE LEVEL
19
Public Opinion
20
Public 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
21
Special InterestsIts All About Money
22
Americans 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

23
Suicidal 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

24
How 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

25
National 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

26
Government 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

27
Big Government on the Brink American Dependency
on Federal Benefits
Samuelson (WP), 2010
28
Behavioral Health Reform Three Notable
Publications
29
The Legislative Policy Making Process
30
Is access to health insurance for all Americans a
right or a privilege?
  1. A right
  2. A privilege

31
Given the known tension between federal and state
governments, which legislative body should
prevail in the health care reform debate?
  1. Federal
  2. State

32
Will provisions of the health reform law likely
bend (reduce) the cost curve over time?
  1. Yes
  2. No

33
Which of the four population groups described
provides the greatest opportunity to reduce
health care cost and improve quality?
  1. Medicaid and CHIP
  2. Employers with fewer than 50 employees
  3. Medicare recipients
  4. Midsized and larger employers

34
A 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

35
Thank You
  • Questions ?
  • Comments?
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