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Public
Policy and
the Primary
Care
Physician

Senator Irene Aguilar, MD
Case Report
Lewin Analysis of Health Proposals for Colorado
September 2007
CHS/ Single
Payer
Author
Remaining
Uninsured
Health
Spendin...
US v. Other G7 Countries

Updated

Canada

France

Germ.

Italy

Japan

UK

Avg

USA

MD visits (2009)
per capita

6.5

6....
IOM: Best Care at Lower Cost
7.2%
9.8%

27.5%

INSTITUTE OF
MEDICINE 2012:
US Health Care
Annual Waste

$ 765
Billion

24....
Determinants of Health

2011
U.S.
Healthcare
Spending:

$2.7
Trillion
Health Reform in Colorado
 2011 Bipartisan legislation to establish a
health care exchange: Connect for Health
 2013 Med...
Brings together buyers and sellers of insurance
Compare health insurance options and shop for
coverage that will take ef...
As of October 28th
316,326 visitors
44,945 accounts
created
30,862 calls to
Service Center
3164 purchases
Table 2: Estimate of ACA Effect, 2016
With ACA

ACA Impact

2,630,000

2,600,000

-30,000

Small Firm ESI (1-50 employees)...
Research shows significant variation in
health care spending.
Medicare Payments per Enrollee, by Hospital Referral Region,...
Massachusetts: Private, Medicare & Medicaid
Payment for Professional Procedures
Private Payer
Payment Variation
Min
Price
...
Percent of Total Health Care Spending

Concentration of Health Care Spending in the U.S.
Population, 2009

(≥$51,951)

(≥$...
Cooperative would put Colorado on
sustainable path: Spending growing no
faster than the GSP
Savings grow by “bending the
c...
Figure 4. Share of Colorado population without
health insurance coverage, alternative funding
programs, 2015-24.
21
If you’re not at the table,
you’re on the menu
Senator Aguilar SLC 2013 Presentation
Senator Aguilar SLC 2013 Presentation
Senator Aguilar SLC 2013 Presentation
Senator Aguilar SLC 2013 Presentation
Senator Aguilar SLC 2013 Presentation
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Senator Aguilar SLC 2013 Presentation

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  • Total US government spending is actually higher because of tax breaks for purchase of insurance. Estimate this as $1000 per capita so that our taxes pay $4900 per person toward health care, more than 9 other industrialized countries.
    Why is this?
  • Industry of Denial Management – spend $1.50 to be sure you don’t get $1.00 more of care than you deserve.
    Al Gore, the inconvenient truth…. (? Insert video clip)
    Having multiple insurance companies is inefficient and wasteful.
    The “marketplace” penalizes efficiency, encourages inconsistency, and has absolutely no demonstrable relationship between the price of any single health care product and its actual value.
  • It has been estimated that by 2026 the expansion will be responsible for adding 22,388 new jobs to Colorado’s economy, with 14,357 of those jobs being added in the first 18 months of the expansion. The same study projects an additional $4.4 billion in additional economic activity for the state as a direct result of the expansion.
     
    Over 50% of the people who would be newly eligible under this expansion are people who are working. Many people who work in retail services, have jobs in construction, take care of other people’s children, and work in the agriculture industry will qualify for coverage under this expansion. In enacting this expansion, Colorado will be helping hardworking families stave off financial disaster because of accident or injury while also giving those families access to preventative care.
     
     
    Charles Brown, Warren Olson, Dr. Phyllis Resnick (February 2013). Medicaid Expansion: Examining the Impact on Colorado’s Economy. Colorado Health Foundation
    Christopher Stiffler, Andrew Ball, Emily Wattman-Turner (December 19, 2012). Expanding Medicaid Makes Colorado’s Workforce and Economy Healthier. Colorado Center on Law and Policy
  • The Cost Conundrum. Atul Gawande
    McAllen, Texas vs Grand Junction Colorado
    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
    FOOTNOTES:
    For more information about price adjustment, click here.
    DENOMINATOR DEFINITION:
    A 20% random sample of the enrollment file for beneficiaries age 65-99 enrolled in both Medicare Parts A and B, selected on the basis of the terminal digits in the Social Security number. Patients enrolled in risk-bearing health maintenance organizations (HMOs) are excluded.
    ADJUSTMENTS:
    Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard. Gender-specific rates are age and race adjusted; race-specific rates are age and sex adjusted.
  • A small proportion of the U.S. population accounts for half of all U.S. health care spending. The 5% of the population with higher health care expenses (≥$17,402 annually) was responsible for nearly half (49.5%) of total health care spending, while the 50% of the population with the lowest expenses (<$851) accounted for only 2.9% of total spending.
    The Hot Spotters, Atul Gawande
  • Rocky Mountain Health Plan
    Kaiser
    Denver Health
  • Transcript of "Senator Aguilar SLC 2013 Presentation"

    1. 1. Public Policy and the Primary Care Physician Senator Irene Aguilar, MD
    2. 2. Case Report
    3. 3. Lewin Analysis of Health Proposals for Colorado September 2007 CHS/ Single Payer Author Remaining Uninsured Health Spending Medicaid/CHP Subsidies Benefit Floor Benefit Cap Mandates Solutions for a Health CO CO Assn of State Health Underwriters Better Health Care for CO 0 138,000 487,000 108,600 106,600 ($1,400 M) Obsolete Progressive Premium $271 M Expand $595 M Expand $1,289 M Expand $861 M Expand 250% FPL Less than current law $35,000 Individual 300% FPL Basic 400% FPL Comprehensi ve None Individual Employer 400% FPL Basic HCAC Comprehensive None Individual Employer SEIU $35,000 None A Plan for Commission’s Covering CO 5th Proposal Committee for 208 CO Health Commission Solutions $50,000 Individual
    4. 4. US v. Other G7 Countries Updated Canada France Germ. Italy Japan UK Avg USA MD visits (2009) per capita 6.5 6.9 8.2 NA 13.2* 5.0 6.3 3.9 Hosp discharges per 100 pop 8.4 17.0 26.3 NA NA 13.3 16.0 13.1 Avg hospital LOS (2009) 7.7 5.2 7.5 NA NA 6.8 5.9 5.4 144.0 83.2 (2009) Hospital days per 100 population $4,445 $3,974 $4,338 $2,964 NA $3,433 $ 3,831 $8,232 HC spending as % of GDP 11.4 11.6 11.6 9.3 NA 9.6 10.6 15.8 LE at birth (2010) 80.8 (08) 80.2 80.5 82 (09) 83 80 81.1 78.7 Infant deaths per 1000 live births NA 3.6 3.4 3.4 2.3 4.2 3.4 6.1 HC spending (2010) per capita (PPP) (2010) OECD website : http://stats.oecd.org/index.aspx The spending per capita numbers were converted from the currency of the country to US dollars by a PPP index. (2010) ORIGINAL BY: John A. Nyman, PhD University of Minnesota 5
    5. 5. IOM: Best Care at Lower Cost 7.2% 9.8% 27.5% INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste $ 765 Billion 24.8% 17% 13.7%
    6. 6. Determinants of Health 2011 U.S. Healthcare Spending: $2.7 Trillion
    7. 7. Health Reform in Colorado  2011 Bipartisan legislation to establish a health care exchange: Connect for Health  2013 Medicaid Expansion endorsed by Legislature and signed by Governor  Moving forward: focus on Payment Reform
    8. 8. Brings together buyers and sellers of insurance Compare health insurance options and shop for coverage that will take effect as early as January 1, 2014 Choice of up to 150 different private health insurance plans from ten carriers Financial assistance based on income available to close to 500,000 Coloradans
    9. 9. As of October 28th 316,326 visitors 44,945 accounts created 30,862 calls to Service Center 3164 purchases
    10. 10. Table 2: Estimate of ACA Effect, 2016 With ACA ACA Impact 2,630,000 2,600,000 -30,000 Small Firm ESI (1-50 employees) 560,000 540,000 -20,000 Other ESI 2,070,000 2,060,000 -10,000 Unreformed Non-group 340,000 60,000 -280,000 Reformed Non-group 0 620,000 620,000 Tax Credit Recipients 0 470,000 470,000 Non-Recipients 0 150,000 150,000 Public Insurance 550,000 710,000 160,000 Uninsured 860,000 400,000 -460,000 Total 4,390,000 4,390,000 ESI → → Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011 → No Reform
    11. 11. Research shows significant variation in health care spending. Medicare Payments per Enrollee, by Hospital Referral Region, 2009 Source: The Dartmouth Atlas of Health Care. DENOMINATOR DEFINITION: A 20% random sample of the enrollment file for beneficiaries age 65-99 enrolled in both Medicare Parts A and B, selected on the basis of the terminal digits in the Social Security number. Patients enrolled in risk-bearing health maintenance organizations (HMOs) are excluded. ADJUSTMENTS: Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard. Gender-specific rates are age and race adjusted; race-specific rates are age and sex adjusted.
    12. 12. Massachusetts: Private, Medicare & Medicaid Payment for Professional Procedures Private Payer Payment Variation Min Price Max Price Office Visit $45 $330 MRI Brain $104 $646 Colonoscopy $203 $1,045 Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost Trends: Price Variation in Massachusetts Health Care Services, May 2011.
    13. 13. Percent of Total Health Care Spending Concentration of Health Care Spending in the U.S. Population, 2009 (≥$51,951) (≥$17,402) (≥$9,570) (≥$6,343) (≥$4,586) (≥$851) (<$851) Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included. Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Household Component, 2009.
    14. 14. Cooperative would put Colorado on sustainable path: Spending growing no faster than the GSP Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation
    15. 15. Figure 4. Share of Colorado population without health insurance coverage, alternative funding programs, 2015-24.
    16. 16. 21
    17. 17. If you’re not at the table, you’re on the menu
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