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
Senator Irene Aguilar, MD
2. Case Report
3. Lewin Analysis of Health Proposals for Colorado
a Health CO
CO Assn of
Care for CO
A Plan for
Covering CO 5th Proposal
4. US v. Other G7 Countries
MD visits (2009)
per 100 pop
Hospital days per
$ 3,831 $8,232
as % of GDP
LE at birth (2010)
Infant deaths per
1000 live births
per capita (PPP)
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.
ORIGINAL BY: John A. Nyman, PhD
University of Minnesota
5. IOM: Best Care at Lower Cost
US Health Care
6. Determinants of Health
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. Brings together buyers and sellers of insurance
Compare health insurance options and shop for
coverage that will take effect as early as January 1,
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. As of October 28th
30,862 calls to
10. Table 2: Estimate of ACA Effect, 2016
Small Firm ESI (1-50 employees)
Tax Credit Recipients
Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011
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.
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.
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. Massachusetts: Private, Medicare & Medicaid
Payment for Professional Procedures
Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost
Trends: Price Variation in Massachusetts Health Care Services, May 2011.
13. Percent of Total Health Care Spending
Concentration of Health Care Spending in the U.S.
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. 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. Figure 4. Share of Colorado population without
health insurance coverage, alternative funding
17. If you’re not at the table,
you’re on the menu