Healthcare Reform: What's Really Happening

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Enter Sean McGuire, Health Reform Guru and Political Analyst. Sean was there, working for Congress when the law began the legislative process, and unlike many who actually voted on the law, Sean has actually read the legislation multiple times. He offers a concise summary of the law, and quantifies what it really means to you and those you care about. Featuring the latest developments from Capitol Hill, answers to your questions, and information you need to prepare yourself, your family and your business.

A frequent commentator in the media, Sean offers enlightening and informative commentary on the widely acclaimed and cited health policy blog HealthReformExplained.com - a non-partisan resource explaining health reform to the audience in common language. Audiences can also hear him every Saturday morning in the heartland as host of America’s Healthcare Challenge, a weekly radio program preparing business owners and the public with up to date information on health reform and changing government policies.

An authority in explaining America's new healthcare laws, Sean delivers a powerful, no-nonsense, non-partisan diagnosis for healing our hospitals and reforming our broken healthcare system. Sean dissects the Patient Protection and Affordable Care Act and exposes the fallacies and prejudices of both political parties. He uses his healthcare leadership experience as a lens, through which he brings into focus the problems existing in healthcare today.

Sean continues to be a highly sought after speaker on the Affordable Care act and its implications for our future. Only those wanting a straightforward explanation, stripping away the rhetoric of the political sound bites and looking at the incentives that have been woven into our healthcare system, and the consequences that have resulted, should consider Sean McGuire for their next event.

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Healthcare Reform: What's Really Happening

  1. 1. Sean M. McGuire HEALTHCARE REFORM: What’s Really Happening
  2. 2. “This  is  a  simple  law   once  you   understand  the   complexi5es.” SEAN McGUIRE, Principal + Founder
  3. 3. OBJECTIVES What are the key problems of the current system? –  Why some people feel reform is needed. How did the legislation evolve over time? –  Why ongoing monitoring is important What are the key provisions of the new law? –  How will it impact YOU? 1 2 3
  4. 4. IMPACT: YOU + YOUR HEALTH IMPACT = DIFFERENT FOR EVERYONE INDIRECT COSTS & CONSEQUENCES –  Uncertainty is a cost FINANCIAL IMPACT? –  How do these things affect your employer? –  How are your customers, clients and friends impacted? 1 2 3
  5. 5. Health care COSTS are TOO HIGH. Too many people are UNINSURED or UNDERINSURED. KEY PROBLEMS 1 2
  6. 6. US HEALTHCARE
  7. 7. The main driver of healthcare spending and industry leader. Composed of four components covering hospitalization, outpatient, prescription drugs 10,000 American’s Eligible for it everyday MEDICARE 1 2 3
  8. 8. Federally  run  program  administered  at  the  state   level.       Targeted  towards  low-­‐income  individuals,  however,   significant  por;on  goes  to  long-­‐term  care.     Reimburses  lower  than  Medicare  and  private   insurance.     Expanded  under  the  Affordable  Care  Act.   MEDICAID 1 2 3 4
  9. 9. — Nearly one-third of US health care spending is on administration of our complex system. — Huge regional variation in spending: —  Minneapolis: $3,341 per Medicare enrollee —  Miami: $8,414 per Medicare enrollee — Average health outcomes do not vary by region. —  Actually a trend for more spending à worse outcome •  From: Dartmouth Atlas of Health Care: http://www.dartmouthatlas.org — U.S. ranks #19 in preventable mortality •  From: Nolte E, McKee M.Health Affairs 2008;27:58-71 SPENDING ≠ QUALITY CARE"
  10. 10. $ INSURANCE↑↑↑
  11. 11. LEGISLATIVE PROCESS
  12. 12. ACA Legislative Process = (The Congressional Version of March Madness)
  13. 13. •  WORKFORCE  SHORTAGES  PLAGUE  NATION:   – We  are  facing  a  serious  shortage  of  healthcare   providers  in  the  next  decade.       – Doctors  are  op;ng  out  of  Medicare.   •  PROBLEM  NOT  ADEQUATELY  ADDRESSED:   The  Government  has  not  provided  more  to   hospitals  to  train  physicians  and  other   providers.    All  will  be  needed  in  this  new   normal.     ON THE BUBBLE
  14. 14. In order for the law to pass they had to be vague in legislative language giving the federal bureaucracy an unprecedented amount of authority to implement and write critical parts of the law. 1,693 times they give the executive branch authority to set up a new program or execute a deliverable. (Estimated 120,000 new FTEs needed). EXHIBIT A: WHY THIS MATTERS 1 2
  15. 15. Ambulatory patient services Emergency services Hospitalizations Maternity and newborn care Mental health and substance use disorder services, behavioral health Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care ESSENTIAL BENEFITS 1 2 3 4 5 6 7 8 9 10
  16. 16. ü  FEDERAL LAWSUITS: Due to contraceptive mandate and others coming soon… ü  ADDED COSTS: Rate shock for certain young and healthy individuals. ü  FIGHTS over Future Essential Benefits THE AFTERMATH
  17. 17. ü  LARGE PROVIDER NETWORKS →   CONGLOMORATES:    “Accountable Care Organizations” ü  RE-ADMISSION + OTHER PENALTIES ü  How will this IMPACT INDEPENDENT PROFESSIONALS? HEALTHCARE CONSOLIDATION
  18. 18. q IS THIS TOO MUCH GOVERNMENT? q CAN WE AFFORD IT? THE CONTROVERSY
  19. 19. •  Currently, MORE THAN HALF of health care spending in the U.S. is from government sources. •  After the new law takes effect: –  The government will have a greater role in regulating private insurance. –  About 15 million people will be added to Medicaid –  About 15 million people will buy insurance through a private insurance exchange. –  About 160 million people were predicted to remain covered by employer-based private insurance. TOO MUCH GOVERNMENT?
  20. 20. LACK OF AWARENESS = SERIOUS PROBLEM The amount of Americans who actually believe the Affordable Care Act is the law is less than you think. The MORE PEOPLE LEARN about the law the LESS THEY FAVOR IT. EVERYBODY has to have health insurance in 2014. FACT 1 2 3
  21. 21. ACA: The Bigfoot of American Law
  22. 22. q CAN WE AFFORD IT? q IS THIS TOO MUCH GOVERNMENT? THE CONTROVERSY
  23. 23. Exchanges = Clearing House FIVE AGENCIES OF GOVERNMENT. Thousands of NEW FEDERAL GOVERNMENT EMPLOYEES needed to implement 10,000 pages of regulations and counting. INDIRECT COSTS 1 2
  24. 24. MEDICAL INDUSTRY: Compensation Changes + New Administrative Burdens Employer Mandate DELAY: Cost = $12 Billion. (The amount they estimated the taxes would be the first year). INDIRECT COSTS 3 4
  25. 25. Originally, CBO said the deficit will be reduced over 10 years. – Deficit spending has slowed, but we still lose $845 Billion as a government (after sequester) and recent updates indicate higher costs. UNCERTAINTY: Long-range forecasts and funding comes from reduced Medicare growth and new taxes. COLLECTIVE COSTS 1 2
  26. 26. How  Your  Taxes  Were  Spent  in  2009  
  27. 27. ↑  INSURANCE PREMIUMS ↓  TAKE HOME PAY.  ↑  TAXES/FEES:    Non-­‐Compliance    (Individuals + Businesses) NEW COSTS 1 2
  28. 28. WHO WILL PAY?
  29. 29. IRS Official: “We are on target for all deliverables” August, 2013 Ways and Means hearing. Almost 20 New Taxes –  Tax on Health Insurers. –  Tax on Medical Devices. –  Tax on Pharmaceutical Industry. –  Tax to fund exchanges the first year Flexible spending accounts will be limited to $2500 annually. NEW TAXES 1 2 3
  30. 30. NEW MEDICARE TAXES ↑  MEDICARE PAYROLL: 1.45% => 2.35% Individuals > $200,000 Couples > $250,000 UNEARNED INCOME: Income Brackets > 3.8+% 1st TAX POLICY EVER to put the concept of PASSIVE INCOME = REVENUE SOURCE NEW TAXES 4
  31. 31. THE 49’ER: Purposefully trimming workforce to not be qualified as a large employer. (Remember, 50 is the magic number) THE ROARING 20’s: Reduction of employee hours to fewer than 30 (usually 28). * Popular among restaurants, service industries, and other employers with a lower wage and younger workforce. EMPLOYER STRATEGIES 1 2
  32. 32. MAIN STREET: The employer establishes a Private Marketplace where employees can choose from a variety of health insurance options and services. OLD FAITHFUL: Maintains coverage no matter what! EMPLOYER STRATEGIES 3 4
  33. 33. EMERGING CONCEPT as a reaction to strained healthcare workforces. Companies/Individuals PAY CASH FOR ACCESS to healthcare professionals. Concierge Medicine could become more prevalent and cash pay industry will surface. DIRECT PRIMARY CARE 1 2 3
  34. 34. Essentially Primary Care the Way Supposed to be delivered through team-based care. Run with a physician as manager and includes other healthcare professionals, pharmacists, social workers and others. GOAL: To manage primary care and the person over time. TEAM BASED CARE 1 2 3
  35. 35. The ACA is bringing sweeping change to our healthcare delivery system. Few truly know the details of how providers will be paid differently. Major link to quality in the future, but this is not as easy as one would think. KNOWN KNOWNS 1 2 3
  36. 36. If they fail to enroll young and healthy then you could see pre-existing by cost if people cannot afford it. Subsidy structure flawed and needs revision. How healthcare providers will be able to handle impact of this law on their profit margins. (Lost productivity, new costs, lower reimbursement creates new challenges). KNOWN UNKNOWNS 1 2
  37. 37. RURAL PROVIDER IMPACT: How do we staff rural and urban under- served areas moving forward? PHYSICIANS REACTION: How will physicians react as new administrative challenges deplete morale and compensation goes down? UNKNOWN UNKNOWNS 1 2
  38. 38. 3 LEGS OF HEALTH POLICY: ACCESS QUALITY COST BOTTOM LINE: BACK  TO  THE  BASICS 1 2 3
  39. 39. FOCUS: Changing the system to reduce overhead and fraud in the healthcare system ADDED FOCUS: PREVENTION First dollar coverage is nice but has a cost Millions of Americans will have ACCESS TO HEALTHCARE COVERAGE in 2014 THE GOOD 1 2 3
  40. 40. WAIT TIME: Less face time with your doctor due to additional administrative burdens. QUALITY: Universal coverage DOES NOT GUARANTEE quality care. Workforce shortages will persist if not addressed. CHOICE OF PROVIDER: may be limited by provider choice due to lower reimbursement rates. THE BAD: Access Concerns 1 2 3
  41. 41. Authority given to executive branch to define ambiguity and implement fines. Hidden fines + penalties will be detrimental to some companies. BE PROACTIVE, NOT REACTIVE with regulators. THE WORSE: Unknown Unknowns 1 2 *
  42. 42. Chronic disease management and changing health behavior Medications result in new diagnoses. Example: Side effect of schizophrenia medications is diabetes and weight gain. Creative solutions for this problem and others at the State level are desirable and possible in 2017, maybe sooner. THE UGLY: National Obstacles 1 2 *
  43. 43. CANADA: -  Single Payer System -  Regional Policy -  Low Administrative Costs -  Less Bureaucracy -  Easier Access to Prescription Drugs ü Comparative Studies Are Essential ü Average health outcomes vary by region ü Regional Variations Could Be Controlled WHAT WE CAN LEARN
  44. 44. E.D. BELLIS HEALTHCARE CONSULTING 2 3 PREPARING: - Business owners - Executives - Healthcare providers … with synthesized information on healthcare reform + providing ongoing regulatory management during the entire Affordable Care Act implementation.
  45. 45. Grab your smart phone Go to http://presentnow.me Enter the code “obamacare” NEWSLETTER 1 2 3
  46. 46. DOWNLOAD Download Today’s Presentation http://bit.ly/1adGqmp
  47. 47. Sean@EDBellisInc.com   @SeanMMcGuire     @AmericasCanary         SEAN McGUIRE.
  48. 48. QuesDons  

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