Health Reform: A not-for-profit health and tax policyresearch organization Where are we now? Grace-Marie Turner January 8, 2013 Central Kentucky Association of Health Underwriters /GalenInstitute www.galen.org
Source: Ari Melber,”POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,” The Nation, July 4, 2012,http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
Americans agreed on goals for health reform… • The U.S. needs health reform to: – make coverage more affordable – assure quality, and – expand access to insurance • Most people rate their own coverage as good or excellent • They want stability. Change is for others.www.galen.org
Americans’ views of health law after Supreme Court decision• Americans say it will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance.• Opposition to the law higher after Supreme Court decision.Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBSNews Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
Source: “Kaiser Health Tracking Poll: July 2012,” The Henry J. Kaiser Family Foundation, July 31, 2012, http://www.kff.org/kaiserpolls/8339.cfm.
Majority of Americans Oppose Government Health Care Gallup asked: Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government? % Government responsibility % Not government responsibility 69 64 64 64 62 62 59 58 54 54 50 50 50 47 47 46 44 41 39 38 34 35 34 33 31 28 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2011 2012Source: Jeffrey M. Jones, “Now Against Govt Healthcare Guarantee,” Gallup Politics, November 28, 2012,http://www.gallup.com/poll/158966/majority-against-gov-healthcare-guarantee.aspx.
The health law in one graphSource: Avik Roy, “Fact-Checking the Obama Campaigns Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012,http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
Why ObamaCare isn’t settled 38% of Americans supported the law in the last major poll before the November elections Of the 50.6% who voted for President Obama… 12% said they wanted the law repealed The election was not about ObamaCareSource: “Kaiser Health Tracking Poll: October 2012,” The Henry J. Kaiser Family Foundation, October31, 2012, http://www.kff.org/kaiserpolls/8381.cfm.
ObamaCare Resistance MovementGovernors: No exchanges or Medicaid expansionCitizens: Pay fine rather than buy insuranceEmployers: Seeking ways to avoid finesCongress: Delay, defund, dismantle, do strict oversightLegal challenges: 40 and counting, including challenge to religious liberty
State Actions to Address Health Insurance Exchanges Pursuing state-run State plans to State has not Pursuing state-run State not establishing exchange: enacted partner with federal declared their exchange: executive a state-run exchange legislation government plan to HHS branchSource: “State Actions to Address Health Insurance Exchanges,” National Conference of State Legislatures, December20, 2012, http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx.
Exchange bureaucracySource: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012,http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.
ObamaCare’s New TaxesSource: Philip Dittmer and William McBride, “Obamacares New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
More ObamaCare TaxesSource: Philip Dittmer and William McBride, “Obamacares New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
Mercer: Employers planning workforce changes w Mercer study on what employers expectSource: “Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,” Mercer LLC, August8, 2012, http://www.mercer.com/press-releases/1472805.
Employer mandate penalties For companies with +50 employees • $2,000 per year per full-time employee for not providing coverage (minus first 30) • $3,000 per year for any employee getting insurance through the Exchanges * If an employer offers employee-only coverage that’s “affordable” to the worker, family members are not eligible for Exchange subsidieswww.galen.org
Some things to think about1. Employers with <50 FTE EE’s have no 3k/2k penalty2. But employers offering qualified and affordable coverage may actually be hurting their employeesExample SCOTUS Success Boot Camp
Generous Subsidies inExamples: Exchanges• A person earning $42,000 a year with a family of 4 qualifies for $14,759 in new health insurance subsidies• A single person earning $20,600 qualifies for $5,156 in new health insurance subsidiesBut only if employer doesn’t offer coverage or ifit’s not “affordable” (ie costs >9.5% of income)www.galen.org
But employee share still steepExamples:• A young family earning $35,000 a year would have to pay up to $5,555 in total health costs for a $12,130 Silver plan ($1,388/prem.; $4,167 OOP)• A slightly older family earning $85,000 would have to pay up to $16,408 in total health costs for a $15,116 Silver plan ($8,075/prem.; $8,333 OOP)Source: Estimates based upon the Kaiser Family Foundation’s Health Reform Subsidy Calculator, http://healthreform.kff.org/subsidycalculator.aspx.Grace-Marie Turner, “ObamaCare: Pain 2.0,” New York Post, December 27, 2012, http://tinyurl.com/ag92fgv.
What we know for sure• CHOICE: Americans value innovation, diversity and choice to accommodate 300 million people• VALUE IN HEALTH SPENDING: To realize the promise of personalized medicine and achieve overall cost saving, break down payment silos• FOCUS ON THE PATIENT: They want doctors and patients, not government, to make health care decisions
Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012,http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
A market-based solution“Defined contributions” for health coverage A system that puts doctors and patients in charge of medical decisionsRestructuring financing for a 21st century healthsector• Medicare• Medicaid• Private Insurance
States have a big role Seek ways improve their markets • Enhance competition for more choices of affordable coverage • Better safety net with functional high-risk pools • Private exchanges? • What suggestions can you present?www.galen.org
Even Europeans going the other way • Consumerism • Value of private enterprise and competition • Doctor-patient relationship • Decentralized decision-makingwww.galen.org
The future? • The global move toward consumerism is real, driven by greater patient demand for more control over decisions. • People will seek more affordable options outside the ACA’s centralized control. Search for your opportunities!
Why ObamaCare Is Wrong for America How does the health care law drive up costs? Is your doctor really in charge of your health care decisions? Are your Constitutional rights threatened? Discover the law’s impact on your life in a new book from four nationally recognized health policy experts Published by Broadside Books, an imprint of HarperCollins www.WrongForAmericaBook.comwww.galen.org
Grace-Marie Turner A not-for-profit health and tax policyresearch organization Galen Institute 703-299-8900 firstname.lastname@example.org twitter.com/GalenInstitute facebook.com/GalenInstitute Subscribe to our free email alerts at /GalenInstitute www.galen.org www.galen.org/subscribe