1. A not-for-profit health and tax policyresearch organization What’s coming and what it means for medical practice Grace-Marie Turner November 16, 2012 Southern Medical Association /GalenInstitute www.galen.org
2. Americans’ views on the law • Americans say the health law will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance. • Opposition to the law remains as high as it was when the law was enacted. • Three more states passed ballot initiatives to block the individual mandate – AL, WY, MTSources: ―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
3. 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 wanted stability. Change was for others.www.galen.org
4. A not-for-profit health and tax policyresearch organization /GalenInstitute www.galen.org
5. Taxes and spending in ObamaCareSource: 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/.
6. Generous Subsidies in Exchanges Examples: • 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 subsidies But only if employer doesn’t offer coverage or if it’s not ―affordable‖ (costs >9.5% of income)www.galen.org
8. Two issues: Taxes. Trust.www.galen.org
9. 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.
10. 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.
11. The law fails to meet goals • Health costs and health spending increase • One-third of businesses may drop insurance • Young people worried about high cost of policies • Doctors concerned about Medicaid expansion and fraying the safety net • Seniors worried about rationing of care and finding a doctor who takes Medicare • 30 million will remain uninsured -- CBOwww.galen.org
12. Some realitieswww.galen.org
13. 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.
14. The AMA and practicing physicians • The SGR Medicare payment fix was its key bargaining chip • The chance for a permanent fix is missed; the president got the AMA endorsement for an empty promise • Pleas for short-term fixes are likely to continue indefinitelywww.galen.org
15. The Doctors Co. Survey: – 60% say increased patient volume will hurt the level of care they can provide – 43% said they are thinking about retiring in the next five years – Nine out of ten said they would discourage friends and family members from pursuing a career in medicinewww.galen.org http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671
16. Physician concerns • Questions about Accountable Care Organizations • Authority of HHS Secretary to set new rules for quality of care • Regulatory requirements impacting private medical practices • More burdensome record-keepingwww.galen.org
17. Specific changes to watch • IPAB — the Independent Payment Advisory Board • Patient-Centered Outcomes Research Institute and comparative effectiveness ―guidelines‖ • Physician Quality Reporting Initiative • Value-based Payment Modifierwww.galen.org
18. CRS previews impact of health law on physicians PPACA has the potential to change fundamental aspects of how physicians organize, practice, and deliver care in the future. • Some of these provisions create new structures and entities, like the CMS Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute • Others seek to develop alternatives to traditional fee-for-service payment, such as the National Pilot Program on Payment Bundling, the shared savings program (including the accountable care organization, or ACO, model), or the value-based payment modifier under the physician fee schedule In the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers.Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, ―Medicare Provisions in the Patient Protection and Affordable CareAct, (PPACA): Summary and Timeline,‖ November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.
19. Health care in 2013 • Legislation Searching for bi-partisan support for fixes; hearings to highlight problems and successes • Regulation 13,000+ pages so far, and they’ve only begun! • Legal At least new 35 court challenges proceed …and the battle over the doc fix continueswww.galen.org
20. 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 • Targeted subsidies for the uninsured • Portable insurance, equal tax treatment • More functional high-risk pools • Cutting Medicaid’s red tapewww.galen.org
21. Even Europeans going the other way • Consumerism • Value of private enterprise and competition • Doctor-patient relationship • Decentralized decision-makingwww.galen.org
22. A market-based solution “Defined contributions” for health coverage A system that puts doctors and patients in charge of medical decisions Restructuring financing for a 21st century health sector • Medicare • Medicaid • Private Insurancewww.galen.org
23. The future? • The global move toward consumerism is real, driven by greater patient demand for more control over decisions. • Physicians will find new and creative ways to deliver patient care outside the ACA’s centralized control. Search for your opportunities!www.galen.org
24. 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
25. Grace-Marie Turner A not-for-profit health and tax policy Galen Instituteresearch organization 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