Healthcare Presentation

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Healthcare presntation from Jane Kusiak, Lou Rossiter, Michael Cassidy and John McInerney.

Healthcare presntation from Jane Kusiak, Lou Rossiter, Michael Cassidy and John McInerney.

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  • 1. Health Care Reform: Opportunities and Challenges in Virginia April 16, 2010
  • 2. Aspirations for the Session ✤ Provide a foundation upon which to consider the implications of health care reform legislation ✤ Explore the Patient Protection and Affordable Care Act (ACA) ✤ Discuss the upcoming opportunities and challenges for health care reform in Virginia 2
  • 3. Agenda Overview of Session and Basic Jane N. Kusiak, Executive Director, Council Health Care Information on Virginia’s Future Patient Protection and Affordable John McInerney, Policy Director, The Care Act: What’s in the Bill? Commonwealth Institute for Fiscal Analysis The Politics of Health Care Reform Michael Cassidy, Executive Director, The Commonwealth Institute for Fiscal Analysis The Economics of Health Care Dr. Louis Rossiter, Research Professor, The Reform Thomas Jefferson Program in Public Policy, College of William & Mary Opportunities for Health Care Jane N. Kusiak Leadership in Virginia Summary and Discussion Jane N. Kusiak and Panel 3
  • 4. Health Status In Virginia Jane N. Kusiak, Executive Director 4
  • 5. Health Status in Virginia Health & Family State Ranking Indicator Progress Trend 1-10 11-20 21-30 31-40 41-50 Cancer Deaths ] Cardiovascular Disease ] Health Insurance a Immunization ] Infant Mortality ] Obesity a Smoking ] Suicide a Teen Pregnancy ] Source: Virginia Performs (VaPerforms.virginia.gov) 5
  • 6. Regional Health Trends Health & Family Hampton West Indicator Central Eastern Roads Northern Southside Southwest Valley Central Cancer ] ] ] ] ] [ [ ] Cardiovascular Disease ] ] ] ] ] ] ] ] Infant Mortality ] a ] a [ [ [ a Obesity a a [ a a a a a Suicide [ ] [ ] [ [ a [ Teen Pregnancy ] ] ] ] ] [ ] ] Source: Virginia Performs (VaPerforms.virginia.gov); Estimates of current performance trends provided by the Weldon Cooper Center at U.Va. 6
  • 7. Infant Mortality by Race/Ethnicity and Level of Education, 2005-2007 20 Infant Deaths per 1,000 Live Births 15 Less than 12 years 12 years Greater than 12 years 10 5 0 White Black Hispanic Other/NR Non-Hispanic Non-Hispanic Source: Virginia Department of Health, Office of the Commissioner 7
  • 8. Virginia Smoking Rate by Income Level 40% Less than $15,000 34% $15,000 – $24,999 $25,000 – $34,999 $35,000 – $49,999 28% $50,000+ 22% 16% 10% 2003 2004 2005 2006 2007 2008 Source: Virginia Performs (VaPerforms.virginia.gov); based on data from the Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System 8
  • 9. Cardiovascular Death Rates Source: Virginia Performs (VaPerforms.virginia.gov); based on Virginia Center for Health Statistics; City County Profiles (www.vdh.state.va.us/healthstats/stats.asp) 9
  • 10. Health Insurance 10
  • 11. 0% 5% 10% 15% 20% 25% Massachusetts Hawaii 30% Minnesota Wisconsin Iowa Connecticut Pennsylvania Maine New Hampshire Vermont North Dakota Delaware Rhode Island Michigan Ohio Washington South Dakota Indiana Alabama Utah Kansas Nebraska Missouri Maryland Illinois 11 Virginia New York Wyoming Virginia Idaho Kentucky New Jersey Tennessee West Virginia United States Colorado North Carolina United States Oklahoma States, 2007-2008; United States, 2008 Montana South Carolina Oregon Arkansas Georgia Nevada California Mississippi Alaska Non-Elderly Uninsured by State Arizona Louisiana Florida New Mexico Texas Source: The Henry J. Kaiser Family Foundation; stathealthfacts.org; http://www.statehealthfacts.org/comparetable.jsp?ind=139&cat=3
  • 12. Health Insurance Status of Non-Elderly Virginians, 2008 Uninsured 13.8% 1.6% Medicare Medicaid and CHIP TRICARE 7.3% Private Nongroup Employer 4.8% 67.7% 4.8% Source: Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010 12
  • 13. Uninsured Virginians by Age Cohort Share of Total Non-Elderly Uninsured Rate of Uninsured in Each Age by Age Group, 2007-2008 Group, 2007-2008 30% 27.5% 9.2% 25.3% 17.8% 24% 18% 31.1% 16.2% 13.9% 12% 10.6% 9.3% 6% 25.7% 0% Under 19 19-24 25-34 35-54 55-64 Under 19 19-24 25-34 35-54 55-64 Source: Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010 13
  • 14. Non-Elderly Uninsured Virginians by Race / Ethnicity Share of Total Non-Elderly Uninsured Rate of Uninsured by Race/Ethnicity, 2007-2008 by Race/Ethnicity, 2007-2008 50% 8.9% 40% 41.7% 19.7% 30% 50.1% 20% 17.8% 16.2% 10% 11.5% 21.3% 0% White Black Hispanic Other (Non-Hispanic) (Non-Hispanic) White (Non-Hispanic) Black (Non-Hispanic) Hispanic Other Source: Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010 14
  • 15. Non-Elderly Uninsured Virginians by Employment Status / Firm Size Share of Total Non-Elderly Uninsured by Percent Uninsured by Employment Employment Status/Firm Size, 2007-2008 Status/Firm Size, 2007-2008 6.2% 40% 35.3% 34.3% 10.4% 20.2% 30.9% 30% 16.2% 21.5% 20% 27.7% 9.7% 19.3% 10% 7.6% 0% Non-working 500+ ng d 10 -99 99 0+ rki loye n 10 0-4 50 10-99 Less than 10 wo mp tha 10 n- -e ss Self-employed 100-499 No Self Le Source: Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010 15
  • 16. Non-Elderly Uninsured Virginians by Family Poverty Level Share of Total Non-Elderly Uninsured by Percent Uninsured by Family Poverty Family Poverty Level (FPL), 2007-2008 Level, 2007-2008 40% 38.0% 22.4% 30% 35.2% 26.3% 20% 15.0% 15.6% 10% 6.2% 26.8% 0% At or Below 101-200% 201-300% 301%+ Poverty of FPL of FPL At or Below Poverty Level 101-200% FPL 201%-300% FPL Above 300% FPL Source: Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010 16
  • 17. The Patient Protection and Affordable Care Act (ACA): What’s in the Bill? John McInerney, Policy Director 17
  • 18. Health Reform in Brief (VERY BRIEF) ✤ Covers 32 million additional Americans by 2019 ✤ Expands Medicaid and creates new health insurance marketplace for those without insurance through their jobs ✤ Authorizes cost control measures to slow growth of health care spending 18
  • 19. What to Expect from ACA in 2010 ✤ Young adults will be able to stay on parents’ plan until 26 ✤ No pre-existing condition exclusions for children’s health insurance ✤ Drug costs for seniors will decrease through rebates and other measures ✤ Provides small business tax credits 19
  • 20. What to Expect from ACA in 2010 Other Insurance Market Reforms ✤ Removing lifetime caps ✤ Ending of “rescissions” ✤ Providing access to high-risk pool coverage for adults with pre-existing conditions ✤ Small business reinsurance program for those insuring 55-64 year olds 20
  • 21. Then What? ...Reforms in 2014 ✤ Creation of Health ✤ Expansion of Medicaid Insurance Exchange program marketplace ✤ An end to pre-existing ✤ Individual mandate; condition discrimination subsidies to help middle and lower income Americans afford insurance ✤ New tax credits for small businesses 21
  • 22. Cost-Control and the ACA “...Pretty much every proposed (cost containment) innovation found in the health policy literature these days is encapsulated in these measures.” - John Iglehart, founding editor of Health Affairs 22
  • 23. Specific Cost-Containment Strategies ✤ Collecting excise tax on high-cost health plans ✤ Demonstration programs to remove waste, improve quality and efficiency ✤ Measures to improve coordination and delivery of care 23
  • 24. Implementation is Next ✤ Passage of national health care reform was difficult and unprecedented... ✤ Putting reforms in place will require more heavy lifting 24
  • 25. The Politics of Health Care Reform Michael Cassidy, Executive Director 25
  • 26. Health Care Reform: A Circular Problem? !"#$%&$'&()"$ </*)1)*'28%:2/*2$+% )()"#*&+#$ ?""0%/++*%#'(#)*)+#%% =1+0>("*>%)#/3$%6"1+0+*% !"#$#%"&%#'(#)*)+#%,)-,% 7'(#)*)+#%)/2*+;'2$+% !'$%#.+/*)/-%"/%.0"1)*+0#% 7628+%(269%.0"-02:% !2/3$%*"%+/"'-,% 5'6,% 42)#+%0+1+/'+#% 26
  • 27. How Was the Cycle Broken? ✤ Muted opposition ✤ Support from the health care industry ✤ Grassroots emerge 27
  • 28. “There Has to Be a Better Way” In 1994, Harry and Louise were very concerned about the Clinton health reform plan. 28
  • 29. ...15 Years Later ✤ By 2009, Harry and Louise (Association of Health Insurance Plans) became supporters of early versions of health reform! ✤ They didn’t like the final version, but no new ads were made. 29
  • 30. Strange Bedfellows ✤ In 2009, these groups came together to propose cost-cutting strategies for health reform. ✤ AMA, PhRMA, AHA, and SEIU endorsed the final health reform legislation. 30
  • 31. Grassroots Organizations ✤ In 1993-94, the grassroots were no match for industry and provider groups ✤ By 2009, activists were ready to support and push for health care reform... 31
  • 32. Powerful Advocates for Reform 32
  • 33. Groups May Now Look Out for Their Own Interests 33
  • 34. The Economics of Reform Dr. Louis Rossiter, Research Professor, The Thomas Jefferson Program in Public Policy, College of William & Mary 34
  • 35. President Obama “... in the end, coverage without cost containment will shift our burdens, not relieve them. So we will take steps to remove the waste and inefficiency from the system so we can bring down costs and improve the quality of our care while we are at it.” 35
  • 36. Economically - Who’s Helped, Who’s Hurt? Helped Hurt ✤ Medicare beneficiaries (who have opted out of traditional Medicare) in ✤ 32 million of the 46.3 million Medicare Advantage private plans uninsured Americans ✤ Taxpayers with income over $250,000 ✤ The nation, because the number (couple) and $200,000 (individual) with insurance increases from ✤ Providers currently receiving subsidies 255 million to 287 million for serving the uninsured could see patients go elsewhere ✤ States with above average ✤ Families and individuals with high- uninsured premium health plans subject to the new excise tax ✤ States who will have to fund a portion of expanded Medicaid and CHIP after four years 36
  • 37. Impact of Reform on Spending? MORE 37
  • 38. Biggest Economic Changes Will Be for the Young Immortals No Health Ins urance Is Highe s t Am ong Young Im m ortals 2005 35.0 30.0 25.0 20.0 Percent 15.0 10.0 5.0 0.0 18-24 25-34 35-44 45-54 55-64 Age in Ye ars 38
  • 39. The Cost Shifting for Hospitals and Physicians Will All But Disappear 40% 1998 2008 31.6% 30.7% 30% 21.5% 21.2% 20% 16.5% 14.0% 12.9% 15.1% 10.0% 10% 7.4% 7.5% 5.9% 2.8% 2.8% 0% Hospital Physician/ Prescription Nursing Home Health Other Other Health Care Clinical Drugs Home Care Care Personal Spending Services Health Care Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip). 39
  • 40. These Old Medicaid Categories Will Be Replaced By 133% of Federal Poverty Line 200% 185% Federal Poverty Line (For a family of four is $21,200 per year in 2008) 74% 68% 41% 0% Children Pregnant Elderly and Working Non- Childless Women Individuals Parents Working Adults with Parents Disabilities Note: Medicaid income eligibility for most elderly and individuals with disabilities is based on the income threshold of Supplemental Security Income (SSI). SOURCE: Based on a national survey conducted by the Center on Budget and Policy Priorities for KCMU, 2009. 40
  • 41. Medicaid Eligibility for Working Parents by Income, January 2009 NH VT WA ME MT ND MN MA OR NY ID SD WI RI MI WY CT PA IA NJ NE IN OH NV ILIL WV DE UT VA CO MD CA KS MO KY NC DC TN OK SC AR AZ NM AL GA MS TX LA AK FL HI 20-49% FPL (14 states) 50- 99% FPL (20 states) US Median Eligibility = 68% FPL: $11,968 per > 100% FPL (17 states including DC) year *The Federal Poverty Line (FPL) for a family of three in 2008 is $17,600 per year. SOURCE: Kaiser Commission on Medicaid and the Uninsured, Where are States Today: Medicaid and State- Funded Coverage Eligibility Levels for Low-Income Adults. October 2009. 41
  • 42. Medicaid Today Health Insurance Assistance to Long-Term Care Coverage Medicare Beneficiaries Assistance 29.5 million children & 15 8.8 million aged and disabled 1 million nursing home million adults in low-income — 19% of Medicare residents; 2.8 million families; 14 million elderly and beneficiaries community-based residents persons with disabilities MEDICAID Support for Health Care State Capacity for Health System and Safety-net Coverage 16% of national health spending; Federal share ranges 50% to 76%; 40% of long-term care services 44% of all federal funds to states Source: Kaiser Commission on Medicaid and the Uninsured, 2009 42
  • 43. Estimated Federal Outlays & Revenues OUTLAYS ($billions) Health Insurance Exchanges $358 Reinsurance and Risk Adjustment Payments 106 Coverage Medicaid/CHIP 434 Medicare Payment Cuts -455 Other Changes to Direct Spending -40 REVENUES Small-Employer Tax Credit -$37 Penalty Payments from Employers and Uninsured 65 Excise Tax on High-Premium Plans 32 Additional Hospital Insurance Tax 210 Other Changes Revenue Provisions 149 43
  • 44. In Summary: Economics of Reform ✤ Small Business Response to Incentives ✤ Hospital and Physician Response to Virtual Changed Elimination of Uninsured Incentives in ✤ Excess Demand for Insurance and Primary Care Providers Medical Markets ✤ Affording Expansion of Medicaid ✤ Virginia’s Response in Its Own Tax Code 44
  • 45. Opportunities for Leadership In Virginia Jane N. Kusiak 45
  • 46. Opportunities for Leadership in Virginia ✤ High-Risk Pool in 2010 ✤ Insurance Exchange State Plan Approval by January 2013 with Implementation by 2014 ✤ Medicaid Expansion by 2014 ‣ Outreach / Enrollment / Delivery ✤ Health Workforce Alignment ✤ Continuing Wrap-Around Support for High-Risk Populations 46
  • 47. Summary and Discussion 47
  • 48. Projected Health Insurance Status in Virginia Now 2019 100% 5.7% 14.1% 7.7% Unisured 4.9% 5.4% Exchange 80% 7.4% 8.9% Private Nongroup Medicaid/CHIP Employer Insured 60% 40% 73.6% 72.2% 20% 0% Source: 2008 (Now) data from Profile of Virginia’s Uninsured and Trends in Health Insurance Coverage, 2000-2008, The Urban Institute, January 2010. Non-elderly insured through Medicare not included. Estimates for 2019 are based on estimates for the nation made by the Congressional Budget Office. 48
  • 49. ACA National Projections, 2010 - 2019 (in Billions) Uses Sources Excise Tax 1,200! on High-Cost Other: $30 $965 $1,108 Plans: $32 1,000! Other: $169 Employer & Small- Individual Penalty: Employer $65 800! Tax Credit: $37 Health Insurance Voluntary 600! Exchanges: Medicare Long-Term Care Reinsurance $358 Payroll Program: $70 Tax: $210 & Risk Adjustment: $106 400! Medicare Insurer / Medicaid Payment Provider Fees: and Cuts and $107 200! CHIP Other Coverage: Savings: $434 $455 0! Source: Congressional Budget Office, March 2010. 49
  • 50. Contact Information Michael Cassidy Michael@thecommonwealthinstitute.org Jane Kusiak JaneKusiak@virginia.edu John McInerney John@thecommonwealthinstitute.org Lou Rossiter Lfross@wm.edu 50