Breakfast with Bob: The Obamacare Ruling

493 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
493
On SlideShare
0
From Embeds
0
Number of Embeds
148
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Breakfast with Bob: The Obamacare Ruling

  1. 1. The  Affordable  Care  Act  (ACA):  Facts,  Issues,  Implica/ons,  Opinions  
  2. 2. Summary  of  ACA  •  Individual  requirement   •  Subsidies  to  individuals   –  Tax  of  $695  or  2.5%  of   up  to  400%  FPL   taxable  income  in  2016   •  Exchanges  created  by   –  Only  $95  in  2014   states  •  Employer  requirement  to   –  Benefit  Lers   offer  “minimum  essenLal   •  General  insurance  rules:       coverage”   –  Guaranteed  issue,  no  life   –  Only  employers  with  >50   limits,  no  pre-­‐exisLng   FTE   clauses,  limits  on  premium   –  PenalLes  for  not  offering   variaLon   coverage  or  offering   •  Taxes:    ñMedicare,   unaffordable  coverage   Cadillac  plans,  Pharma  •  Small  employer  tax  credit   and  Devices,  Insurance,  •  Medicaid  expansion   Tanning  Salons  
  3. 3. Summary  of  ACA,  con/nued  •  Medicare  $  changes   •  Several  measures  to   –  Ind.  Payment  Adv.  Board   “improve  quality,  health   –  Cut  in  DisproporLonate   system  performance”   Share  Hospital  Payments   –  ACOs   –  Cut  in  growth  rate  of   –  InnovaLon  Center   Medicare  payments   –  ComparaLve   –  Restructure  payments   effecLveness  research   for  Medicare  Advantage   –  Medicare  pilot  program   on  bundled  payment   •  NaLonal  strategy  on   prevenLon/wellness  
  4. 4. The  subsidies  (tax  credits)  are  substan/al   Congressional  Research  Service,  Private  Health  Insurance  Provisions,  4/15/10  
  5. 5. A  “saving  construc/on”  
  6. 6. This  could  be  the  sleeper  
  7. 7. What  do  I  think?  •  On  the  plus  side   •  On  the  minus  side   –  Expansion  of  coverage  to   –  Hodgepodge  of  taxes   needy   –  Doesn’t  move  away  from   –  Sorely  needed  fixes  to   employer  sponsored   health  insurance  markets   insurance   –  Some  impetus  and  a   –  Doesn’t  break  down  state   plaGorm  for   barriers   experimenta/on  (ACO,   –  Too  much  government   bundled  payments)   control  over  benefits   design   –  Exacerbates  market  power   on  supplier  side   –  Cons/tu/onal  issues   linger  
  8. 8. Equity  concerns  have  to  be  given   heavier  weight   Efficiency  Equity  
  9. 9. “We  had  to  break  it  before  we  could  fix  it”  
  10. 10. Issue  #1:    Demand  and  Supply  Basics  Price   S   30  mm  newly  insured   P   D2   D1   Q   Health  Services  
  11. 11. Staiger,  Auerbach,  Buerhaus,  “Health  Care  Reform  and  the  Health  Care   Workforce  –  the  Massachusees  Experience,”  NEJM,  Sept.  22,  2011  
  12. 12. Issue  #2:    States  and  Medicaid   State  &  federal  share  of  new  Medicaid  spending  2014-­‐19  *#& !"#!$%&!#&+#&$#& "#!(&"#& (%#($& (%#)*& (+#!!(& (+#"!"& (#,(,&(#& "#*(,& "#)& $#+%%& "#)& "#$+!& (#"$$& )$& (#!+& %(+& *)*& +%& (+%& (**& (+%& (*& & 1& 0& >. & 0& & 0& 0& & I. 0& & 4& 60 0; 01 K0 /0 67 ?6 36; G G 96 0; ;1 01 6? 45 F4 F4 45 8 -. 54 6A9 3= H0 J5 23 E0 1< @ ;; 9& CD :. B4 2.7.503&L&MN63364;1O& BD0D.&L&MN63364;1O&Source:  Holohan  &  Headen  for  Kaiser  Commission  on  Medicaid  &  the  Uninsured,  2010  
  13. 13. Washington  Post,    Ezra  Klein’s  Wonkblog    
  14. 14. “...Last  year,  Georgia  hospitals  lost  an  esLmated  $1.5  billion  caring  for  people  without  insurance...The  promise  of  fewer  uninsured  is  what  led  the  naLonal  hospital  industry  to  agree  to  the  health  law’s  $155  billion  in  Medicare  and  Medicaid  cuts  over  a  10  year  period.”    “Hospitals  face  lower  payments  from  insurers  and  pressures  to  consolidate.    One  in  three  Georgia  hospitals  lose  money...”    “Georgia  is  one  of  at  least  10  states  that  may  reject  the  Medicaid  expansion,  according  to...the  nonprofit  Brookings  InsLtuLon.”    “Get  as  big  as  you  can  get  and  as  strong  as  you  can  get  as  an  organizaLon  is  the  overarching  strategy,”  Jennings  said  (CEO  of  Wellstar  Health  System  in  Atlanta)   Williams  and  Teegardin,  Atlanta  Journal   ConsLtuLon,  July  8,  2012  
  15. 15. Issue  #3:  Employer  Sponsored  Insurance:   Will  it  Disappear  under  ACA?  •  You  cannot  just  compare  the  penalty  with  the   cost  of  an  employer  providing  health   insurance!   –  Dropping  a  benefit  is  not  free...  •  Indeed,  why  would  a  penalty  on  employers  for   not  providing  insurance  lead  to  a  decline  in   ESI??  •  The  right  comparison  is  penalty  to  employer   vs.  subsidy  to  employees  on  exchange,  less  tax   advantage  of  employer-­‐provided  insurance  
  16. 16. L  DuBay,  SK  Long,  and  E  Lawton,  Will  Health  Reform  Lead  to  Job  Loss?    Urban  InsLtute,  June  2012.    Thanks  to  J.  Skinner,  Dartmouth,  for  slide.  
  17. 17. Opinion:    Wouldn’t  this  be  nice?  
  18. 18. Issue  #4:    Isn’t  the  employer  mandate  a  tax  on   employees?   Wage   S1   Demand,  supply  of   labor   D1   D2   Labor    
  19. 19. As  a  first  approximaLon,  wages  should  fall  and   employment  stay  the  same   S1   Wage   S2   Demand,  supply  of   labor   D1   D2   Labor    
  20. 20. Caveats    •  If  insurance  was  not  available  compeLLvely,   employees  might  value  it  more  than  cost  to   employer  •  On  the  other  hand,  some  employees  might  prefer   cash  to  health  insurance...especially  with  exchange-­‐ available  insurance  •  And  wages  tend  to  be  inflexible   downward...especially  at  low  wage  levels  •  And  many  employers  have  already  chosen  to  not   offer  insurance...   Overall,  I  have  a  hard  /me  not  seeing  this   as  a  net  tax  on  employment  
  21. 21. Opportuni/es  •  Mergers     –  (NYU  Langone/ConLnuum/Mt.  Sinai)   –  Turs  Health  Plan  buys  Network  Health   –  Yesterday:    Wellpoint  acquires  Amerigroup!  •  Health  plan  creaLvity,    for  exchanges  and   employer-­‐sponsored   –  Design  of  networks   –  Tiering  (of  plans,  of  suppliers)   –  Benefits  creaLvity  •  Focus  on  value  of  health  care  delivery!  
  22. 22. The  Major  Management  Challenges  (Some  of  the…?)   Balance  mission  with  financial  viability   Adapt  to  new  reimbursement/payment  models   Cope  with  health  care  reform/regula?ons   Deal  with  changing  popula?on  health  and  demographics   Get  the  incen?ves  right   Create  managerial  and  leadership  capacity   Coordinate/collaborate  –  at  all  levels,  including  across  organiza?ons   Build  a  capacity  for  organiza?onal  innova?on/change   Deal  effec?vely  with  technological  advances   Appropriately  use  evidence  in  determining  care  
  23. 23. Why  we  are  here    Tremendous  change…   Massive  challenges…   For  an  unimaginably   important  cause…   And  all  happening  at   once    

×