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Sundwall keynote


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Sundwall keynote

  1. 1. AAFP 2011 State Legislative Conference Salt Lake City, UT November 5, 2011 David N. Sundwall, M.D. Professor, Public Health (clinical) University of Utah School of Medicine “ Health Reform” in the U.S.A. Are we there yet?
  2. 2. Overview…… <ul><li>PPACA, or ACA, or “Obamacare” </li></ul><ul><li>Health Reform in Utah </li></ul><ul><li>The Medicaid and CHIP Payment and Access Commission [ MACPAC ] </li></ul><ul><li>The IOM Committee on Integrating Primary Care and Public Health (PC/PH) </li></ul><ul><li>Px…… guarded. </li></ul>
  3. 3. <ul><li>Landmark – the Inside Story of America’s New Health-Care Law and What It Means for All of Us. The staff of the Washington Post </li></ul><ul><li>Historical perspective, </li></ul><ul><li>Political shenanigans, and </li></ul><ul><li>Bias? </li></ul>The Patient Protection and Affordability Care Act [PPACA]
  4. 4. PP (ACA) – “Obamacare” <ul><li>I. Policies </li></ul><ul><li>a. Promises </li></ul><ul><li>b. Problems </li></ul><ul><li>II. Politics </li></ul><ul><li>a. Republican </li></ul><ul><li>b. Democrat </li></ul><ul><li>c. “Tea party” </li></ul><ul><li>III. Prognosis </li></ul>
  5. 5. Policies <ul><li>#1 Priority – Expand health insurance coverage (32 million more?) starting in 2014 </li></ul><ul><li>NOTE: Does not strive for universal coverage, but if implemented as intended, 95% of legal U.S. residents would have coverage by 2016. </li></ul><ul><li>HOW ? </li></ul><ul><li>Expand Medicaid (increase to 138% of FPL) </li></ul><ul><li>Subsidies to help lower income individuals and families pay for private insurance </li></ul><ul><li>Health Insurance Exchange (HIE) – make shopping for health insurance easier </li></ul>
  6. 6. Policies – cont. <ul><li>“ Mandate” – starting in 2014 “almost every American” will need to carry insurance or pay a fine. </li></ul><ul><li>Insurance Regulations – </li></ul><ul><li>1. Sharp restriction or “recissions” </li></ul><ul><li>2. Can no longer deny coverage to children with preexisting conditions </li></ul><ul><li>3. No longer able to impose limits on lifetime benefits paid out </li></ul><ul><li>4. By 2014 prevent insurance companies from denying policies to people with preexisting conditions. (Temporary bridge, “High Risk Pools - HIP) </li></ul>
  7. 7. Policies cont <ul><li>Public Health Provisions </li></ul><ul><li>Focus on preventing chronic disease and reduce the rate of death from our “top killers”: </li></ul><ul><li>Heart disease </li></ul><ul><li>Cancer </li></ul><ul><li>Stroke </li></ul><ul><li>Chronic respiratory disease </li></ul><ul><li>Diabetes </li></ul>
  8. 8. Policies cont <ul><li>How ? </li></ul><ul><li>New Prevention and Public Health Fund (increase from $100 million “Preventive Health Services Block Grant” to $2 billion by 2015) </li></ul><ul><li>School based health centers </li></ul><ul><li>Community transformation grants </li></ul><ul><li>Increase funding for immunizations </li></ul><ul><li>Improve capacity and technology of public health labs </li></ul><ul><li>Fund home visits in maternal and child health (MCH) program, etc. up to $4 billion dollars !!! </li></ul>
  9. 9. Policies cont <ul><li>Health care work force </li></ul><ul><li>Increase number and geographic distribution of the nation’s “health work force” – doctors, nurses, dentists, and other health professionals . </li></ul><ul><li>How ? </li></ul><ul><li>Increase payment for primary care services </li></ul><ul><li>Strengthen and expand the National Health Service Corps (NHSC) </li></ul><ul><li>Fund pilot project related to “medical homes”, e.g. for pediatric special needs patients </li></ul><ul><li>And others . . . </li></ul>
  10. 10. Utah’s version of “health reform” <ul><li>Rely on private health insurance market </li></ul><ul><li>Promote personal responsibility </li></ul><ul><li>Ensure “transparency” and value </li></ul><ul><li>Maximize tax advantages </li></ul><ul><li>Optimize public programs </li></ul>
  11. 11. “ Defined Contribution Market” <ul><li>Keep all payments “pre-tax” </li></ul><ul><li>Employees cannot be penalized for health status </li></ul><ul><li>Guaranteed issue ( same options for all employees ) </li></ul>
  12. 12. Utah Health Insurance Exchange <ul><li>Internet-based information portal </li></ul><ul><li>Connects consumers to vital information re: private health insurance plans available: </li></ul><ul><li>single shopping point with reliable information, </li></ul><ul><li>side-by side comparison </li></ul><ul><li>Consumers make personal and informed choices, “electronically”. </li></ul>
  13. 13. The MACPAC Medicaid and CHIP Payment and Access Commission <ul><li>Is Medicaid “eating our lunch”? </li></ul><ul><li>( see data – you decide) </li></ul>
  14. 14. Institute of Medicine Study- Integrating Primary Care and Public Health <ul><li>Due to be published in March, 2012 </li></ul><ul><li>Series of recommendations related to how HRSA and CDC can better coordinate their efforts to improve population health. </li></ul><ul><li>Also…. Hopefully showcase how to accomplish the same in the private sector. </li></ul>
  15. 15. Politics <ul><li>We are in the midst of an intense national debate related to health care in the United States – what should be provided, for whom, an how to pay for it. The outcome of will redefine the roles of governments ( federal and states), and the private sector in our health care enterprise”. </li></ul><ul><li>Draft introduction – IOM report on Integrating Primary Care and Public Health ( pending publication – 3/12). </li></ul><ul><li>“ Fasten your seatbelts – it’s going to be a bumpy night [ride]” </li></ul><ul><li>Betty Davis – It’s All About Eve </li></ul>
  16. 16. What’s next….. <ul><li>Challenge to constitutionality of “mandates” [and other provisions ?] by Supreme Court. </li></ul><ul><li>Key aspects of the PPCAC blocked by funding being cut in the House Appropriations Committee for the “Center for Consumer Information and Insurance Oversight” the office handling the bulk of the implementation effort, as well as the recently disbanded office in charge of setting up the controversial CLASS program . </li></ul>
  17. 17. Prognosis…… <ul><li>For PPACA, guarded…… </li></ul><ul><li>For health care in general, it will likely be more of the same and fairly good for most citizens in the near term. </li></ul><ul><li>The really hard part will be determining how we care for the most vulnerable among us, the uninsured, and the costly disabled “duals” ( Medicare and Medicaid beneficiaries), without breaking the bank. </li></ul>