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  1. 1. Doctors Can Become A not-for-profit health and tax policyresearch organization ARE Policy Experts, Too Grace-Marie Turner September 9, 2012 Docs4PatientCare /GalenInstitute
  2. 2.
  3. 3. Source: Ari Melber,‖POLL: Half of Americans Don‘t Know How Court Ruled on Healthcare,‖ The Nation, July 4, 2012,
  4. 4. Americans’ views after Supreme Court decision• Americans say the health law will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance.• Health care will be an extremely or very important issue for 82% of Americans in deciding their vote for the president in November.• Opposition to the law is higher now than before the Supreme Court decision.Sources: ―Americans: Healthcare Law Helps Some, Hurts Others ,‖ Gallup, July 16, 2012, The New York Times/CBSNews Poll, July 11-16, 2012, ―Kaiser Health Tracking Poll,‖ The Kaiser Family Foundation, July2012,
  5. 5. Source: Kaiser Family Foundation, July 2012.
  6. 6. 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 medicineSource:
  7. 7. Two issues:Taxes. Trust.
  8. 8. 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,
  9. 9. ObamaCare’sNew TaxesSource: Philip Dittmer and William McBride, ―Obamacares New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
  10. 10. More ObamaCare TaxesSource: Philip Dittmer and William McBride, ―Obamacares New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
  11. 11. ObamaCares 7 Tax Hikes On Under $250,000-A-Year EarnersSource: Ebeling, Ashlea, Forbes Staff - "Obamacares 7 Tax Hikes On Under $250,000-A-Year Earners,‖
  12. 12. Trust: Costs won’t fall by $2,500/family CBO: The law will raise some family premiums by $2,100 in 2016 above what they would have been without the reform law Health insurance already has increased by $1,700 for the average family since 2009 to $15,073 in 2011 Richard S. Foster, Chief Actuary, ―Estimated Financial Effects of the Patient Protection and Affordable Care Act, as Amended,‖ U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of the Actuary, April 22, 2010, Congressional Budget Office and the Joint Committee on Taxation, ―An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act,‖ November 30, 2009, ―Employer Health Benefits 2011 Annual Survey,‖ The Kaiser Family Foundation and Health Research & Educational Trust, September 27, 2011,
  13. 13. “If you like your health insurance…” • 51 to 80% of Americans will lose current coverage, according to Obama admin. estimates • CBO: Up to 20 million could lose job-based plans • McKinsey: Up to 80 million will be forced to change policies • Child-only policies will vanish in 17 states • 35 million more will move from job-based insurance to taxpayer-subsidized exchanges―Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and ‗Grandfathered‘ Health Plans,‖ U.S. Department of Health and HumanServices,,"CBO and JCTs Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance," Congressional Budget Office, March2012,, JerisStueland, and Drew Ungerman, ―How US health care reform will affect employee benefits,‖ McKinsey Quarterly, June2011,―Health Care Reform Law‘s Impact on Child-Only Health Insurance Policies,‖ Senate Committee on Health, Education, Labor and Pensions, August2, 2011,,%202011.pdf.Douglas Holtz-Eakin and Cameron Smith "Labor Markets and Health Care Reform: New Results," American Action Forum, May27, 2010,
  14. 14. 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 --
  15. 15. Some
  16. 16. 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)
  17. 17. Source: Frank Hill, ―The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,‖ Telemachus, July 22, 2012,
  18. 18. Employer mandate penalties For companies with +50 employees • $2,000 per year per 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
  19. 19. 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 • Budget concerns in the Congress mean short-term fixes are likely to
  20. 20. Physician concerns • Questions about Accountable Care Organizations • Authority of HHS Secretary to set new rules for quality of care • Regulatory requirements that make private practice much more difficult • More burdensome
  21. 21. Anna Wilde Mathews, ―When the Doctor Has a Boss,‖, The Wall Street Journal Nov. 8, 2010,
  22. 22. 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,
  23. 23. Specific changes to watch • IPAB — the Independent Payment Advisory Board • Patient-Centered Outcomes Research Institute • Physician Quality Reporting Initiative • Value-based Payment
  24. 24. Action items • Government requirements for use of EMR • Comparative effectiveness ―guidelines‖ • Payment policies that penalize those with the top 10% of
  25. 25. Studies on employers’ plans Deloitte • 1 in 10 plan to drop coverage; 1/3 considering it Mercer • 60% expect higher costs • Up to 46% plan changes to avoid penalties • 56% were waiting until after SCOTUS to plan; 11% will wait until after November National Business Group on Health • Health costs expected to rise by 7% next year • 60% expect to increase employees‘ premium shareSources: ―2012 Deloitte Survey of U.S. Employers: Opinions about the U.S. Health Care system and Plans for Employee Health Benefits,‖ Deloitte Center for Health Solutions &Deloitte Consulting, July 2012,; ―Large Employers‘ 2013Health Plan Design Survey,‖ National Business Group on Health, August 2012,; ―Health Reform Poses BiggestChallenges to Companies with the Most Part-Time and Low-Paid Employees,‖ Mercer LLC, August 8, 2012,
  26. 26. NBGH Large employer surveySource: ―Large Employers‘ 2013 Health Plan Design Survey,‖ National Business Group on Health, August2012,
  27. 27. Mercer study on what employers expect wSource: ―Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,‖ Mercer LLC, August 8, 2012,
  28. 28. State Action (or not) Re: ExchangesSource: ―State Action Toward Creating Health Insurance Exchanges, as of August 1, 2012,‖ The Henry J. Kaiser Family Foundation,
  29. 29. Health care in 2012 • Legislation Depends upon the outcome of the election • Regulation 13,000+ pages so far • Legal Many other court challenges continue • Political The voters will ultimately decide on Nov.
  30. 30. Widespread pushback• Economic nightmare – Killing jobs and suffocating economic recovery – 46% of doctors plan to leave practice• Impossible complexity – Multiple deadlines missed by Obama bureaucrats – Enormous costs, complexity, privacy issues – 13,000 pages of regulations -- so far• Resistance from states – Balking at setting up exchanges or otherwise complying – Weighing Medicaid expansion
  31. 31. A not-for-profit health and tax policyresearch organization /GalenInstitute
  32. 32. 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
  33. 33. 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
  34. 34. Grace-Marie Turner A not-for-profit health and tax policyresearch organization Galen Institute 703-299-8900 Subscribe to our free email alerts at /GalenInstitute