A not-for-profithealth and tax policyresearch organization/GalenInstitutewww.galen.orgUpdate onHealth ReformGrace-Marie TurnerMay 8, 2013PNC HealthCare2013 Spring Healthcare Advisory BoardPhiladelphia
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 asgood or excellent• They want stability. Change was forothers.www.galen.org
but many say the ACA changes too much• 36% of Americans now view theAffordable Care Act favorably• 42% view the law unfavorably• Cost continues to be the biggestconcernwww.galen.orgKaiser Health Tracking Poll, February 2013. http://www.kff.org/kaiserpolls/upload/8251-F.pdf
Americans’ views of health lawafter Supreme Court decision• Americans say it will make things worse ratherthan better for– taxpayers– businesses– doctors– and those who currently have health insurance.Sources: “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
Why the ACA isn’t settled 38% of Americans supported the law in thelast major poll before the November elections Of the 50.6% who voted for PresidentObama…12% said they wanted the law repealedThe election was not about health reformSource: “Kaiser Health Tracking Poll: October 2012,” The Henry J. Kaiser Family Foundation, October 31, 2012,http://www.kff.org/kaiserpolls/8381.cfm.
NOTE: Don’t know/Refused answers not shown.SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)Majority Say They Don’t Understand HowACA Will Impact Them, Including Two-Thirds of Uninsured and Low-IncomeDo you feel you have enough information about the health reform law to understand how it will impact youpersonally, or not?30%33%41%68%67%57%Household income lessthan $40,000Uninsured (under age 65)TotalYes, have enough information No, do not have enough information
Source: 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/.The health law in one graph
The paperwork mazeCourtesy of The Wall Street Journal at www.opinionjournal.com
Source: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012,http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.An ACA State Exchange
Do you qualify for subsidies?Source: Sen. John Cornyn, Facebook, March 22, 2013,http://www.facebook.com/photo.php?fbid=10151499130834424&set=a.112318184423.92543.75755694423&type=3&l=83fcd3ca01&permPage=1
Source: “Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,” Mercer LLC, August 8, 2012,http://www.mercer.com/press-releases/1472805.Mercer: Employers planning workforce changesw Mercer study on what employers expect
SCOTUS SuccessBoot CampEmployers and health coverage1. Employers with <50 FTE EE’s have no3k/2k penalty2. But employers offering qualified andaffordable coverage may actually behurting their employeesExample
Generous Subsidies inExchangesExamples:• A person earning $42,000 a year with a familyof 4 qualifies for $14,759 in new healthinsurance subsidies• A single person earning $20,600 qualifies for$5,156 in new health insurance subsidiesBut only if employer doesn’t offer coverage or ifit’s not “affordable” (ie costs >9.5% of income)www.galen.org
Impact of new rating rulesJames T. O’Connor, Milliman, for America’s Health Insurance Plans. Comprehensive Assessment of ACA Factors That Will Affect Individual MarketPremiums in 2014. http://www.ahip.org/MillimanReportACA2013/ Accessed 4-26-13
New and higher 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.
More new and higher 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.
What we know for sure• CHOICE: Americans value innovation,diversity and choice to accommodate 300million people• VALUE IN HEALTH SPENDING: To realizethe promise of personalized medicine andachieve overall cost saving, break downpayment silos• FOCUS ON THE PATIENT: They wantdoctors and patients, not government, tomake health care decisions
A market-based solution“Defined contributions” for health coverageA system that puts doctors and patients in charge ofmedical decisionsRestructuring financing for a 21st century healthsector• Medicare• Medicaid• Private Insurance
States have a big roleSeek ways improve their markets• Enhance competition for more choices ofaffordable coverage• Better safety net with functional high-riskpools• Private exchanges?www.galen.org
2013 questions• Will Exchanges be ready by Oct 1?• Will there be bi-partisan support for delay?• Will people enroll after they see cost?• Will the number of uninsured be higher aspeople understand guaranteed issue?• Will private exchanges fill a market need?www.galen.org
Europeans moving towardpatient-centered care/decentralization• Consumerism• Value of private enterpriseand competition• Doctor-patient relationship• Decentralizeddecision-makingwww.galen.org
The future?• The global move towardconsumerism is real, drivenby greater patient demandfor more control overdecisions.• People will seek moreaffordable options outsidethe ACA’s centralizedcontrol.
A not-for-profithealth and tax policyresearch organization/GalenInstitutewww.galen.orgGrace-Marie TurnerGalen Institute703firstname.lastname@example.org/GalenInstitutefacebook.com/GalenInstituteSubscribe to our free email alerts atwww.galen.org/subscribe