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Southern Medical Association
1. A not-for-profit
health and tax policy
research organization
What’s coming and what it
means for medical practice
Grace-Marie Turner
November 16, 2012
Southern Medical Association
/GalenInstitute
www.galen.org
2.
3. Americans’ views on the law
• Americans say the health law will make things
worse rather than better for
taxpayers, businesses, doctors, and those who
currently have health insurance.
• Opposition to the law remains as high as it was
when the law was enacted.
• Three more states passed ballot initiatives to
block the individual mandate – AL, WY, MT
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/CBS
News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. ―Kaiser Health Tracking Poll,‖ The Kaiser Family Foundation, July
2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
4. 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 wanted stability. Change was for others.
www.galen.org
7. Taxes and spending in ObamaCare
Source: Avik Roy, ―Fact-Checking the Obama Campaign's 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/.
8. 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)
www.galen.org
11. ObamaCare’s New Taxes
Source: Philip Dittmer and William McBride, ―Obamacare's 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.
12. More ObamaCare Taxes
Source: Philip Dittmer and William McBride, ―Obamacare's 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.
13. 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 -- CBO
www.galen.org
17. Source: Frank Hill, ―The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,‖ Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
18. 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
• Pleas for short-term fixes are likely to
continue indefinitely
www.galen.org
19. 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 medicine
www.galen.org
http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671
20. Physician concerns
• Questions about Accountable Care
Organizations
• Authority of HHS Secretary to set new
rules for quality of care
• Regulatory requirements impacting private
medical practices
• More burdensome record-keeping
www.galen.org
21. Specific changes to watch
• IPAB — the Independent Payment Advisory
Board
• Patient-Centered Outcomes Research
Institute and comparative effectiveness
―guidelines‖
• Physician Quality Reporting Initiative
• Value-based Payment Modifier
www.galen.org
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 Care
Act, (PPACA): Summary and Timeline,‖ November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.
23. Health care in 2013
• Legislation
Searching for bi-partisan support for fixes;
hearings to highlight problems and successes
• Regulation
13,000+ pages so far, and they’ve only begun!
• Legal
At least new 35 court challenges proceed
…and the battle over the doc fix continues
www.galen.org
24.
25. 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
• Targeted subsidies for the uninsured
• Portable insurance, equal tax treatment
• More functional high-risk pools
• Cutting Medicaid’s red tape
www.galen.org
26. Even Europeans going the other way
• Consumerism
• Value of private enterprise
and competition
• Doctor-patient relationship
• Decentralized
decision-making
www.galen.org
27. A market-based solution
“Defined contributions” for health coverage
A system that puts doctors and patients in charge of
medical decisions
Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance
www.galen.org
28. The future?
• The global move toward
consumerism is real, driven by
greater patient demand for more
control over decisions.
• Physicians will find new and
creative ways to deliver patient
care outside the ACA’s centralized
control.
Search for your opportunities!
www.galen.org
29. 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 www.WrongForAmericaBook.com
www.galen.org
30. Grace-Marie Turner
A not-for-profit
health and tax policy
Galen Institute
research organization
703-299-8900
gracemarie@galen.org
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