5. Percent of Women Ages 19 to 64 Uninsured by State,
2009–2010 and Under the Affordable Care Act When Fully Implemented
Affordable Care Act
fully implemented (estimated)
2009–2010
WA VT NH NH
ME WA VT
ME
MT ND
MT ND
MN
OR NY MN
SD WI MA OR NY
ID ID WI MA
WY MI RI SD
PA MI RI
IA NJ CT WY
PA NJ CT
NE OH IA
NV IN DE NE OH
IL WV MD IN DE
UT VA NV IL
CO DC UT WV MD
KS MO KY CO VA
CA DC
NC CA KS MO KY
TN NC
OK SC TN
AZ AR OK
NM AZ AR SC
MS AL GA NM
AL GA
MS
TX LA
TX LA
FL
FL
<7%
AK
AK
HI 7%–<11% HI
11%–<16%
20% of women 16%–<21% 8% of women
ages 19–64 uninsured ages 19–64 uninsured
21%–30%
Sources: Analysis of the March 2011 and 2010 Current Population Surveys by N. Tilipman and B. Sampat of Columbia University
for The Commonwealth Fund; uninsured rates are two-year averages. Estimates for the Affordable Care Act when fully implemented
by Jonathan Gruber and Ian Perry of MIT using the Gruber Microsimulation Model for The Commonwealth Fund.
6. People are more likely to die from cancer
More likely to die from car accidents
Less likely to be vaccinated and therefore
more likely to develop life threatening
infections
More likely to die from virtaly all chronic
illnesses .
7. Private Insurance Govt Insurance
Medicare
Large Group Mkt 60M
218M
Medicaid and
Small Uninsured SCHIP
Group 57M 63M
Mkt
26M
Other
Individual Fed
Mkt 15M
26M
8. Private Insurance Govt Insurance
Large Group Mkt Medicare
218M 60M
Small
2M Medicaid and
Group
Mkt SCHIP
83M
Individual
Mkt Uninsured
23M Other
Fed
Health 15M
Insurance
Exchanges
10. ―Change is hard because people
overestimate the value of what
they have—and underestimate the
value of what they may gain by
giving that up.―
— James Belasco and Ralph Stayer
Flight of the Buffalo (1994
11. HB 3200
Page 50/section 152: The bill will Page 317 and 321: The government
provide insurance to all non-U.S.
residents, even if
they are here illegally.
will impose a prohibition on hospital
expansion; however, communities
may petition for an exception.
**
** Page 425, line 4-12: The government
JUDGE KITHIL IS Page 58 and 59: The government will
have real-time access to an
individual's bank
account and will have the authority
to make electronic fund transfers
mandates advance-care planning
consultations.
Those on Social Security will be
required to attend an "end-of-life
planning" seminar
from those every five years. (Death
THE 2ND accounts. **
Page 65/section 164: The plan will
be subsidized (by the government)
for all union
members, union retirees and for
counseling..)
**
Page 429, line 13-25: The
government will specify which
doctors can write an end-of-life
community organizations (such as order.
OFFICIAL WHO the Association of Community
Organizations for Reform Now -
ACORN).
**
HAS OUTLINED
Page 203/line 14-15: The tax
imposed under this section will not
be treated as a tax.
(How could anybody in their right
mind come up with that?)
THESE PARTS **
OF THE Page 241 and 253: Doctors will all be
paid the same regardless of
specialty, and the government will
set all doctors' fees.
**
CARE BILL. Page 272. section 1145: Cancer
hospital will ration care according to
the patient's age.
**
13. • No preexisting condition
exclusions
• No gender rating differences
• No 9 month waiting periods
• No annual lifetime limits
• Parents can cover their adult
children until age 26 through
their health insurance plan
14. Abdominal aortic aneurysm screening HIV screenings
Alcohol misuse screenings and Mammograms (screening)
counseling Nutrition therapy services
Annual Wellness exams* Obesity screenings and
Bone mass measurements (bone counseling*
density)* One-time ―Welcome to Medicare‖
Cardiovascular disease screenings preventive visit
Cardiovascular disease (behavioral Pap tests and pelvic exams
therapy) (screening)
Colorectal cancer screenings* Prostate cancer screenings
Depression screenings Sexually transmitted infections
screening and counseling
Diabetes screenings*
Tobacco use cessation counseling*
Diabetes self-management training
Glaucoma tests*
Flu shots
Hepatitis B shots
Pneumococcal shots
15. Abdominal Aortic Aneurysm one-time
screening for men of specified ages who Immunization vaccines for adults--
have ever smoked doses, recommended ages, and
Alcohol Misuse screening and recommended populations vary:
counseling ◦ Hepatitis A
Aspirin use for men and women of
certain ages ◦ Hepatitis B
Blood Pressure screening for all adults ◦ Herpes Zoster
Cholesterol screening for adults of ◦ Human Papillomavirus
certain ages or at higher risk ◦ Influenza (Flu Shot)
Colorectal Cancer screening for adults
over 50 ◦ Measles, Mumps, Rubella
Depression screening for adults ◦ Meningococcal
Type 2 Diabetes screening for adults ◦ Pneumococcal
with high blood pressure ◦ Tetanus, Diphtheria, Pertussis
Diet counseling for adults at higher risk
for chronic disease ◦ Varicella
HIV screening for all adults at higher risk
16. Anemia screening Gestational diabetes screening for
BRCA counseling about genetic testing women at high risk of developing
Breast Cancer Mammography gestational diabetes*
screenings Hepatitis B screening for pregnant
women at their first prenatal visit
Breastfeeding comprehensive support
and counseling* Human Immunodeficiency Virus
(HIV) screening and counseling for
Cervical Cancer screening for sexually sexually active women*
active women
Chlamydia Infection screening for Human Papillomavirus (HPV) DNA
younger women and other women at Test: high risk HPV DNA testing every
higher risk three years who are 30 or older*
Osteoporosis screening for women
Contraception: Food and Drug over age 60 depending on risk factors
Administration-approved contraceptive
methods, sterilization procedures, and Prenatal Care
patient education and counseling, not Tobacco Use screening and
including abortifacient drugs* interventions for all women, and
Domestic and interpersonal violence expanded counseling for pregnant
screening and counseling for all women* tobacco users
Folic Acid supplements for women who Sexually Transmitted Infections (STI)
may become pregnant counseling for sexually active women*
Well-woman visits to obtain
recommended preventive services*
17. Alcohol and Drug Use assessments for adolescents
Autism screening for children at 18 and 24 months Vision screening for all children
Behavioral assessments for children of all ages Immunization vaccines for children from birth to age 18 —doses,
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 recommended ages, and recommended populations vary:
to 17 years. ◦ Diphtheria, Tetanus, Pertussis
Blood Pressure screening for children ◦ Haemophilus influenzae type b
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 ◦ Hepatitis A
to 17 years.
◦ Hepatitis B
Cervical Dysplasia screening for sexually active females
◦ Human Papillomavirus
Congenital Hypothyroidism screening for newborns
◦ Inactivated Poliovirus
Depression screening for adolescents
◦ Influenza (Flu Shot)
Developmental screening for children under age 3, and
surveillance throughout childhood ◦ Measles, Mumps, Rubella
Dyslipidemia screening for children at higher risk of lipid disorders ◦ Meningococcal
Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. ◦ Pneumococcal
Fluoride Chemoprevention supplements for children without ◦ Rotavirus
fluoride in their water source
◦ Varicella
Gonorrhea preventive medication for the eyes of all newborns
Iron supplements for children ages 6 to 12 months at risk for
Hearing screening for all newborns anemia
Height, Weight and Body Mass Index measurements for children Lead screening for children at risk of exposure
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15
to 17 years. Medical History for all children throughout development
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15
Hematocrit or Hemoglobin screening for children to 17 years.
Hemoglobinopathies or sickle cell screening for newborns Obesity screening and counseling
HIV screening for adolescents at higher risk Oral Health risk assessment for young children
Tuberculin testing for children at higher risk of tuberculosis Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 Phenylketonuria (PKU) screening for this genetic disorder in
to 17 years. newborns
Sexually Transmitted Infection (STI) prevention counseling and
screening for adolescents at higher risk
18. Begins when total costs for your
medications ( your cost and the amount
Medicare has paid) exceed @ $2900
Ends when YOUR total costs exceed
$4750 ( equivalent to drug costs $14,250)
19. Your drug costs within the ―HOLE‖
2008: 100% brand-name 100% generics
2012: 50% brand-name 86% generics
2020: 25% brand-names 25%generics
20. Who will see these patients?
◦ It will take a long time to get these patients into a primary
care system.
◦ We will need more mid level providers.
◦ The ER will still continue to see many Medicaid patients
◦ Urgent care clinics will be heavily utilized –
Carson Tahoe urgent/emergent care clinics
CMG plus
Wal-Mart
24. E-prescribing
Record Demographic Implement one clinical
Smoking status decision support
Medications Laboratory value(s)
Allergies Vital signs – height, weight,
Drug drug interaction alerts blood pressure, BMI
Problem list Care plan field(s), including
Protect health information goals and instructions
Capability to exchange key
clinical information
electronically
25. Charts are legible
Charts are accessible from multiple locations and
are never lost although they may ―crash‖
Patients now have access online to there
charts, test results, vaccine records.
Fewer medication errors
Improved use of preventative healthcare
26. In our region alone millions of dollars have
been spent already trying to achieve this
communication
They are not interconnected.
Protection of patient privacy/patient records
may be more difficult at high levels.
Physicians brains aren’t structured to work
like computers-
Data is difficult to enter.
27. Patients Providers
Make costs more Identify and Drive best
transparent practices
Find ways to move away
Move towards Consumer
from paying for health
Driven Health Care
care procedures and
decision making
instead pay for health
care outcomes
Hello everyone. My name is Dr Sandra Koch, I’m on obgyn and I’ve been delivering babies in Northern Nevada for over 20 years. Tonight though I’m here to deliver my views on the ACA I want to Thank Dr Pintar and the Sierra Nevada Forum for inviting me to talk tonight about the affordable care act. It’s quite a task trying to summarize 2700 pages in 15 minutes – I know DrPintar thinks I talk fast- but this is really going to be a challenge.
America has the most expensive healthcare in the world and yet we rank only 37th in the quality of the healthcare we provide, right behind Slovenia! Too many Americans aren’t covered by health insurance, there are too many medical errors, too much inefficiency and it costs too much.
The red line shows the growth in the percent of GDP that represents our expenditures on health care. The cost is Bankrupting our nation. It’s also bankrupting many of us.
Health care costs are the number 1 reason for bankruptcy in our community.
The map on the left side represents the percent of uninsured women in the United States ages 19-64. The dark blue represents states where 1 in 4 women are with out insurance, the light blue 1 in 5 and the purple 1 in 8. the map on the right side shows the changes we’ll see when the ACA is fully implemented. Being without insurance is dangerous for your health.
If youre unlucky enough to get really sick, not having health insurance reduces your chance of survival. So how many uninsured do we have?
By 2019 we would have had @ 57 million uninsured.
With the ACA there will be 34 million less uninsured by 2019
I like this quote from the flight of the buffalo. Many folks are scared about the changes coming, afraid they will lose coverage or be refused treatment based on age. A show of hands please from anyone who has received an email like this one.
This particular email has been the subject of debunking and fact checking by multiple sites .Virtually every statement is exaggerated, misleading, inaccurate or just plain wrong. I would ask all of you to identify a fact checking website and use it whenever you receive information that just doesn’t seem quite right. Here are two that I recommend.
So lets look at some of the beneficial changes.
No preexisting condition I”ve seen many cases where woman had a single abnormal pap test leading to exclusion of the entire reproductive system for life. That won’t happen any moreWomen have been paying up to twice as much for individual health care plans. Under the ACA that won’t happen any moreI’ve seem many women over the years that sign up for insurance that have a 9 month exclusion and if they got pregnant during that 9 months – no coverage. That won’t happen any more.Many folks with serious health condition, for example transplant patients, run through their lifetime limits on insurance expenditures and get dropped. That won’t happen anymore.Young people when they finish their educations have had very high rates of being uninsured. IF they get sick or more likely injured their health care and sometimes their futures are compromised. Requiring insurance companies to allow parents to insure their children until age 26 has dropped the number of uninsured in this age group. Another area of major change is in preventative health care coverage. In an effort to encourage folks to take advantage of life saving services the ACA has mandated coverage of many services.
Formedicare patients there will be No more Part B deductibles or copayments if your doctor acceptsassignmen for these services.The four most important things you can do to improve or prolong your health are control your BP, don’t smoke, control your weight and get get vaccinated. These are all covered under the preventative services listed above
A busy slide listing services for those too young for medicare- please notice all the vaccines covered with no co-pay.
For women the biggest changes are first dollar coverage for pregnancy and for contraception. Everyone understands the importance of prenatal care. I want to emphasize the importance of the contraception coverage. Nevada has one of the highest rates of unplanned pregnancy in the US. About one in three unplanned pregnancies is also an unwanted pregnancy. It’s clear that Unintended and unwanted pregnancies are bad for babies, mothers and our society. The ACA by mandating this coverage is going to significantly impact these pregnancies. IN addition. For every dollar we spend as a nation on contraception we SAVE three dollars the first year and thirty dollars over the next ten years.
The last list of preventative service sis for the children- as you can see- many services are covered. The next topic I want to review is medicare coverage of medications.
Has anyone heard of the donut hole? Until the ACA anyone who’s medication costs exceeded $2900 ended up in the donut hole. This meant- no assistance in paying for an individual’s medications until they’re personal outlay for medications had exceeded almost $5000. The ACA addressed this immediately.
Theamount of money you will have to pay for prescription medications within the donut hole will be reduced each year until 2020 when Medicare will pay for ¾ of your medication expenses. .
Many folks are wondering who’s going to see the 34 million newly insured Americans. AS some of you know from first hand experience- Already it is hard to find a physician willing to accept you as a new patient if you have medicaid or medicare in our community. This is not going to get better right away. We need many more providers- both physicians and midlevel providers. Ideally everyone will eventually have a medical “HOME” but until that time ERs will continue to see many of these folks. Urgent cares will also be heavily utilized. Carson Tahoe has free standing urgent care centers in Dayton and Carson city as well as one in all three Walmarts. Carson Medical Group has an urgent care for established patients also.
Standardization to reduce error -improve efficiencyIncrease transparency so that patients and their families are better aware of their treatment options including effectiveness of therapies and costs. Improve communication between health care providers to increase care coordination and decrease overlapActively promote best practices for prevention and treatment of the leading causes of death through mandates and dat analysisInvolve communities by promoting best practices for healthy living.
To get this accomplished we need computers. Healthcare at 18% of the GDP until recently has largely been run as a cottage industry. To move that volume to a computerized system is an enormous undertaking. First step is to move computers into the health care arena. To help this along CMS introduced a program called
The goal is to institute quality measure reporting using the Electronic Health Record for “Meaningful Use”Participation is mandatory for all health care providersPhysicians who participated got 1% bonus payments in 2011. to help with the costsPQRI bonuses fall to 0.5% in 2012 to 2014. Physicians will receive penalties in 2015 if they don’t participate.
Have you noticed that you’ve been filling out a lot more paper work at your doctors office? These are some of the first measures CMS has asked to have reported.
Carson Tahoe hospital has a computer system and it slowly working its’ way to fully utilizing it. On labor and delivery all our orders are computerized and all the nurses charting is. Here’s a problem though- one that’s even worse in the ORs and ICUs WE have lots of machines that do things for us but they don’t communicate. Therefore nurses and doctors are spending an inordinate amount of time transcribing data. Example BP and fetal monitoring on OB
Cost containment For patients- making cost more transparent- the idea that Computer generated data should steer healthcare. For providersIN theory best practices will be identified and implemented using EMR. The most effective and cost efficient treatment approaches will be sought. Using computers Health care centers will be linked to avoid duplication.Additionally finding ways to stop paying for procedures and instead pay for health outcomes. No one fully understands the implications of the ACA. The regulations for many parts of the ACA have yet to be written. Will it increase costs for private health insurance- yes because it mandates what must be covered. Is it perfect- NO will it change – yes. It was a first step in moving our country to a system that will cover most of our uninsured and may help us control our health costs through increasing standardization while mprovingthe quality of our health care.
For those of you who can’t read this it saysMay I be excused? My brain is full. I’m sure many of you feel this way – it’s a lot to take in.
I’ll leave you with one final comment- you might as well Embrace the Change – because There’s no going back!Thank you
