The Truth About Health Reform

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Countdown to Health Reform
Congress is close to passing substantial health reform, with important incremental steps to expand coverage, improve quality, and begin to control costs

Many are misinformed or uninformed about the proposals.
This resource presents:
The Problems
Cost, Access, Quality
Financing, Organization, Delivery
Health Care and Health
Why Insurance Doesn’t Work
The Politics of Reform
The Proposals: House and Senate
Keep Fighting for Single Payer
Fix It and Pass It!

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  • CVD: Cardio-vascular Disease
  • Nolte and McKee, “Measuring the Health of Nations,” HEALTH AFFAIRS, Vol27, Jan/Feb, 2008, 58. Deaths before age 75 from bacterial infections (mostly <15yo), treatable cancers (eg leukemia <44yo), diabetes (<50yo),
  • The money slide from the American Cancer Society showing all cancer patients without health insurance or with Medicaid have a 65% five year survival rather than an 80% five year survival.
  • Pts 18-64, n = 310,000
  • Finance and reimbursement changes not enough Need entity with ability to extract, diffuse cost-effective practices
  • The Truth About Health Reform

    1. 1. The Truth About Health Reform: It’s Up To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL/Center for Policy Analysis www.centerforpolicyanalysis.org 415-922-6204 [email_address] February, 2010 February, 2010 EQUAL/ Center for Policy Analysis
    2. 2. Countdown to Health Reform <ul><li>Congress is closer to passing substantial health reform than at any time since 1965 </li></ul><ul><li>Pending proposals take important incremental steps to expand coverage, improve quality, and begin to control costs </li></ul><ul><li>President Obama will debate Republicans on Feb. 25 </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    3. 3. Congress and the Public Stalemated <ul><li>Many have legitimate reservations about the bills </li></ul><ul><li>These provisions can and must be fixed </li></ul><ul><li>The health insurance industry and their political allies want to stop reform </li></ul><ul><li>They can and must be opposed </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    4. 4. Many are Misinformed Many are Uninformed February, 2010 EQUAL/ Center for Policy Analysis
    5. 5. The Public Must Step Up <ul><li>The House and Senate disagree </li></ul><ul><li>The White House has not galvanized a movement </li></ul><ul><li>Everyone agrees someone should do something </li></ul><ul><li>It’s up to the public to step up </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    6. 6. The Truth About Health Reform <ul><li>The Problems </li></ul><ul><ul><li>Cost, Access, Quality </li></ul></ul><ul><ul><li>Financing, Organization, Delivery </li></ul></ul><ul><li>Health Care and Health </li></ul><ul><li>Why Insurance Doesn’t Work </li></ul><ul><li>The Politics of Reform </li></ul><ul><li>The Proposals: House and Senate </li></ul><ul><li>Keep Fighting for Single Payer </li></ul><ul><li>Fix It and Pass It! </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    7. 7. What Is EQUAL? February, 2010 EQUAL/ Center for Policy Analysis
    8. 8. EQUAL Partners <ul><li>E quitable, Q uality, U niversal, A ffordab l e health care </li></ul><ul><li>Center for Policy Analysis, anchor organization </li></ul><ul><li>Rekindling Reform, NY </li></ul><ul><li>California Public Health Association-North </li></ul><ul><li>California Women’s Agenda </li></ul><ul><li>Older Women’s League </li></ul><ul><li>Links: </li></ul><ul><ul><li>Unitarian Universalist Legislative Ministry of Calif. </li></ul></ul><ul><ul><li>American Medical Women’s Association </li></ul></ul><ul><ul><li>National Women’s Health Network/Raising Women’s Voices </li></ul></ul><ul><li>Congressional Progressive Caucus Inside-Outside Group </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    9. 9. Activities <ul><li>Forum, Oct. 2008 </li></ul><ul><li>Policy Statements 2009 </li></ul><ul><ul><li>First 100 Days Health Agenda </li></ul></ul><ul><ul><li>Women’s Health </li></ul></ul><ul><ul><li>APHA Policy – Medical Care, CHPPD </li></ul></ul><ul><li>Presentations </li></ul><ul><li>Conference calls </li></ul><ul><li>Radio Series - KPFA </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    10. 10. The Truth About Health Reform Executive Summary February, 2010 EQUAL/ Center for Policy Analysis
    11. 11. Crisis in Costs, Access, Quality <ul><li>$2.5 trillion a year </li></ul><ul><li>Health care inflation growing faster than economy </li></ul><ul><li>45 million uninsured </li></ul><ul><li>Outcomes in U.S. worse than countries with universal coverage </li></ul><ul><li>U.S. companies and workers: constraint on competitiveness </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    12. 12. Health Care in the U.S. <ul><li>Progress </li></ul><ul><ul><li>Advances in science and technology </li></ul></ul><ul><ul><li>Social change: inclusion of women, people of color, patients’ perspectives </li></ul></ul><ul><li>Financing, Delivery system, have not kept pace </li></ul><ul><li>Role of Government - controversial </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    13. 13. The Problems: Financing, Organization, Delivery <ul><li>Fragmented financing </li></ul><ul><ul><li>Maze of public and private payment systems </li></ul></ul><ul><ul><li>No guarantee of coverage for most people </li></ul></ul><ul><ul><li>Profit motive for a public good </li></ul></ul><ul><li>Drives fragmented delivery system </li></ul><ul><ul><li>Complex, hierarchical </li></ul></ul><ul><ul><li>Too much acute care, not enough primary care </li></ul></ul><ul><ul><li>Little coordination among health care providers </li></ul></ul><ul><ul><li>No match between where health care needed and where available </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    14. 14. Losing Primary Care: February, 2010 EQUAL/ Center for Policy Analysis Shortages in pediatrics, internal medicine and family medicine. Decreased access to geriatricians and gynecologists.
    15. 15. Focus on Health Care vs. Health <ul><li>Money is concentrated on health care vs. public health </li></ul><ul><li>Improvements in health, increased life span in 20 th Century, related to </li></ul><ul><ul><li>Environment – clean air, water, housing </li></ul></ul><ul><ul><li>Social and economic equality </li></ul></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Economic wellbeing </li></ul></ul><ul><ul><li>Democratic participation, control over life circumstances </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    16. 16. Structural Obstacles to Health <ul><li>Social and economic inequalities undermine individual/community health </li></ul><ul><li>Economic policies </li></ul><ul><ul><li>Low income, unstable economy, multiple jobs/unemployment </li></ul></ul><ul><ul><li>Suburban sprawl and design discourage exercise </li></ul></ul><ul><ul><li>Food & agriculture policies encourage poor diets </li></ul></ul><ul><ul><li>Reduced social spending, education </li></ul></ul><ul><ul><li>Reduced democratic participation, community </li></ul></ul><ul><li>Health Consequences </li></ul><ul><ul><li>Stress, incidence and poor management of chronic diseases, tobacco use, violence </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    17. 17. Private Vs. Social Insurance <ul><li>We have to cover everyone to save money. </li></ul><ul><li>Private insurance has failed as a mechanism to assure coverage for health care or to control costs. </li></ul><ul><li>Social insurance programs through the government are much more successful. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    18. 18. Politics of Reform <ul><li>Entrenched interests and appeals to ideology have successfully blocked reform for decades. </li></ul><ul><li>The incremental proposals on the table are a step forward but not a final solution. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    19. 19. Health Care Costs Too Much February, 2010 EQUAL/ Center for Policy Analysis
    20. 20. Health Care is Big Business $2.5 Trillion A Year February, 2010 EQUAL/ Center for Policy Analysis
    21. 21. Distribution of National Health Expenditures, by Type of Service, 2008 February, 2010 EQUAL/ Center for Policy Analysis Note: Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
    22. 22. Relative Contributions of Different Types of Health Services to Total Growth in National Health Expenditures, 1998-2008 February, 2010 EQUAL/ Center for Policy Analysis Notes: Percentages may not total 100% due to rounding. Other Personal Health Care includes, for example, dental and other professional health services, durable medical equipment, etc. Other Health Spending includes, for example, administration and net cost of private health insurance, public health activity, research, and structures and equipment, etc. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip).
    23. 23. February, 2010 EQUAL/ Center for Policy Analysis
    24. 24. Total Health Expenditures Per Capita, U.S. and Selected Countries, 2003 February, 2010 EQUAL/ Center for Policy Analysis
    25. 25. * 2008 and 2009 NHE projections. .Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, (New York: The Commonwealth Fund, Aug. 2009). Insurance Premiums Rising Faster Than Workers’ Earnings 2000–2009 Percent 108% 32% 24%
    26. 26. Premium as % of Median Family Income, 2008–2020 February, 2010 EQUAL/ Center for Policy Analysis Percent Projected
    27. 27. February, 2010 EQUAL/ Center for Policy Analysis
    28. 28. Health and Welfare Expenditures, General Fund, All K-12 Districts and County Offices of Education, California 1999 – 2008 February, 2010 EQUAL/ Center for Policy Analysis
    29. 29. February, 2010 EQUAL/ Center for Policy Analysis Notes: Percentages may not total 100% due to rounding. Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Health Expenditures by type of service and source of funds, CY 1960-2008; file nhe2008.zip). Distribution of National Prescription Drug Expenditures by Source of Payment, 1998-2008 Private Insurance Consumer Out-of-Pocket Payments Public Funds
    30. 30. Private Health Insurance Administrative Costs per Person Covered, 1986-2008 February, 2010 EQUAL/ Center for Policy Analysis Notes: These data show the net cost of private health insurance per private enrollee (including Blue Cross/Blue Shield, commercial insurance, HMOs, and self-insured plans), as calculated by the Centers for Medicare and Medicaid Services. Net cost of insurance is the difference between premiums earned and benefits incurred, and includes insurers’ costs of paying bills, advertising, sales commissions, and other administrative costs; net additions/subtractions from reserves; rate credits and dividends; premium taxes; and profits or losses. Private enrollment is estimated by CMS using the National Health Insurance Survey and the Current Population Survey. Source: Kaiser Family Foundation calculations NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http:// www.cms.hhs.gov/NationalHealthExpendData / (see Historical; National Expenditures by type of service and source of funds, CY1960-2008, file nhe2008.zip, Admin.& Net Cost of Priv. Hlth Insurance, Pvt Health Insurance); and private health insurance enrollment data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, Table 4 at http://www.cms.hhs.gov/NationalHealthExpendData/downloads/bhg08.pdf .
    31. 31. Number of Uninsured Growing February, 2010 EQUAL/ Center for Policy Analysis
    32. 32. February, 2010 EQUAL/ Center for Policy Analysis
    33. 33. February, 2010 EQUAL/ Center for Policy Analysis New York Times
    34. 34. February, 2010 EQUAL/ Center for Policy Analysis
    35. 35. Health Care in California <ul><li>6.6 million uninsured in 2006 = 20 % of non-elderly population </li></ul><ul><li>763,000 children uninsured </li></ul><ul><li>300,000 significantly at risk for losing their coverage </li></ul><ul><li>Health care spending grows two to three times faster than California's economy </li></ul><ul><li>Health insurance premiums grow significantly faster than overall health care spending </li></ul><ul><li>- source: SB 810 </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    36. 36. Quality of Care: People Suffer and Die Because of Our Cruel and Unfair System February, 2010 EQUAL/ Center for Policy Analysis
    37. 37. Uninsured: Dying from a Toothache in the U.S. February, 2010 EQUAL/ Center for Policy Analysis A man in his early 20s with a worsening dental infection was unable to afford a dentist. He finally saw a physician who prescribed an antibiotic, but the patient was unable to pay for the prescription. He came to our clinic when the infection had spread to his chest. He died soon after admission. The egregious is commonplace in our non-system. JAMAVol. 286 No. 20, November 28, 2001&quot;Within the System of No-System,&quot; Robert L. Ferrer, MD, MPH
    38. 38. Quality/Outcomes <ul><li>Infant Mortality: 29th in world </li></ul><ul><li>Life Expectancy: 78 yrs. (Below other developed nations ) </li></ul><ul><li>Cancer/Cardiovascular disease rates: Canada, England, most European countries are better </li></ul><ul><li>Preventable Hospital Deaths: 100,000/yr. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    39. 39. February, 2010 EQUAL/ Center for Policy Analysis
    40. 40. February, 2010 EQUAL/ Center for Policy Analysis
    41. 41. February, 2010 EQUAL/ Center for Policy Analysis
    42. 42. Potential Years of Life Lost Due to Diabetes per 100,000 Population, 2006 February, 2010 EQUAL/ Center for Policy Analysis *2005 **2004 Data: OECD Health Data 2008 (June 2008).
    43. 43. Mortality Amenable to Health Care: U.S. Failing to Keep Pace with Other Countries Deaths per 100,000 population* * Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections. Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality files (Nolte and McKee, Health Affairs 2008). Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008. Exhibit 2
    44. 44. Lack of Insurance and Mortality <ul><li>18,000 excess deaths a year are associated with lack of insurance </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    45. 45. 66% of personal bankruptcies are due to medical debt February, 2010 EQUAL/ Center for Policy Analysis
    46. 46. February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. FIGURE 10 Cancer Survival by Insurance Status*
    47. 47. February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Uninsured Rates Among Adults Aged 19 to 64 Years by Income Level, 2001 to 2005 LOW INCOME MORE LIKELY UNINSURED
    48. 48. Race, Class, Insurance and Health February, 2010 EQUAL/ Center for Policy Analysis
    49. 49. February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Breast Cancer: Blacks and Hispanics Diagnosed Later, More Likely Uninsured
    50. 50. February, 2010 EQUAL/ Center for Policy Analysis Copyright ©2008 American Cancer Society From Ward, E. et al. CA Cancer J Clin 2008;58:9-31. Colorectal Cancer Stage Distribution by Race and Insurance Status
    51. 51. February, 2010 EQUAL/ Center for Policy Analysis Copyright restrictions may apply. Haider, A. H. et al. Arch Surg 2008;143:945-949. Adjusted odds of mortality by race and insurance status (n = 311 503 )
    52. 52. February, 2010 EQUAL/ Center for Policy Analysis
    53. 53. We Pay More But Don’t Get More <ul><li>Higher costs are related to intensity of care </li></ul><ul><li>Higher costs are not related to better outcomes </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    54. 54. Variations in Cost/Quality <ul><li>Regions experience different per capita costs </li></ul><ul><li>High-cost areas pay 30% more than low-cost areas </li></ul><ul><li>Costs are unrelated to health, wealth, outcome </li></ul><ul><li>Two determinants of costs: </li></ul><ul><ul><li>Supply of providers </li></ul></ul><ul><ul><li>Medical decisions/culture </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    55. 55. We Have To Cover Everyone To Control Costs February, 2010 EQUAL/ Center for Policy Analysis
    56. 56. The Costs of Fragmented Coverage <ul><li>Illnesses and accidents are predictable for large groups over time </li></ul><ul><li>But unpredictable for small groups in any year </li></ul><ul><li>Problems for small groups </li></ul><ul><ul><li>A single catastrophic illness can wipe out funds </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    57. 57. Insurance, Access, Costs <ul><li>Private for-profit insurance companies face incentives to avoid spending premiums </li></ul><ul><ul><li>Identify and avoid “risky” patients </li></ul></ul><ul><ul><li>Exclude pre-existing conditions </li></ul></ul><ul><li>Insurance companies run up administrative costs to avoid “expensive” enrollees (sick people) </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    58. 58. Employment-Based Insurance <ul><li>The U.S. is the only country where most people get health care coverage through work </li></ul><ul><li>But there is no requirement for employers to offer or pay for coverage!!! </li></ul><ul><li>Large employers: 96% offer </li></ul><ul><li>Small employers: 43% offer </li></ul><ul><ul><li>(fewer than 50 employees) </li></ul></ul><ul><li>Principles of insurance </li></ul><ul><ul><li>Cover everyone at risk = Affordability </li></ul></ul><ul><ul><li>If not, assume only those at risk will buy = Not affordable </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    59. 59. (How Did We Get Here? U.S. Path to Private Insurance) <ul><li>Began in 1930s/Depression </li></ul><ul><ul><li>Communities pooled funds in nonprofits to help pay for health care </li></ul></ul><ul><li>Continued as tax-free benefit during WWII </li></ul><ul><li>Other countries turned to government-financed social insurance, or combined with heavily regulated nonprofit insurance </li></ul><ul><li>U.S. medical societies, businesses, and insurance companies opposed these trends </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    60. 60. Private Insurance Has Failed Government Plans are More Successful February, 2010 EQUAL/ Center for Policy Analysis
    61. 61. Free Market Cannot Control Costs <ul><li>Doctors, hospitals, drug companies try to get highest price for best care </li></ul><ul><li>Payers try to pay lowest price for best care </li></ul><ul><ul><li>Individual patients </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Insurance companies </li></ul></ul><ul><ul><li>Government </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    62. 62. Why Doesn’t It Work? <ul><li>Individual patients </li></ul><ul><ul><li>Don’t know what care we need, rely on providers </li></ul></ul><ul><ul><li>Vulnerable when sick, can’t negotiate </li></ul></ul><ul><ul><li>Prices not transparent </li></ul></ul><ul><li>Employers </li></ul><ul><ul><li>Only cover a small percent of “covered lives” </li></ul></ul><ul><ul><li>Part of fragmentation problem </li></ul></ul><ul><li>Insurance companies </li></ul><ul><ul><li>Generally not big enough to negotiate lower prices with hospital chains, drug companies </li></ul></ul><ul><ul><li>If successful, keep savings for profits, other costs </li></ul></ul><ul><ul><li>Not sufficiently regulated </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    63. 63. Administrative Barriers <ul><li>Multiplicity of protocols, formularies complicate medical decision-making </li></ul><ul><li>Insufficient regulation </li></ul><ul><ul><li>Unclear fine print -- not standardized, unknown coverage </li></ul></ul><ul><ul><li>State rules can set benefit levels, some standards </li></ul></ul><ul><ul><li>Need federal agency with staff and clout to assure accountability </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    64. 64. Prevention <ul><li>Incentives for prevention are undermined </li></ul><ul><li>Employer who pays for prevention may not still be the employer in 5 years </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    65. 65. Government Can Do It <ul><li>Big enough to negotiate with drug companies and hospital chains </li></ul><ul><li>No profit motive </li></ul><ul><li>But now covers less than half the population </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    66. 66. Government Successes <ul><li>Medicare </li></ul><ul><li>Veterans Administration </li></ul><ul><li>Community Health Centers </li></ul><ul><li>Hawaii </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    67. 67. Medicare <ul><li>Popular federal government program covers population over age 65 </li></ul><ul><li>From 1997 to 2007, Medicare’s cost per beneficiary rose on average 4.4% per year </li></ul><ul><li>Private insurance premiums increased by 7.4% per year—a 30% difference over the full 10 years. </li></ul><ul><ul><ul><li>Http://www.cms.hhs.gov/nationalhealthexpenddata/downloads/tables.pdf (see table 13) </li></ul></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    68. 68. Hawaiian Health Care System <ul><li>The Daily Show, Feb. 11, 2010 </li></ul><ul><li>“ Hawaiians have government-mandated health care and they love it.” </li></ul><ul><li>“ We’ve been doing it this way for 40 years.” </li></ul><ul><li>Dog the Bounty-Hunter supports Hawaiian health care. </li></ul><ul><li>http://www.thedailyshow.com/watch/thu-february-11-2010/the-apparent-trap/ </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    69. 69. Health Reform Is A Political Challenge February, 2010 EQUAL/ Center for Policy Analysis
    70. 70. Tough Road February, 2010 EQUAL/ Center for Policy Analysis
    71. 71. Some Victories <ul><li>1965 – Johnson: Medicare, Medicaid </li></ul><ul><li>1994 – Clinton: State Children’s Health Insurance Program (SCHIP) </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    72. 72. $2.5 Trillion: Spending or Income ? Industry Opposes Income Constraints February, 2010 EQUAL/ Center for Policy Analysis Spending Income Individuals Insurance Industry Employers Pharmaceutical Co.s Governments Hospitals, Physicians
    73. 73. Controlling Costs Means Reducing Income <ul><li>Effective cost control would improve access and quality </li></ul><ul><li>But it involves reducing payments to the health care industry </li></ul><ul><li>Provokes political opposition </li></ul><ul><li>Political leadership needed to galvanize reform </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    74. 74. Politics in 2008: Auspicious February, 2010 EQUAL/ Center for Policy Analysis
    75. 75. February, 2010 EQUAL/ Center for Policy Analysis
    76. 76. Politics in 2010: Challenging February, 2010 EQUAL/ Center for Policy Analysis
    77. 77. Economic Collapse – But Corporations Still In Charge February, 2010 EQUAL/ Center for Policy Analysis
    78. 78. Social institutions weakened: labor, women, civil society - ++Faith Community, online networks growing ++ February, 2010 EQUAL/ Center for Policy Analysis
    79. 79. Corporate media February, 2010 EQUAL/ Center for Policy Analysis
    80. 80. Reform Opponents Just Say No To Stop Reform <ul><li>Better ideas not necessary </li></ul><ul><li>Scare tactics: “government bureaucrats,” “socialism,” “rationing,” “class warfare,” “death panels” </li></ul><ul><li>Racial backlash </li></ul><ul><li>Immigrants backlash </li></ul><ul><li>Political backlash </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    81. 81. What Health Reform Bills Do February, 2010 EQUAL/ Center for Policy Analysis
    82. 82. House and Senate Passed Different Bills <ul><li>House bill generally more affordable, better safeguards for public, costs </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    83. 83. Summary of Changes: Coverage, Affordability, Insurance Reform <ul><li>Coverage </li></ul><ul><ul><li>Low Income people: Medicaid expansion </li></ul></ul><ul><ul><ul><li>To 150% of poverty (House) or 133% (Senate) </li></ul></ul></ul><ul><ul><li>Employed people: Individual and employer mandates </li></ul></ul><ul><ul><li>Self-Employed/Small Businesses: Insurance Exchange </li></ul></ul><ul><ul><ul><li>? PUBLIC OPTION ? 2013 (House bill) ? 2014 ? (Senate) </li></ul></ul></ul><ul><ul><li>Children to age 26 (27) (House/Senate) </li></ul></ul><ul><li>Affordability </li></ul><ul><ul><li>Premium subsidies related to income </li></ul></ul><ul><ul><li>Limits on out-of-pocket costs </li></ul></ul><ul><ul><li>No lifetime maximums on cost of care </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    84. 84. Coverage <ul><li>Medicaid: Covers everyone up to 150% of poverty (House) </li></ul><ul><ul><li>15 million would be newly covered </li></ul></ul><ul><li>Employed people: Individuals and employer mandates </li></ul><ul><ul><li>150 million already covered </li></ul></ul><ul><ul><li>For the first time, employers required to contribute </li></ul></ul><ul><li>Self-Employed/Small Business: </li></ul><ul><ul><li>Access to a new Insurance Exchange </li></ul></ul><ul><ul><li>21 to 26 million would be newly covered </li></ul></ul><ul><ul><ul><li>? PUBLIC OPTION ? 2013 ? 2014 ? </li></ul></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    85. 85. For Those Insured Now: More Secure Coverage <ul><li>Standards for employment-based insurance </li></ul><ul><li>Medicare improved, protected </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    86. 86. Insurance Exchanges <ul><li>Offer regulated plans to everyone without another source of coverage </li></ul><ul><li>House version </li></ul><ul><ul><li>National exchange negotiates contracts, enforces insurance reforms </li></ul></ul><ul><ul><li>Reviews/rejects excess premiums </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    87. 87. The Public Option <ul><li>Gives enrollees choice of a publicly administered program like Medicare </li></ul><ul><ul><li>Changes insurance </li></ul></ul><ul><ul><li>Health care providers (MDs, nurses, hospitals): No change </li></ul></ul><ul><ul><ul><li>Still private or public, as they are now </li></ul></ul></ul><ul><li>Politically popular despite massive opposition by private insurance industry </li></ul><ul><li>Critical to improve access, affordability </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    88. 88. Insurance Reforms: Curbs Insurance Co. Abuses <ul><li>No denials of coverage: Pre-existing condition exclusions prohibited </li></ul><ul><li>Rescissions prohibited </li></ul><ul><li>Gender-rating prohibited </li></ul><ul><li>Age-rating limited </li></ul><ul><li>Administrative costs limited </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    89. 89. Insurance Reform: Denials of Care Addressed <ul><li>20% of claims denied now in California </li></ul><ul><li>Rescissions </li></ul><ul><ul><li>Means coverage revoked for a person or a treatment </li></ul></ul><ul><ul><li>Technically would be prohibited </li></ul></ul><ul><ul><li>Still allowed in the case of “fraud or misrepresentation” </li></ul></ul><ul><ul><li>A PUBLIC OPTION would have no incentive to deny legitimate claims </li></ul></ul><ul><ul><li>Need regulation by Federal Trade Commission (revoke anti-trust exemption) </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    90. 90. Now: Women Can Pay More Example: Kaiser Permanente monthly premiums 2010 February, 2010 EQUAL/ Center for Policy Analysis Age Male Female Difference 19-24 $260 $273 5.0% 25-29 $292 $306 4.8% 30-34 326 342 4.9% 40-44 354 372 5.1% 45-49 418 439 5.0% 50-54 476 499 4.8% 55-59 559 559 0 60-64 628 598 -4.8%
    91. 91. Gender Discrimination In Premium Rates Would Be Prohibited February, 2010 EQUAL/ Center for Policy Analysis
    92. 92. Oldest Compared to Youngest: 215% Example: Kaiser Monthly Premium 2010 February, 2010 EQUAL/ Center for Policy Analysis Age Male Female Difference 19-24 $260 273 25-29 292 306 30-34 326 342 40-44 354 372 45-49 418 439 50-54 476 499 55-59 559 $559 +215% (2:1)
    93. 93. Age Discrimination In Premium Rates Would be Permitted but Limited <ul><li>House bill: 2:1 </li></ul><ul><li>Senate bill: 3:1 </li></ul><ul><li>Interim: 4:1 </li></ul><ul><li>(high risk pool) </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    94. 94. What is it going to cost? February, 2010 EQUAL/ Center for Policy Analysis
    95. 95. Affordability: Individuals <ul><li>Individuals and employers required to pay </li></ul><ul><ul><li>Same as all other countries </li></ul></ul><ul><li>Premiums </li></ul><ul><ul><li>More affordable than now </li></ul></ul><ul><ul><li>Absolute limit on plans sold thru Exchange </li></ul></ul><ul><li>Still a big concern </li></ul><ul><ul><li>Can still be a stretch for some </li></ul></ul><ul><ul><li>PUBLIC OPTION would provide choice and bargaining clout </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    96. 96. New: Insurance Exchange -- House Bill Example: 4-person family at 200% FPL ($44,000) February, 2010 EQUAL/ Center for Policy Analysis House Senate Premiums $2400 $2772 % Income 5.5% 6.3% OOP Cap $2000 $4100 Max OOP $4400 $6872 Max % Income 10% 15%
    97. 97. Estimates by House TriCommittee Staff February, 2010 EQUAL/ Center for Policy Analysis
    98. 98. Affordability: Deficit Reduction 2010-2019 (CBO) <ul><li>$132-138 B. (House) </li></ul><ul><li>$650B to $1.3 Trillion (Senate bill) </li></ul><ul><li>Spending per Medicare beneficiary: </li></ul><ul><li>Annual rate of increase (in real terms) cut in half, from 4% over last 2 decades to 2% in the future. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    99. 99. Quality, Cost Control <ul><li>Primary care expanded </li></ul><ul><li>Prevention – no co-pays </li></ul><ul><li>Public health workforce expanded </li></ul><ul><li>Incentives for providers to practice in teams </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    100. 100. What Happens to Medicare? February, 2010 EQUAL/ Center for Policy Analysis
    101. 101. Medicare Changes <ul><li>Medicare Advantage </li></ul><ul><ul><li>House: Eliminate/reduce overpayments </li></ul></ul><ul><ul><li>Senate: Competitive bidding </li></ul></ul><ul><ul><li>Both: Bonuses for Quality Improvements </li></ul></ul><ul><li>Reduce/Reform provider payments </li></ul><ul><li>Disproportionate Share Hospital cuts </li></ul><ul><li>Control drug prices </li></ul><ul><ul><li>House: Negotiate rates, Eliminate doughnut hole </li></ul></ul><ul><li>Study geographic differences </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    102. 102. Reconciling House and Senate Bills February, 2010 EQUAL/ Center for Policy Analysis
    103. 103. What Do We Need To Fix? <ul><li>* The public option: our toe-hold on structural change. </li></ul><ul><li>Affordable coverage - Strong employer mandate. </li></ul><ul><ul><li>House: Pay ~70% of premium, or pay 8% of payroll to Exchange </li></ul></ul><ul><ul><li>Senate: $750/year per employee </li></ul></ul><ul><li>* Fair financing - Tax income, not hard-won benefits. </li></ul><ul><li>Immigrants’ inclusion: allow to purchase thru Exchange </li></ul><ul><li>* Accountability for insurance companies </li></ul><ul><ul><li>A single national exchange </li></ul></ul><ul><ul><li>Eliminate anti-trust exemption – FTC regulation </li></ul></ul><ul><li>* State options for innovative approaches </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    104. 104. What to Fix <ul><li>Abortion Coverage – Both bills retreat from current law </li></ul><ul><li>Immigrants’ inclusion: allow to purchase thru Exchange </li></ul><ul><li>State options for innovative approaches </li></ul><ul><ul><li>Senate provision for Medicare waivers </li></ul></ul><ul><ul><li>Kucinich amendment: ERISA waiver </li></ul></ul><ul><ul><ul><li>Employee Retirement Income Security Act (1974) </li></ul></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    105. 105. Process: Reconciliation <ul><li>Move some items to reconciliation </li></ul><ul><ul><li>Must be germane to the budget </li></ul></ul><ul><ul><li>Parliamentarian decides what’s included </li></ul></ul><ul><li>House to vote on amendments to Senate bill </li></ul><ul><li>Then adopt Senate bill </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    106. 106. How can we get a single payer plan in our state? February, 2010 EQUAL/ Center for Policy Analysis
    107. 107. Single Payer: What it Is and Why We Need to Fight For It <ul><li>A government-sponsored system like Medicare </li></ul><ul><li>Everyone automatically covered, most cost efficient, contributes to social & economic equity, good outcomes… </li></ul><ul><li>Gives government the authority to constrain health care spending </li></ul><ul><li>Who could possibly object to that? </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    108. 108. $2.5 Trillion: Spending or Income ? February, 2010 EQUAL/ Center for Policy Analysis Spending Income Individuals Insurance Industry Employers Pharmaceutical Co.s Governments Hospitals, Physicians
    109. 109. Build Momentum Now <ul><li>A government-sponsored (single payer) system like Medicare would do a better job of controlling costs and covering everyone. </li></ul><ul><li>The insurance industry will continue to oppose single payer strongly at the state level. </li></ul><ul><li>A strong national bill will build momentum to rein in the industry and keep up the effort for state single payer systems. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    110. 110. Follow the Money State Campaign Contributions 2004-8 <ul><li>Health Industry TOTAL: $132,943,232 </li></ul><ul><li>Pharmaceuticals </li></ul><ul><li>Hospitals & Health Systems </li></ul><ul><li>Health Insurance & HMO </li></ul><ul><li>Physician Practice Groups and Associations </li></ul><ul><li>Nursing Homes </li></ul><ul><li>http:// www.followthemoney.org/press/ReportView.phtml?r =408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7 </li></ul><ul><li>Provides free online access to public records in all 50 states, to document political donor and lobbyist contributions to policymakers. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    111. 111. Health Insurance & HMO State Contributions 2004-8 <ul><li>Insurance companies $42,233,972  </li></ul><ul><li>13% to ballot measures. </li></ul><ul><li>51% to Officeholders: $21.4 million </li></ul><ul><li>3rd top recipient: California Republican Party - $1.3 million </li></ul><ul><li>http:// www.followthemoney.org/press/ReportView.phtml?r =408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7 </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    112. 112. Reclaiming the Narrative: Democratic Process <ul><li>Five separate congressional committees had hearings; each chamber had floor debates. That’s hundreds of hours the GOP had to talk about health care, all of it in public view and televised on C-SPAN. And that’s not even including all of the unofficial channels at the Republicans’ disposal. Generally speaking, the party of Rush Limbaugh and Fox Television doesn’t struggle to get across its message. </li></ul><ul><ul><ul><ul><li>Jonathan Cohn, TNR </li></ul></ul></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    113. 113. Republican Roadmap for America's Future <ul><li>Convert Medicare to a voucher program </li></ul><ul><ul><li>Reduce federal spending from 14% GDP to 4% </li></ul></ul><ul><li>Rely on seniors to shop for cheaper care </li></ul><ul><li>Why Not? </li></ul><ul><ul><li>Not enough money to pay for care!!! </li></ul></ul><ul><ul><li>Imperfect information re: price, quality </li></ul></ul><ul><ul><li>Vulnerable when sick – can’t bargain on price </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    114. 114. Rely on Your Wits, or on Medicare? <ul><li>If you simply reduce the money flowing into Medicare, relying only on the wits of beneficiaries to figure out how best to spend what’s left, seniors are bound to end up with less care. That's the Republican method. </li></ul><ul><li>But if you also introduce system-wide changes that reward more efficient care and force down provider prices, the dollars in the program really might go farther--so that spending less doesn't always mean getting less. That's the Democratic approach. - Jonathan Cohn, New Republic </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    115. 115. The Republican Health Plan NY Times November 6, 2009 <ul><li>Here is the first thing you need to know: It would do almost nothing to reduce the scandalously high number of Americans who have no insurance. And it makes only a token stab at slowing the relentlessly rising costs of medical care. </li></ul><ul><li>Despite that, the Republicans are pitching their bill as far more affordable than the Democrats’ approach. But a lot of the Republicans’ savings on premiums come from reduced coverage. Pay less and get less. </li></ul><ul><li>Unless the White House and Congressional Democrats push back with the hard facts, the Republicans could use it to spread false hope of a “cheaper” alternative to scuttle real health care reform. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    116. 116. NY Times (cont’d) : Repub Plan <ul><li>There’s no question that the Republicans’ bill is cheaper because it does so little to help the uninsured. According to the Congressional Budget Office, it would provide $61 billion over 10 years to expand coverage, compared with more than $1 trillion in the Democrats’ bill. </li></ul><ul><li>That paltry effort, the budget office estimates , would extend coverage to a few million people who would otherwise be uninsured in 2019, leaving 52 million citizens and legal residents below Medicare age without coverage or about 17 percent of that population, right where it is today. This is a dismaying abdication of responsibility. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    117. 117. Undermines Insurance Regulation <ul><li>The Republican bill is an amalgam of market-oriented and state-based reforms that conservatives have long proposed, including enhancement of tax-sheltered accounts to help pay premiums and allowing people to buy insurance in other states that might permit skimpier benefits than their home state. </li></ul><ul><li>It has some good provisions, such as prohibiting insurers from imposing annual or lifetime caps on what they will pay and automatic enrollment of workers in employer-sponsored group coverage. But it would not prevent insurers from denying coverage or charging higher premiums based on pre-existing conditions. </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    118. 118. What We Can Do February, 2010 EQUAL/ Center for Policy Analysis
    119. 119. SUMMING UP <ul><li>Expanding coverage for health care is crucial </li></ul><ul><li>There is an historic chance to move forward </li></ul><ul><li>The bills need to be FIXED so that care is affordable and accessible </li></ul><ul><li>The bills need to be FIXED to protect abortion coverage and immigrants’ inclusion </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    120. 120. SUMMING UP <ul><li>It is up to us </li></ul><ul><li>These are the critical weeks </li></ul><ul><li>Opponents still want to kill the bill </li></ul><ul><li>It is the public’s job to express our will </li></ul><ul><li>It is our elected officials’ job to figure out how to do it </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    121. 121. Who Needs to Hear From Us <ul><li>Senate Majority Leader Harry Reid </li></ul><ul><li>Our Senators </li></ul><ul><li>President Obama </li></ul><ul><li>Speaker Pelosi </li></ul><ul><li>House Committee Chairs </li></ul><ul><ul><li>Ed & Labor Chair George Miller </li></ul></ul><ul><ul><li>Ways & Means – Charlie Rangel, Pete Stark </li></ul></ul><ul><ul><li>Energy & Commerce Chair Henry Waxman </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis
    122. 122. A million calls on February 24th and 25th! <ul><li>Fix It and Pass It! </li></ul><ul><li>Call Congress and the White House on Feb. 24th and 25th, to make a HUGE push to fix the Senate bill via reconciliation and to pass it! We need to finish the job on health care reform. </li></ul><ul><li>http://www.centerforpolicyanalysis.org/id68.html </li></ul>February, 2010 EQUAL/ Center for Policy Analysis
    123. 123. Help Make History <ul><li>Join the EQUAL Listserv </li></ul><ul><ul><li>Send a blank message to </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>See our website: </li></ul><ul><ul><li>www.centerforpolicyanalysis.org </li></ul></ul><ul><ul><li>We gratefully acknowledge the participation of </li></ul></ul><ul><ul><li>Deborah LeVeen and Elinor Blake in preparation of this </li></ul></ul><ul><ul><li>presentation. </li></ul></ul>February, 2010 EQUAL/ Center for Policy Analysis

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