“Health Reform” in the U.S.A.Where are we in the quest for amore fair and affordable health care system? David N. Sundwall, M.D. Professor, Public Health (clinical) University of Utah School of Medicine
Presentation Outline 1. Historical perspective 2. The Patient Protection and Affordability Care Act (PPACA) 3. Utah’s version of Health Reform
PP (ACA) – “Obamacare”I. Policies a. Promises b. ProblemsII. Politics a. Republican b. Democrat c. “Tea party”III. Prognosis
Policies#1 Priority – Expand health insurance coverage (32 million more?) starting in 2014 NOTE: Does not strive for universal coverage, but if implemented as intended, 95% of legal U.S. residents would have coverage by 2016.HOW ? Expand Medicaid (increase to 138% of FPL) Subsidies to help lower income individuals and families pay for private insurance Health Insurance Exchange (HIE) – make shopping for health insurance easier
Policies – cont.“Mandate” – starting in 2014 “almost every American” will need to carry insurance or pay a fine.Insurance Regulations – 1. Sharp restriction or “recissions” 2. Can no longer deny coverage to children with preexisting conditions 3. No longer able to impose limits on lifetime benefits paid out 4. By 2014 prevent insurance companies from denying policies to people with preexisting conditions. (Temporary bridge, “High Risk Pools - HIP)
Policies cont.Public Health Provisions Focus on preventing chronic disease and reduce the rate of death from our “top killers”: Heart disease Cancer Stroke Chronic respiratory disease Diabetes
Policies cont.How ? New Prevention and Public Health Fund (increase from $100 million “Preventive Health Services Block Grant” to $2 billion by 2015) - HRSA School based health centers - HRSA Community transformation grants - CDC Increase funding for immunizations - CDC Improve capacity and technology of public health labs - CDC Fund home visits in maternal and child health (MCH) program, etc. up to $1.5 billion dollars (in addition to the $635 million/yr. appropriated for the MCH Block Grant.
Policies cont.Health care work forceIncrease number and geographic distribution of the nation’s “health work force” – doctors, nurses, dentists, and other health professionals.How ?Increase payment for primary care servicesStrengthen and expand the National Health Service Corps (NHSC)Fund pilot project related to “medical homes”, e.g. for pediatric special needs patientsAnd others . . .
Utah’s version of “health reform” Rely on private health insurance market Promote personal responsibility Ensure “transparency” and value Maximize tax advantages Optimize public programs, e.g. “Medicaid reform”.
“Defined Contribution Market” Keep all payments “pre-tax” Employees cannot be penalized for health status Guaranteed issue ( same options for all employees )
Utah Health Insurance Exchange Internet-based information portal – start with businesses , eventually make available to individuals. Connects consumers to vital information re: private health insurance plans available: single shopping point with reliable information, side-by side comparisonConsumers make personal and informed choices, “electronically”.
PoliticsWe are in the process of an intense nationaldebate related to health care in the UnitedStates – what should be provided, and how topay for it. The outcome will redefine the roles ofgovernments ( federal and states) and theprivate sector in our health care enterprise.“Fasten your seatbelts – it’s going to be a bumpy night [ride]”. Betty Davis – All About Eve
Supreme Court Decision – July 2012 Most of the ACA upheld, i.e. “the law of the land”. This included the “mandate” on individuals • and businesses employing more than 50 people to have or provide health insurance. • Monkey wrench – states can’t be required to expand Medicaid ( made optional)
Current Challenges: Medicaid – “ to expand [coverage] of not to expand, that is the question”. Utah – what do you think? What do you think the legislature will do? [ a study has been commissioned by the UDOH to determine cost, impact, etc.] Arkansas - use federal $ to purchase private insurance for those who would be eligible for Medicaid expansions? “Health Insurance Exchanges” – federal version or “Avenue H”? Very different views on how best to facilitate expansion of health insurance coverage…..
Prognosis…. PPACA – “guarded”, i.e. while currently the law of the land, it will inevitably be modified. For health care - good for most, but we need to revisit how we provide care for the most vulnerable among us and how to make it affordable for all over the long run.NOTE: Social Security-Medicare trustees voice doubt abut that the federal government could maintain its financial commitments to pay the bulk of the Medicaid expansions through 2020. “ Mercatus” – March, 2013.