Healthcare Reform And You


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An overview of possible healthcare reform provisions and how they will impact various stakeholders. Presented at Health Camp Nashville on May 30.

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Healthcare Reform And You

  1. 1. Healthcare Reform and You. Presented by: Martin Trussell, SVP First Horizon Msaver, Inc. HealthCampNash, May 30, 2009
  2. 2. Healthcare Reform Why now? What will it look like? How will it affect me? Carriers & TPAs Brokers & Agents Employers Individuals Providers Others… Healthcare Reform and You.
  3. 3. Why Now? Economic crisis. Medicare and Medicaid. Stakeholder consensus. Needs to happen in 1st Term. Healthcare Reform and You.
  4. 4. Why Now? National healthcare spending reached $2.2 trillion, or $7,421 per person, in 2007 representing more than 16% of the gross domestic product. Continuing at the same pace, it will reach 20.3% of the country's gross domestic product by 2018. Healthcare Reform and You.
  5. 5. Why Now? 32% of state budgets now go to paying for Medicaid. Growth rates for Medicare is unsustainable. Healthcare Reform and You.
  6. 6. What will it look like? We don’t know, for sure. Legislation to be revealed in June. Passed by July 31. Healthcare Reform and You.
  7. 7. What will it look like? The promise: All Americans guaranteed affordable, high-quality healthcare the freedom to choose whatever doctor or health plan they want, all at a savings of some $2,500 per family. Healthcare Reform and You.
  8. 8. What will it look like? The cost: $1.5 trillion. Healthcare Reform and You.
  9. 9. What will it look like? Individual mandate. Sufficient coverage. Elimination of underwriting. Tax equity, subsidy (indiv. vs. group). Public Plan to complete. Emphasis on prevention & wellness. Elimination of waste. Electronic data keeping. Comparative effectiveness. Healthcare Reform and You.
  10. 10. Employer Elimination or reduction the favored tax status of healthcare expenses. Revenue “lost” to current policy at $194.2 billion a year. Less control over plan designs offered to employees. Loss of members to individual plans. Healthcare Reform and You.
  11. 11. Carriers Competition from “Public Plan.” Inability to underwrite. Increased regulation. Shift to individual policies. Looking for $2T in savings. Healthcare Reform and You.
  12. 12. TPAs Potential loss of FSA/HRA admin. Potential gain of HSA substantiation. Shift from groups to individuals. Healthcare Reform and You.
  13. 13. Brokers and Agents Competition from “Connectors.” Shift to individual market. Relief from underwriting. Healthcare Reform and You.
  14. 14. Individuals Requirement to purchase insurance. Tax credits or subsidy. Reduced the tax advantages of HSAs, FSAs and itemized deductions of medical expenses. New “sin taxes” on products such as alcohol and sugary soft drinks. Healthcare Reform and You.
  15. 15. Providers Reduced Medicare spending on home healthcare, durable medical equipment, medical imaging and prescription drugs. Increased demand for services, especially primary care. 5% bonus payment for office visits and other “primary care services.” Input on “best practices.” Looking for $2T in savings. Healthcare Reform and You.
  16. 16. Providers (Medicare) Increase payments to doctors who regularly exceed “national benchmarks” for the quality of care. Bonuses to hospitals that provide superior care for heart attacks, heart failure, pneumonia and selected other conditions. Doctors could receive extra payments if they hire nurses to manage follow-up care for chronic cases. Government to set national standards for the appropriate use of CAT scans, magnetic resonance and other diagnostic imaging techniques. Healthcare Reform and You.
  17. 17. Providers (Medicare) Medicare would make a single “bundled payment” for all the services provided to a hospital patient. Bad for nursing homes, home care, hospice, etc. Healthcare Reform and You.
  18. 18. Pharmaceuticals Reduce government spending on prescription drugs. Re-importation of drugs from other countries to lower costs. Shifting insurance coverage toward prevention, could increase sales for heart, diabetes and other drugs that patients take long term. Increased Rx spend by $15 to $18 billion. Looking for the $2T in savings. Healthcare Reform and You.
  19. 19. Wellness Tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. Make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees. Healthcare Reform and You.
  20. 20. Health IT Providers $20 billion in Stimulus Money. Electronic Health Records. Healthcare Reform and You.
  21. 21. Marketing Communications Need to communicate new programs. Healthcare Reform and You.
  22. 22. Benefits Attorneys Need to interpret new regs. Healthcare Reform and You.
  23. 23. Healthcare Reform and You. Thank you. Martin Trussell, SVP First Horizon Msaver, Inc. HealthCampNash, May 30, 2009