Assessing U.S. and International Experience with Health Reform and Implications for the Future by W. David Helms, Ph.D, President and CEO, Academy Health

1. Assessing U.S. and International Experience with Health Reform and Implications for the Future National Chlamydia Coalition Meeting W. David Helms December 3, 2009

3. Source of Insurance Employer (55%) Uninsured (15%) Military (1%) Individual (5%) Medicaid (10%) Medicare (13%) Total population Data: K. Davis, Changing Course: Trends in Health Insurance Coverage 2000-2008 , The Commonwealth Fund at Joint Economic Committee hearing, September 10, 2009. 46.3 Million Uninsured, 2008

4. Growth in the Uninsured Data: K. Davis, Changing Course: Trends in Health Insurance Coverage 2000-2008 , The Commonwealth Fund at Joint Economic Committee hearing, September 10, 2009. Projected estimates Uninsured Projected to Rise to 61 million by 2020 Millions uninsured

5. Health Insurance Coverage by Poverty Level, 2008 FPL -- The federal poverty level was $22,025 for a family of four in 2008. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2009 ASEC Supplement to the CPS.

6. Average Family Premium as a Percentage of Median Family Income, 1999–2020 Source: K. Davis, Why Health Reform Must Counter the Rising Costs of Health Insurance Premiums, The Commonwealth Fund, August 2009. Projected

10. No One is Immune From Quality Deficits Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al 2006)

11. Money Doesn’t Buy Quality Source: McGlynn, B. Colorado College Lecture April 7, 2008 (Data Source Asch et al 2006)

12. Total and Per Capita Spending on Health Care, 1965-2005 Source: CBO based on data on spending on health services and supplies, as defined in the national health expenditure accounts, maintained by the Centers for Medicare & Medicaid Services. Note: Spending amounts are adjusted for inflation using the gross domestic product implicit price deflator from the Bureau of Economic Analysis.

13. Projected Growth in Medicare and Medicaid as Percent of GDP Source: Congressional Budget Office, Projected Federal Spending Under One Fiscal Scenario (Percentage of gross domestic product)

19. Infant Mortality Rate National Average and State Distribution International Comparison, 2004 Infant deaths per 1,000 live births ^ Denotes baseline year. Data: National and state—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003, 2004, 2005, 2006, 2007a); international comparison—OECD Health Data 2007, Version 10/2007. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

20. Mortality Amenable to Health Care Deaths per 100,000 population* Data: E. Nolte and C.M. McKee, "Measuring the Health of Nations: Updating an Earlier Analysis," Health Affairs Jan.-Feb. 2008, 27(1):58-71 analysis of World Health Organization mortality files. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008. * Countries’ age-standardized death rates before age 75, including ischemic heart disease, diabetes, stroke, and bacterial infections.

21. International Health Expenditures Per Capita, 1980-2005 Data: OECD Health Data 2009 (June 2009)

22. Percentage of NHE Spent on Health Administration and Insurance, 2003 *Includes claims administration, underwriting, marketing, profits and other administrative costs. Data : OECD Health Data 2005 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 Net costs of health administration and health insurance as percent of national health expenditures a a 2002 b 1999 b c 2001 c *

25. State of Play for Congressional Proposals (As of December 1, 2009) Source: Congressional Budget Office Net Change in Deficit Over 10 years Net Change in # Uninsured Over 10 years Senate Leadership -$130 billion -31 million House Leadership -$109 billion -36 million

27. Prevention and Wellness Provision Senate Bill House Bill Preventive services Plans must provide coverage, without cost-sharing for preventive services and immunizations No cost-sharing for preventive services, as defined by HHS Prevention and wellness trust Authorizes up to $12.9 billion from FY 2010-2014 for Prevention and Public Health Fund Authorizes up to $15.4 billion from FY 2011-2015 for the Prevention and Wellness Trust Fund Focus on prevention -Creates the National Prevention, Health Promotion, and Public Health Council to establish and implement a national prevention and health promotion strategy -Invests in programs at the federal, state, and local level to increase access to clinical preventive services -Creates a national prevention and wellness strategy to improve the nation’s health through evidence-based clinical and community-based prevention Focus on wellness Creates a 10-state pilot project that tests the impact of providing wellness programs to at-risk communities Focus on community prevention and wellness services