This document discusses health reform in the U.S. and Utah. It provides an overview of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. Key points of the ACA include expanding health insurance coverage through Medicaid expansion, subsidies, and health insurance exchanges. The ACA also includes regulations on insurance companies and funding for public health initiatives. Utah is taking its own approach focused on private insurance, personal responsibility, and Medicaid reform. The politics around health reform are intense as roles of government and private sectors are redefined. The prognosis for the ACA is guarded as it will likely be modified over time.

1. “Health Reform” in the
U.S.A.
Where are we in the quest for a
more fair and affordable health
care system?
David N. Sundwall, M.D.
Professor, Public Health (clinical)
University of Utah
School of Medicine

2. Presentation Outline
 1. Historical perspective
 2. The Patient Protection and
Affordability Care Act (PPACA)
 3. Utah’s version of Health
Reform

3. PP (ACA) – “Obamacare”
I. Policies
a. Promises
b. Problems
II. Politics
a. Republican
b. Democrat
c. “Tea party”
III. Prognosis

5. 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

6. 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)

7. 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

8. 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.

9. Policies cont.
Health care work force
Increase number and geographic distribution of the nation’s “health
work force” – doctors, nurses, dentists, and other health
professionals.
How ?
Increase payment for primary care services
Strengthen and expand the National Health Service Corps (NHSC)
Fund pilot project related to “medical homes”, e.g. for pediatric
special needs patients
And others . . .

10. 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”.

11. “Defined Contribution Market”
 Keep all payments “pre-tax”
 Employees cannot be penalized for health
status
 Guaranteed issue ( same options for all
employees )

12. 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 comparison
Consumers make personal and informed choices,
“electronically”.

13. Politics
We are in the process of an intense national
debate related to health care in the United
States – what should be provided, and how to
pay for it. The outcome will redefine the roles of
governments ( federal and states) and the
private sector in our health care enterprise.
“Fasten your seatbelts – it’s going to be a bumpy night [ride]”.
Betty Davis – All About Eve

14. 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)

15. 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…..

16. 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.