This presentation discusses the impact of health reform. It begins by defining the problem, then provides an overview of legislation and the impact on business. It provides a contrarian view of the subject and explains why health reform is really insurance reform. It also introduces the concept of consumer sovereignty,

1. Third Annual Economic Outlook Forum Maryland Bankers Association The Impact of Health Reform Don McDaniel January 8, 2010

4. Health Reform is Really Insurance Reform Source: US Census Bureau, Current Population Survey, 2008 Annual and Social Economic Supplement. Data released March 2008. Table HI05. Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2007. Link: http://pubdb3.census.gov/macro/032008/health/h05_000.htm.

5. Problem #1 U.S. Health Expenditures as Percent of Gross Domestic Product, 2003-2018 Source: Centers for Medicare and Medicaid Services * 2008 – 2018 Projected

6. Problem #2 Average Percentage Increase in Health Insurance Premiums Compared to Other Indicators, 1988-2007 3.7%

7. Problem #3 Growth in Medicare Spending vs. Private Health Insurance Spending Source: American Hospital Association via the Centers for Medicare & Medicaid Services, Office of the Actuary. Data Released January 8, 2008

8. Aggregate Hospital Payment-to-Cost Ratios for Private Payers, Medicare, and Medicaid Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2007, for community hospitals. (1) Includes Medicaid Disproportionate Share payments.

9. Hospital Payment Shortfall Relative to Costs for Medicare, Medicaid, and Other Government Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2007, for community hospitals. (1) Costs reflect a cap of 1.0 on the cost-to-charge ratio.

10. A beacon of light, but…

12. Problem #5 National Supply & Demand Projections for FTE RNs Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration. (2004). What Is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses? Link: ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf.

13. Problem #6 Number of Full-time and Part-time Hospital Employees Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2007, for community hospitals.

14. HEALTH REFORM IMPLICATIONS SENATE BILL

15. Estimated Effect of the Patient Protection and Affordable Care Act of 2009 on Enrollment by Insurance Coverage, 2019 Source: CMS