Health Care Reform Update

1. Health Care Reform Update Ruth T. Perot, MAT Managing Director, NHIT Collaborative Executive Director, SHIRE Health IT Resource Technology Teach-In October 29, 2009

2. SHIRE National Health Expenditures per Capita, 1990-2018 $13,100 (2018) Actual Projected $8,160 (2009) $2,814 (1990) Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (Historical data from NHE summary including share of GDP, CY 1960-2007, file nhegdp07.zip; Projected data from NHE Projections 2008-2018, Forecast summary and selected tables, file proj2008.pdf).

3. SHIRE

4. SHIRE HOUSE AND SENATE LEGISLATION HR3200, America’s Affordable Health Choices Act S 1796, America’s Healthy Future Act S 1679, Affordable Health Care Choices Act

5. SHIRE SELECT HOUSE AND SENATE SIMILARITIES • Insurance Reforms: • Create an essential health care benefits package, available in health plans. • Prohibit exclusion from insurance due to pre-existing conditions • Prohibit insurers for charging cost-sharing for preventive services • Access Reforms: • Expand Medicaid to all individuals with incomes up to certain limits (up to 133% of poverty in the House and Senate Finance, 150% in the HELP Committee bill). • Create an Exchange/Gateway where individuals will purchase insurance • Create web-based tools that allow people to access information on the insurance plans and eligibility for subsidies. • Quality Reforms: • Allow Medicare providers to create Accountable Care Organizations (ACOs) that have characteristics of the patient-centered medical home: primary care and specialists accountable for the overall care of the Medicare beneficiaries, promotion of evidence-based medicine, quality reporting. • Develop a national strategy to improve health through investment in prevention and wellness programs. • Establishes a Center within the Agency for Healthcare Research and Quality to conduct research on the effectiveness and outcomes of health care services and procedures. • Require enhanced collection of data on race, ethnicity and primary language.

6. SHIRE HOUSE AND SENATE DIFFERENCES • Public Option • Available • If so, payments linked to Medicare , Medicare + 5 percent, or negotiated rates • Available with state opt-out • Available following a trigger • State public options, with opportunity for multi-state collaboration • Malpractice Reform • Mandatory arbitration in “health courts” • Caps on punitive damages • Antitrust exemption for health insurance companies • Tax treatment of employer-sponsored plans

7. SHIRE SELECT HOUSE AND SENATE DIFFERENCES • HOUSE: • Create the Health Choices Administration, an independent agency to be headed by a Health Choices Commissioner. Establishes the Health Insurance Exchange within the Health Choices Administration, to provide individuals and employers access to health insurance coverage choices, including a public health insurance option. • SENATE: • Develop interoperable standards for using HIT to enroll individuals in public programs and give grants to states to adopt and implement enrollment technology (Senate HELP) • Medicare Advantage providers could be eligible for bonus payments for achieving certain performance levels for evidence-based care management and quality improvements. It is likely that providers will use software to achieve the performance levels. (Finance) • Create CMS Innovation Center to test and evaluate ideas to foster patient-centered care, quality improvement and slow costs (Finance) • Create a Patient-Centered Outcomes Research Institute. One of its goals would be the monitoring of new medical technologies, including the use of EHRs and other digitized components. (Finance)

8. SHIRE Legislative Process Debate anticipated the week of November 2nd Continuing through November Final passage – December?

9. SHIRE Health Insurance Coverage in the U.S., 2008 Total = 300.5 million NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.9% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2009 CPS

10. SHIRE Hispanic 27.4% Percent of Nonelderly Women Reporting No Doctor Visit in Past Year Due to Cost, by Race/Ethnicity American Indian/ Alaska Native 25.7% 21.9% Black White 14.7% Asian and NHPI 12.1% Data: BRFSS, 2004-2006.Source: The Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, available at: www.kff.org/womensdisparities/.

11. SHIRE

12. SHIRE Test Results or Medical Record Not Available at Time of Appointment, by Race/Ethnicity, Income, and Insurance Status, 2007 Percent reporting test results/records not available at time of appointment in past two years Race/ethnicity Income Insurance status Data: 2007 Commonwealth Fund International Health Policy Survey. Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008