Health Care Reform and Single Payer: How Government Could Be Good For Your Health

1. Health Care Reform and Single Payer: How Government Could Be Good For Your Health Jonathan Kotch and Gus Montana Health Care for All NC Occupy Health and Wellness NC

2. Three Scenarios, One Outcome Supreme Court rules only the individual mandate unconstitutional Single Payer

3. Scenario 2 Supreme Court rules the whole ACA unconstitutional Single Payer

4. Scenario 3 Supreme Court rules ACA constitutional Single Payer

5. Who’s Working On Single Payer • Vermont passes single payer bill • Montana governor endorses single payer • California single payer bill fails in state senate by only 2 votes • Hawaii Health Authority issues roadmap to universal coverage • New York introduces a bill with over 70 senators and representatives co-sponsoring • Oregon House committee hears testimony on single payer

6. Vermont’s Single Payer Bill • Signed into law May 26, 2011. • Universal and unified health system by 2017 • Financing • Pooling federal Medicare and Medicaid dollars with payroll and progressive income tax dollars • Premiums and out of pocket payments eliminated • Eligibility • Every person meeting VT residency requirements

7. Benefits • “High quality, medically necessary health services” TBD by an independent Board • Likely to include • Hospital care • Primary and specialist care • Drugs and medical supplies • May include • Dental • Vision • Hearing

8. Cost Containment • Eliminates administrative waste • Negotiated reimbursement rates for providers • Health planning • Budgeting by Green Mountain Health Care Board • Volume discounts

9. Health Care Delivery • Free choice of provider • The relationship between the provider and the patient must be primary • No pre-existing condition limitations VTHCA@sover.net

10. Massachusetts • No change for those who are “happy with their health insurance” • New rules for insurance companies • No pre-existing condition exclusions • No increased payments for people who are sick • Individual mandate • Subsidies for under 300% of poverty • The Health Connector • www.mahealthconnector.org

11. Results • Uninsuredness dropped by 2/3rds • Private insurance offered by employers grew • Price of non-group individual insurance fell by 50% compared with national trends • 98% of taxpayers filed the requisite forms to comply with the individual mandate in the first year

12. What Commonwealth Care Didn’t Do • Did not eliminate uninsuredness (5.6% of state residents still uninsured, according to the Bureau of the Census) • Did not save high quality insurance offered by small businesses • Did not control costs! • Did not reduce Emergency Room visits • Did not reduce the number of high deductible plans • Did not reduce or eliminate deductibles and co-insurance • Did not reduce the rate of personal bankruptcies due to medical debt • Did not protect the solvency of safety net providers http://masscare.org/massachusetts-health-reform-in-practice/

13. Sound Familiar? • Meet the Affordable Care Act (ACA) • Same three-pronged approach as in MA • Reform health insurance • Eliminate pre-existing condition exclusions • Eliminate increased cost for the sick • Individual mandate • Subsidize insurance premiums for the less well off

14. What Has Already Happened? • Pre-existing condition exclusion eliminated for children • Dependents allowed to remain on parents’ coverage until 26th birthday • Limits on medical expenditures for the sick eliminated • High risk pool for adults with pre-existing conditions established

15. … and • 50% discount on brand name drugs for those in the doughnut hole • Preventive services must be free • High blood pressure and diabetes tests • Screening for cancer such as breast, colon, cervical • Immunizations • Well child visits • Tax credits for small businesses (<25 employees)

16. Holding Our Collective Breath • Starting in 2014, • No more pre-existing condition exclusions for adults • Insurance mandate (?) • No more annual or lifetime limits • $6000 limit on annual out of pocket expenses • Minimum benefit standards • Limits on Medical Loss Ratio • More generous eligibility criteria for Medicaid

17. Health Insurance Exchanges • If you are covered by a plan that meets the minimum benefit package, no change • If not, or if you are a small business, go to the Health Insurance Exchange • One stop shopping • Compare benefits and rates • Sign up for subsidies (up to 400% of poverty)

18. Paying for it • Cutting spending • Reductions in Medicare hospital reimbursements • Eliminating the 13% bonus for private Medicare Advantage plans • “Productivity adjustment” incentive for hospitals to slow the rate of growth of their charges

19. Increasing Revenue • Taxes on pharmaceutical co’s, insurance co’s and medical device manufacturers • Tax surcharge on “cadillacplans,” which save tax dollars for employers, but increase medical care costs for everyone else • Increased payroll tax by ~1% on individuals earning >$200,000 and families earning >$250,000

20. Cost Control? • Cadillac tax on “overly generous” employer insurance • Health Insurance Exchanges • Independent Payment Advisory Board • Comparative Effectiveness Research • Accountable Care Organizations

21. Features for Seniors • Eliminates the doughnut hole by 2019 • Free annual wellness visit • Free preventive screenings • High quality care will be rewarded, poor quality penalized • New long term care insurance program Jonathan Gruber. Health Care Reform. NY: Hill and Wang, 2011.

22. What Won’t Happen under ACA • No mandate for businesses (although employers >50 would have to pay a $2000 fine per employee they don’t insure) • Does not change the delivery system • No guarantee that ACA will control costs • Will not eliminate uninsuredness (est’d. 23 million will remain uninsured) • Nopublic option

23. … and most important We will not have gotten rid of private health insurance companies and for-profit health care providers!

24. Quo Vadis? ACA • 23 million uninsured • Private Insurance • For profit providers • Increasing cost of care • Decreasing access • Same old same old • Co-payments and deductibles • Reimbursement forms Single payer • Zero uninsured • Private insurance only for supplemental (not medically necessary) care • No for-profit providers • Cost control • No forms, no deductibles, no co-payments

25. Health Care for All NC • Vision To have universal health care in North Carolina and across the nation • Mission Our organization works toward a publicly financed, sustainable, quality health care system that is open to all people in North Carolina

26. Occupy Health and Wellness NC • Vision … healthy, thriving communities, where all individuals and families have equal opportunity to enjoy optimal health and wellness and may choose to exercise their right to health care that is high quality, affordable, and accessible • Mission … to educate and empower about efficient, universal, publicly-funded not-for-profit health care system that includes holistic therapies

27. Who yagonna call? • Health Care for All NC www.healthcareforallnc.org pres@healthcareforallnc.org • Occupy Health and Wellness NC http://groups.google.com/group/occupy-health occupy-health@googlegroups.com

28. The End