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Fixing Health Reform It’s Up To Us

Fixing Health Reform It’s Up To Us. Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL/Center for Policy Analysis www.centerforpolicyanalysis.org 415-922-6204 ershaffer@gmail.com January, 2010. Do We Have to Do This? What Does It Do? What is it going to cost me?

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Fixing Health Reform It’s Up To Us

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  1. Fixing Health ReformIt’s Up To Us Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL/Center for Policy Analysis www.centerforpolicyanalysis.org 415-922-6204 ershaffer@gmail.com January, 2010

  2. Do We Have to Do This? What Does It Do? What is it going to cost me? Will they put me in jail if I don’t pay? Will it really fix those insurance companies? Won’t it be better after the next election? How can we get single payer in our state? Doesn’t Congress have all these rules? Isn’t this someone else’s job? What’s wrong with the French anyway? 10 Things About Health Reform EQUAL Health/Center for Policy Analysis

  3. EQUAL Partners • Equitable, Quality, Universal, Affordable health care • Center for Policy Analysis • Rekindling Reform, NY • California Public Health Association-North • California Women’s Agenda • Older Women’s League • Links: • American Medical Women’s Association • NWHN/RWV • CPC Inside-Outside Group EQUAL Health/Center for Policy Analysis

  4. Activities • Women’s Health Leaders, Obama Campaign • Forum, Oct. 2008 • Policy Statements 2009 • First 100 Days Health Agenda • Women’s Health • APHA Policy – Medical Care, CHPPD • Presentations • Conference calls, Radio Series - KPFA EQUAL Health/Center for Policy Analysis

  5. Do we have to do this? YES!

  6. New York Times EQUAL Health/Center for Policy Analysis

  7. EQUAL Health/Center for Policy Analysis

  8. EQUAL Health/Center for Policy Analysis

  9. EQUAL Health/Center for Policy Analysis

  10. Health and Welfare Expenditures, General Fund, All K-12 Districts and County Offices of Education, California$ BILLIONS 1999 – 2008 EQUAL Health/Center for Policy Analysis

  11. Health Care in California • 6.6 million uninsured in 2006, = 20 % of nonelderly population • 763,000 children uninsured. • 300,000 significantly at risk for losing their coverage. • Health care spending grows two to three times faster than California's economy • Health insurance premiums grow significantly faster than overall health care spending - SB 810 EQUAL Health/Center for Policy Analysis

  12. Tough Road EQUAL Health/Center for Policy Analysis

  13. Some Victories • 1965 – Johnson MEDICARE, MEDICAID • 1994 – Clinton SCHIP EQUAL Health/Center for Policy Analysis

  14. Politics: Auspicious EQUAL Health/Center for Policy Analysis

  15. EQUAL Health/Center for Policy Analysis

  16. Politics: Challenging EQUAL Health/Center for Policy Analysis

  17. Economic Collapse –But Corporations Still In Charge EQUAL Health/Center for Policy Analysis

  18. Social institutions weakened: labor, women, civil society - ++Faith Community growing ++ EQUAL Health/Center for Policy Analysis

  19. Corporate media EQUAL Health/Center for Policy Analysis

  20. Just Say NoTo Stop Reform • Better idea not necessary • Scare tactics: government bureaucrats, socialism, rationing, class warfare, death panels • Racial, political backlash EQUAL Health/Center for Policy Analysis

  21. Single Payer: What it Is and Why You Hear Nasty Stories About It • Everyone automatically covered, most cost efficient, contributes to social & economic equity, good outcomes… • Gives government the authority to constrain health care spending • Who could possibly object to that? EQUAL Health/Center for Policy Analysis

  22. $2.5 Trillion: Spending or Income?Balloon or Dirigible? EQUAL Health/Center for Policy Analysis

  23. Health Reform: What Does It Do? • Coverage • Low Income: Expands Medicaid • Employed: Individual and Employer Mandates • Self-Employed/Small Business: Insurance Exchange • ? PUBLIC OPTION ? 2013 ? 2014 ? • Affordability: Premium Subsidies • Access: Curbs Insurance Co. Abuses • Pre-Existing Condition Exclusions, Rescissions • Quality/Cost Control • Primary Care, Incentives for Teams EQUAL Health/Center for Policy Analysis

  24. What Do We Need To Fix? * The public option: our toe-hold on structural change. * Affordable coverage - Strong employer mandate. * Fair financing - Tax income, not hard-won benefits. * No retreat on abortion coverage, and immigrants’ inclusion. * Accountability for insurance companies • A single national exchange • Eliminate anti-trust exemption – FTC regulation * State options for real progress * Use the conference process to improve the bill. EQUAL Health/Center for Policy Analysis

  25. What is it going to cost me? EQUAL Health/Center for Policy Analysis

  26. AFFORDABILITY • Still a big concern • Individuals and employers required to pay • Same as all other countries • Premiums • More affordable than now for uninsured • But not necessarily affordable for many • PUBLIC OPTION would provide choice and bargaining clout EQUAL Health/Center for Policy Analysis

  27. Estimates by House TriCommittee Staff EQUAL Health/Center for Policy Analysis

  28. EQUAL: House Bill EQUAL Health/Center for Policy Analysis

  29. EQUAL: House Bill EQUAL Health/Center for Policy Analysis

  30. Will they put me in jail if I don’t pay? EQUAL Health/Center for Policy Analysis

  31. NO EQUAL Health/Center for Policy Analysis

  32. But there are financial penalties • House: Individuals are required to obtain health insurance coverage or pay a fee equal to lower of 2.5% of their adjusted income above the filing threshold or the average premium on the Exchange. Individuals and families below the income tax filing are exempt. • In 2009, the threshold for taxpayers under age 65 is $9,350 for singles and $18,700 for couples • Individuals may apply for a hardship waiver if coverage is unaffordable and there are elected exemptions from the mandate. Those with coverage through the VA or who are eligible for government-sponsored healthcare because they are a member of a tribe are considered to have fulfilled the requirement to obtain coverage. • Senate: Revises penalty amounts for the individual responsibility requirement. Individuals whodo not purchase coverage will pay the greater of $95 in 2014, $495 in 2015 and $750 in2016, or up to 2% of income by 2016, up to a cap of the national average bronzeplan premium. Families will pay half the amount for children up to a cap of $2,250 forthe entire family. After 2016, dollar amounts will increase by the annual cost of livingEXEMPTIONS FROM INDIVIDUAL RESPONSIBILITY REQUIREMENTS- • (i) there is no affordable qualified health plan available through theExchange, or the individual's employer, covering the individual; or(ii) the individual meets the requirements for any other such exemptionfrom the individual responsibility requirement or penalty; • Individual's status as a member of an exempt religious sect or division,as a member of a health care sharing ministry, as an Indian, or as anindividual eligible for a hardship exemption, EQUAL Health/Center for Policy Analysis

  33. Will it really fix those insurance companies? EQUAL Health/Center for Policy Analysis

  34. Problems For Individuals Pre-existing condition exclusions: Prohibited beginning in 2013/2014 Prohibited for children in 2010 (Senate) Rate discrimination Prohibited by gender But Permitted by age EQUAL Health/Center for Policy Analysis

  35. Problem for Insured:Denials of Care • 20% of claims denied • Rescissions • Coverage for a person or a treatment revoked • Technically would be prohibited • Still allowed in the case of “fraud or misrepresentation” • A PUBLIC OPTION would have no incentive to deny legitimate claims • Need regulation by Federal Trade Commission (revoke anti-trust exemption) EQUAL Health/Center for Policy Analysis

  36. Discrimination by Age and GenderKaiser Permanente Monthly Rates California 2010 EQUAL Health/Center for Policy Analysis

  37. Women Can Pay More NowKaiser Permanente Monthly Premiums 2010 EQUAL Health/Center for Policy Analysis

  38. Gender Discrimination Would Be Prohibited EQUAL Health/Center for Policy Analysis

  39. Oldest Compared to Youngest: 215% EQUAL Health/Center for Policy Analysis

  40. Age Discrimination Would be Permitted • House bill: 2:1 • Senate bill: 3:1 • Interim: 4:1 (high risk pool) EQUAL Health/Center for Policy Analysis

  41. Controlling Premium Costs • Fixes in Senate bill • Strong language, but needs to be enforced by a PUBLIC OPTION EQUAL Health/Center for Policy Analysis

  42. Won’t it be better to do this after the next election? EQUAL Health/Center for Policy Analysis

  43. How can we get a single payer plan in our state? EQUAL Health/Center for Policy Analysis

  44. Build Momentum Now • A government-sponsored system like Medicare would do a better job of controlling costs and covering everyone. • The insurance industry will oppose single payer strongly at the state level. • A strong national bill will build momentum to rein in the industry and keep up the effort for state single payer systems. EQUAL Health/Center for Policy Analysis

  45. Follow the MoneyState Campaign Contributions2004-8 • Health Industry TOTAL: $132,943,232 • Pharmaceuticals • Hospitals & Health Systems • Health Insurance & HMO • Physician Practice Groups and Associations • Nursing Homes http://www.followthemoney.org/press/ReportView.phtml?r=408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7 Provides free online access to public records in all 50 states, to document political donor and lobbyist contributions to policymakers. EQUAL Health/Center for Policy Analysis

  46. Health Insurance & HMO State Contributions 2004-8 • Insurance companies $42,233,972  • 13% to ballot measures. • 51% to Officeholders: $21.4 million • 3rd top recipient: California Republican Party - $1.3 million http://www.followthemoney.org/press/ReportView.phtml?r=408&ext=7&PHPSESSID=da58e785f999fd4ed54c448724038908#tableid7 EQUAL Health/Center for Policy Analysis

  47. Doesn’t Congress have all these rules? EQUAL Health/Center for Policy Analysis

  48. History of Rules - I • Magna Carta, 1215 • Number of days in 2009 the following were in favor of the public option: House of Representatives (majority): 365 Public (61%): 365 Max Baucus: 365 Joe Lieberman (Medicare buy-in)*: 350 Ben Nelson (free Medicaid for Nebraska): 365 • Day on which Senate changed its mind: • December 24 * http://www.huffingtonpost.com/2009/12/14/liebermans-medicare-flip_n_391732.html EQUAL Health/Center for Policy Analysis

  49. History of Rules - II • Day on which the US Senate voted down an anti-abortion amendment, 54 – 45: • December 8 • Day on which the Senate adopted a bill that included an anti-abortion amendment they never voted on: • December 24 EQUAL Health/Center for Policy Analysis

  50. Isn’t this someone else’s job? Email from Congress staff: NOW IS THE TIME TO HEAR FROM DOCTORS, PATIENTS, AND NURSES ON THE MEDICAL IMPACT IF WE PASS “BLUE CROSS BLUE SHIELD FOR ALL.” EQUAL Health/Center for Policy Analysis

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