Understanding Health Reform

1. Understanding Health Reform

2. Health Care Foundation of Greater Kansas City • History of HCF • Our Mission • Target Population • Area Served

3. HCF’s Grantmaking • $18 million in 2011 • Funding Areas • Safety Net Healthcare • Healthy Lifestyles • Mental Health • Applicant Defined Grants • Initiatives

4. Grantmaking • Kansas City Free Health Clinic • PE 4 Life • Rose Brooks • Gordon Parks Academy • MOCSA • Harvesters

5. Community Survey on Health Reform • Phone Survey • 403 registered voters in the Kansas City metropolitan area • Fielded in July 2010

6. The Status Quo is Not Acceptable • Only 7% saw no need for change in the health care system.

7. Initial Impressions of “Health Reform”

8. But… • Many respondents were supportive of specific elements

9. Change in Opinions After Brief Education • After being exposed to these elements of health reforms, respondents were again asked their opinion • Beginning of survey: 34% favorable • End of survey: 45% favorable • This is a 32% increase

10. What is health insurance?

11. Before Insurance • Medical care was purchased on an as-needed basis • Fees were based on services provided

12. Started as a Way to Protect Workers • A firm arose in 1850 to offer accident protection to workers in particularly dangerous professions

13. Workers Began Organizing Themselves • In 1887, African-American workers at a coal plant in Iowa create a mutual protection society • $.50 per month for an individual or $1.00 per family

14. A Marketplace is Born! • In the late 1800s, commercial insurance companies are born

15. World War II • Strict wage and price controls • Employer-sponsored insurance expanded dramatically • Benefits were taxable until 1954

16. What do we think of this “system”? Pre-paid plans HMOs Companies provide insurance Uninsured Mutual Protection Societies Open marketplace “Accident” insurance for those in dangerous professions

17. We don’t have a health system • No logical connection between components • No central manager, but also no true marketplace • No one is making sure we get our money’s worth • People aren’t getting the right care at the right time at the right place

18. We spend a lot of money. Average spending on healthper capita ($US PPP) Total expenditures on healthas percent of GDP

19. Health Care Expenditure per Capita by Source of Funding, 2007Adjusted for Differences in Cost of Living

20. We spend a lot of money.

21. We spend a lot of money.

22. Mortality Amenable to Health Care And we don’t get enough in return. Deaths per 100,000 population*

23. Life Expectancy at Birth, 2007

24. We Need a Bargain Shopper • Without someone wrapping their arms around this “system,” we don’t get what we pay for. • Nothing is free

25. U.S. Health System

26. High Performance Health System

27. Patient Protection and Affordable Care Act • A platform for change • Seeks to move us toward a system • We can pay less and get more

28. Current Source of Coverage, U.S. Medicare (12%) Employer Sponsored Insurance (49%) Individual (5%) Uninsured (17%) Medicaid (16%)

29. Why do we care if people are uninsured? • Receive less preventive care • Enter the health care system sicker • Lack needed medical care • Have worse health outcomes

30. Who are the uninsured? • Young • Sick • Working Poor

31. The Young • 30% of the uninsured are between 18 and 26 • Relatively healthy • Not settled in the job market • Can stay on parents’ insurance through age 26

32. The Sick • People with pre-existing conditions are oftentimes denied insurance. • Or, they are charged exorbitantly high premiums. • ACA requires guaranteed issue.

33. Guaranteed Issue • Requires insurers to offer coverage to anyone, even if they have pre-existing conditions • Allows price-setting based on age, geographic area, family composition, and tobacco use • Not gender • Being a woman is not a pre-existing condition • Imagine guaranteed issue without a mandate

34. Need an Individual Mandate • Guaranteed issue and the individual mandate go hand in hand.

35. The Working Poor • 64% of the uninsured are in households with at least one full-time worker. • Only 41% of small businesses (less than 50 employees) offer health insurance. • 96% of firms with more than 50 employees

36. The Working Poor • Small business tax credits • Big employers will be required to provide insurance or pay a fine. • Those who are still not covered will be eligible for Medicaid or the health exchange.

37. $375/month

41. Health Insurance Exchanges • Creates state or regional exchanges • Individuals and Small Businesses (<100) • Large employers beginning in 2017 • Creates four benefit plans, plus a catastrophic plan • Clearinghouse for information

42. What the Exchange Could Look Like

43. Premium Subsidies to Individuals • Accessible through the health insurance exchange

44. Controlling Costs

45. Medicare • Medicare Advantage • Changes in provider rates • Reduces annual increases in reimbursement • Adjusts payments based on productivity • Reduces payments for hospital readmissions

46. Bending the Cost Curve • Prevention and Wellness • No cost-sharing for preventive care • Employee wellness grants for small businesses • Value-Based Purchasing

47. Medicare/Seniors • Prescription drug doughnut hole closes • CLASS Act • Creates a national, voluntary program for buying community living assistance services and supports • Voluntary payroll deductions • Five-year vesting period • Provides cash benefits of at least $50 per day to purchase non-medical services and supports

48. This is Incremental

49. ACA will be Revisited • Social Security’s many large holes filled over 40 years • Originally excluded women, minorities, agricultural labor, government employees, teachers, and nurses. • Medicare is revised nearly every year • Enactment closes one chapter and opens a new one

50. Call to Action • Stay informed!! • Be part of a constructive dialogue on this issue.