Overview of Health Reform: Why and What

1. Overview of Health Reform: Why and What Ellen R. Shaffer PhD MPH Joe Brenner MA EQUAL Health Network www.equalhealth.info 415-922-6204 ershaffer@gmail.com September, 2010 EQUAL Health Network

2. Historic Achievement Congress has passed the most substantial health reform since Medicare and Medicaid in 1965 Patient Protection and Affordable Care Act (ACA) Important steps to expand coverage and improve quality, begins to control costs Complex, some misunderstandings EQUAL Health Network

3. What Do You Think? • Great law – about time! • Pretty good, wish it were single payer • All depends how it gets implemented… EQUAL Health Network

4. We Are All Ambassadors • If you’re here today, you stand to benefit • Whether insured or not, employed or not • What you do – or don’t do – will make a difference EQUAL Health Network

5. EQUAL Health Network Equitable, Quality, Universal, Affordable health care Network for progressive policy and advocacy Links: Public health, women, seniors, faith groups Policy-makers Center for Policy Analysis, anchor EQUAL Health Network

6. EQUAL’s Program:Making Health Reform Work Educate Handout and website: summary of the law Implement Comment on regulations Improve Next steps toward EQUAL health care EQUAL Health Network

7. Why The Affordable Care Act: Access, Quality, Costs ACA: The Gains Implementing the LawImproving the Future 7 EQUAL Health Network

8. Why We Needed to Do This: The Problems EQUAL Health Network

9. People Are Suffering~ Access, Cost, Quality • 46 million uninsured in U.S. • 6.7 million in California • 44,000 deaths a year due to lack of insurance • 60% of U.S. bankruptcies due to health costs – Mostly to people with insurance • Highest costs in the world: $2.5 Trillion/year • 37th in Quality EQUAL Health Network

10. Amazing Fact The More People We Cover The Better We Can Control Costs

11. Medicare Popular federal government program covers entire population over age 65 Costs controlled better than insurance for people under 65 Even though Medicare covers oldest and sickest 11 EQUAL Health Network

12. Employment-Based Insurance Most people under age 65 get insurance through work – but employers don’t have to provide it Large employers: 96% offer Small employers: 43% offer (fewer than 50 employees) 12 EQUAL Health Network

13. The Great Risk Shift in Health Care 69.0% Private employer-provided health insurance Over 15 percentage point decline Percent covered by own employer insurance 54.9% Source: Economic Policy Institute, State of Working America, 2006/2007 EQUAL Health Network

14. Fragmented Coverage Drives Up Costs. (Other reasons too…) • Without mandates (or universal coverage): • Healthy people will opt out. • If premiums based on health status, sick people can’t afford them. • Insurance industry uses expensive administrative tools to weed out sick people from coverage. • Uninsured delay care, need more costly treatment if/when they do get care. • Uninsured pay more for same services than the insured. • Some costs shifted to the insured. • Are there other factors driving up health care costs? Yes:inadequate bargaining power with providers, too many specialists and acute care, administration, profit. • But expanding coverage is indispensible to controlling costs. EQUAL Health Network

15. ACA: The Gains EQUAL Health Network

16. Timeline: ACA Benefits Phased In 2010-2013 Consumer protections from insurance co. practices Affordability and quality improvements 2014: Major coverage expansions Health Insurance Exchanges For individuals, small business employees Individual Mandate Subsidies to 400% of poverty ($88,000/yr family of 4) Employers contribute to Exchange if employees use subsidy Members of Congress and staff must buy thru Exchanges Medicaid Expanded Everyone up to 133% of poverty level 2020: “Donut hole” in Medicare drug coverage gone EQUAL Health Network

17. Immediate Improvementsin 2010 Coverage: New High Risk Pool for uninsured Coverage for Young Adults through Age 26 on parents’ plans Affordability: Small business tax credits of up to 35% Rebates begin to close gaps in Medicare coverage for drug costs – the “donut hole” Reduces cost of early retiree coverage Down payments on Cost Control: Quality Improvements, Primary care, Public Health and Prevention, Rate Regulations EQUAL Health Network

18. Immediate Improvements Stops Insurance Abuses: Discrimination against children with pre-existing conditions prohibited Rescissions Illegal (withdrawal of care) Bans lifetime limits on coverage Quality First dollar coverage of preventive care Increased funding for Community Clinics EQUAL Health Network

19. Insured Through Work?New Protections • Bankruptcy protection: Limits on out-of-pocket spending No co-payments on preventive health care • Insurance abuse protection: No recissions: cannot withdraw coverage • Workplace abuse protection: You don’t have to keep your job to keep your health insurance EQUAL Health Network

20. Medicare • Insolvency delayed almost 2 decades • Changes to Medicare Advantage • Promising trials on quality improvement EQUAL Health Network

21. Making It Work:Implementing the Law EQUAL Health Network

22. Implementing the Law Comment on Regulations to HHS EQUAL Health Network

23. California Reforms Pending Create an Insurance Exchange:AB 1602 (Bass) & SB 900 (Alquist). To offer transparent rates and benefits, available to buyers inside and outside the Exchange Facilitate a public health insurance option: SB 56 (Alquist). County-organized health plans and other health benefits programs can form joint ventures. Reform individual insurance:SB890 (Alquist). Specific plans with basic benefits so consumers can do “apples-to-apples” comparisons: EQUAL Health Network

24. Improving the Future EQUAL Health Network

25. Policy Issues for the Future Reproductive health care Immigrants’ inclusion Affordability State options for innovative approaches Single payer EQUAL Health Network

26. What To Do Now Analyze/Educate Get the facts about the law Spread the word Implement The Law Make It Work Improve The Law EQUAL Health Network

27. Network with EQUAL to Help Make History! Join the EQUAL Listserv Send a blank message to join-equal@list.equalhealth.info See our website: www.equalhealth.info Thanks for contributions to this presentation to EQUAL partners including Deborah LeVeen, Elinor Blake, Karl Keener, Joel Adelson, Lee Lawrence, Robert Mason, Keely Monroe (Lisa Kernan Social Justice Fellow), Jeoff Gordon, UULM-CA Other source: Health Access CA EQUAL Health Network