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Healthcare for Everyone?

Healthcare for Everyone?. Like the rest of the civilized world. Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Director, Palliative Care, IU Health Bloomington Assistant Clinical Professor of Medicine, IUSM. DISCLOSURES.

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Healthcare for Everyone?

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  1. Healthcare for Everyone? Like the rest of the civilized world Rob Stone MD Director, Hoosiers for a Commonsense Health Plan Director, Palliative Care, IU Health Bloomington Assistant Clinical Professor of Medicine, IUSM

  2. DISCLOSURES Dr. Rob Stone has no relevant financial relationships with commercial interests. Slides can be downloaded at: HCHP.info/Presentations

  3. Countries with Universal Healthcare

  4. What Are We Paying For? • An incredibly complex system • Thousands of plans • Armies of people to: -deny coverage and payments - collect payments - determine eligibility

  5. What Do We Get For Our Money? • The most expensive health care in the world • The best health care in the world?

  6. WHO Global Health Rankings • At the top: France is #1 • US ranks 37th, between Costa Rica and Slovenia

  7. Tobacco Smokers OECD, 2004 (2002 Data, U.K is 2001)

  8. Why spend so much AND get so little? Reason # 1: Our profit-driven insurance system AND As long as millions are left out, everyone will suffer

  9. Health Insecurity Indiana • 800,000 to 900,000 Hoosiers uninsured • Hoosier bankruptcy filings because of medical bills: > 27,000 annually US Census Dept, “Income, Poverty, and Health Insurance Coverage” Sept 2012 Himmelstein et al, American Journal of Medicine, August 2009

  10. Is the ACA Going in the Right Direction?

  11. Affordable Care Act • Original projection: 30-35 million newly covered • Half thru Health Insurance Exchanges (Mandate) • Half thru Medicaid expansion • Supreme Court Decision Summer 2012

  12. Two Very Different Public Programs

  13. Medicaid 101

  14. Indiana Medicaid 2014 250% 200% Premium HIP No Premium 19% Y-axis is % of Federal Poverty Level; Example of a family of four

  15. ACA as Planned Sliding scale premium subsidies: 100% - 400% of poverty level 100-138% poverty: patient’s choice Medicaid in all states: up to 138% of poverty Y-axis is % of Federal Poverty Level; Example of a family of four

  16. Medicaid Expansion Would Help People We All Rely On

  17. Hoosier Medicaid Expansion • Estimated 350 – 450 thousand lives covered, ~ half the uninsured • Largest increase in coverage in >50 years • $11.50 a day versus $30,000 a year eligibility

  18. Medicaid Expansion – Good for All of Us • Traditional Medicaid 60/40 Federal/State • ACA Medicaid 100% tapering to 90% Federal • Cost to Indiana taxpayers: $50-150 million • Federal subsidy: $1.7 billion a year

  19. A Deal Too Good to Refuse • HIP cigarette taxes - $121 million • High risk pool - $48 million • Savings from prisons and jails

  20. “I’m just here for the dental.”

  21. A Deal Too Good to Refuse • HIP cigarette taxes - $121 million • High risk pool - $48 million • Savings from prisons and jails • Hospitals avoid $345 M/year unpaid care • 30,000 new jobs • >$100 million new tax revenues Indiana Hospital Association Report 2/11/13

  22. Indiana Is Being TaxedFor a Program We’re Turning Down Federal responsibility for cost of expansion population Our federal tax dollars are paying for Medicaid but IN is not getting the benefits

  23. Losing $5 Million a Day

  24. Michigan Chamber Applauds Passage of Medicaid Reform Legislation “Make no mistake, the Michigan Chamber remains strongly opposed to Obamacare,” said Jim Holcomb, Senior Vice President for the Michigan Chamber. “However, our Board of Directors believes Medicaid reform makes sense for our state and the business community.” June 13, 2013

  25. Governor Pence has called Medicaid a “broken program” Is Medicaid worse than no insurance at all?

  26. Oregon: Expand Medicaid, Increase ER Usage by 40% A 40% relative increase means one extra visit per person every four years Annual emergency room visits per person Taubman, S. Science Magazine. Jan 2, 2014.

  27. Medicaid Expansion Is About Life and Death In Indiana Annual data for Indiana from Dickman S, Himmelstein D, McCormick D, and Woolhandler S. Opting out of Medicaid Expansion: The Health and Financial Impacts. Health Affairs Blog. January 30, 2014

  28. International Timeline of Universal Healthcare Germany 1883 Switzerland 1911 New Zealand 1938 France 1945 United Kingdom 1946 Sweden 1947 USA 1947* Japan 1961 Canada 1966 Australia 1974 Italy 1978 Spain 1986 Taiwan 1995 *President Truman proposed but failed to pass National Health Insurance

  29. Why Health Care for All - Young and Old, Rich and Poor?

  30. What Can We Do? • Educate Ourselves • Find Our Voices • Join In

  31. PNHP.org

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