health reform 2.0 pnhp meeting may 22, 2010. impact of health reform on: the uninsured # of...
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Health Reform 2.0
PNHP meeting May 22, 2010
Impact of Health Reform on:The Uninsured
• # of uninsured reduced from 46 million today to ~23 million in 2019.
• Safety net hospital funding through Medicare cut by $36 billion through 2019.
• Community health centers receive extra $1 billion annually
Impact of Health Reform on:The Underinsured
• If you like your current coverage you can keep it.
• If you don’t like your current job-based coverage, you HAVE to keep it.
• Policies required to cover at least 60% of expected health costs – e.g. $2,000 deductible + 20% co-insurance for next $15,000 of care.
• $5000 annually in premiums
• $2000 deductible
• 20% coinsurance for next $15,000
Massachusetts Policies Available through the exchange to a 56 yo with income > $32,000
Crimes and Punishments in Massachusetts
# The Crime The Fine
1 Violation of Child Labor Laws $50
2 Employers Failing to Partially Subsidize a Poor Health Plan for Workers
$295
3 Illegal Sale of Firearms, First Offense $500 max.
4 Driving Under the Influence, First Offense $500 min.
5 Domestic Assault $1000 max.
6 Cruelty to or Malicious Killing of Animals $1000 max.
7 Communication of a Terrorist Threat $1000 min.
8 Being Uninsured In Massachusetts ~ $1000
Impact of Health Reform on:Medical Bankruptcy
• No change for 75% of medically bankruptcy filers who have insurance.
• Up to 50% reduction among the 25% of the medically bankruptcy who were uninsured in 2007 but will gain coverage under reform.
• Maximum expected reduction in medical bankruptcies = 12.5%.
Despite high overhead HMOs prosper by cherry-picking
Especially in Medicare, where cherry-picking is already illegal
Impact of Health Reform on:Administrative Costs
• IRS cost to enforce mandate - $5-10 bil
• Running insurance exchanges - ~4% of premiums (based on Massachusetts)
• Insurance overhead - ~13% of new premium revenues = $42 bil
• Cap on insurance overhead - ????
• Standardized claim forms - ????
Role Played by Health Industry in Health Reform
• Insurance donations to Dems & Repubs + ads in favoring AND opposing
• Pharma - >$100 million on ads supporting reform
• Senate framework written by Liz Fowler, former VP of Public Policy for Wellpoint/Anthem
Impact of Health Reform on:Health Care Costs - 1
• Expanded Medicaid - $434 bil.
• Subsidies for private coverage - $358 bil.
• Small employer tax credits - $37 bil.
• Temporary high risk pools, subsidy for retirees <65, etc – ~$10 bil.
All figures reflect spending through 2019
Impact of Health Reform on:Health Care Costs – 2 (savings)
• Decreased Medicare Advantage/HMO overpayment - $136 bil.
• Decreased Medicare (DSH) payment to safety net hospitals - $36 bil.
• Decreased Medicare fee-for-service payments to doctors/hospitals - $196 bil.
• Other Medicare/Medicaid cuts - $87 bil.
All figures reflect spending through 2019
Impact of Health Reform on:Cost Control Provisions
• Insurance exchanges• Health information technology• Comparative effectiveness research• Fraud and abuse prosecution/recovery• Alternatives to F-F-S (experiments)• Coverage of preventive services• Tax on “Cadillac” coverage• Malpractice reform (experiments)• Medicare advisory board
Health Reform Bill:Proven Cost Control Provisions
Hospital Computing and the Cost and Quality of Care
• Data sources:– Computerization – HIMSS surveys 2003-2007– Quality – Medicare/Dartmouth Atlas– Costs – Medicare cost reports
• Data available for ~4,000 U.S. hospitals
Conclusions
• Computerization NOT associated with lower costs of care.
• Computerization NOT associated with lower administrative costs.
• Computerization associated with slightly better quality scores - ? Real improvement vs. more documentation.