health reform: what it means. what's next?
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Grace-Marie Turner's presentationTRANSCRIPT
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Health Reform:What it means. What’s next?
Grace-Marie TurnerApril 19, 2012Georgetown University Hospital
Americans agreed on goals for health reform…
• The U.S. needs health reform to:– make coverage more affordable– assure quality, and– expand access to insurance
• Most people rate their own coverage as good or excellent
• They want stability. Change is for others.
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Early provisions of the new health law
• “Free” preventive care
• Allowing “children” up to age 26 on parent’s policies
• No annual or lifetime limits on coverage
• Pools for pre-existing condition policies
• $250 for seniors with high drug costs
• Insurance regulations and mandates
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The health law’s main features
• Expands coverage to 30 million uninsured
• A new system of Exchanges created to deliver subsidies
• States required to expand Medicaid
• Citizens required to purchase approved health insurance
• Most employers required to offer coverage
• Significant new federal regulation of the health sector (with 159 new regulatory agencies and programs)
• Medicare changes
Financed by
• $575 billion in payment reductions to Medicare
• $550 billion new taxes and penalties
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Americans’ views of Supreme Court decision
• 25% think the law should be upheld in full
• 38% would like the entire law thrown out
• 29% would like the court to strike down the individual mandate
• 39% support health care overhaul in general
Source: Washington Post-ABC News Poll, April 8, 2012, http://www.washingtonpost.com/wp-srv/politics/polls/postabcpoll_04082012.html.
Source: AM&A, Resurgent Republic 1st Anniversary Survey of Likely Voters, April 25-27, 2010
Taxes
Federal Deficit
Health Care Costs
Insurance Premiums
Health Care Quality
Do you think the health care reform plan that Congress passed recently will increase,
decrease, or have no effect on each of the following:
New taxes and fees in the health law
Studies show law fails to meet goals
• Health costs and health spending increase
• One-third of businesses may drop insurance
• Young people worried about high cost of policies
• Doctors concerned about Medicaid expansion and fraying the safety net
• Seniors are concerned about access to care through Medicare and Medicare Advantage
• Up to 25 million will remain uninsuredwww.galen.org
Higher Costs
• Insurance rising 9% to $15,000/yr. in 2011
• Foster: “False more so than true” that law will lower costs for taxpayers
• Latest CBO cost estimate: $1.76 trillion/10 yrs.
• Gruber: Premiums up to 30% higher than without the law
Congressional Budget Office and the Joint Committee on Taxation, “An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act,” November 30, 2009, www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf. Chief Medicare Actuary on President's health care claims: "I would say false, more so than true,“ House Budget Committee, January 26, 2011, http://www.youtube.com/watch?v=XC9rhGWJA2w. “2011 Employer Health Benefits Survey,” Kaiser Family Foundation/Health Research & Educational Trust, September 27, 2011, http://www.kff.org/insurance/092311nr.cfm.
“If you like your health insurance…”
• 51 to 80% of Americans will lose current coverage, according to Obama admin. estimates
• CBO: Up to 20 million could lose job-based plans
• McKinsey: Up to 80 million will be forced to change policies
• Child-only policies will vanish in 17 states
• 35 million more will move from job-based insurance to taxpayer-subsidized exchanges
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“Fact Sheet: Keeping the Health Plan You Have: The Affordable Care Act and ‘Grandfathered’ Health Plans,” U.S. Department of Health and Human Services, HealthReform.gov, http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html. "CBO and JCT's Estimates of the Effects of the Affordable Care Act on the Number of People Obtaining Employment-Based Health Insurance," Congressional Budget Office, March 2012, http://www.cbo.gov/publication/43082.Shubham Singhal, Jeris Stueland, and Drew Ungerman, “How US health care reform will affect employee benefits,” McKinsey Quarterly, June 2011, www.mckinseyquarterly.com/Health_Care/Strategy_Analysis/How_US_health_care_reform_will_affect_employee_benefits_2813.“Health Care Reform Law’s Impact on Child-Only Health Insurance Policies,” Senate Committee on Health, Education, Labor and Pensions, August 2, 2011, http://www.help.senate.gov/imo/media/doc/Child-Only%20Health%20Insurance%20Report%20Aug%202,%202011.pdf.Douglas Holtz-Eakin and Cameron Smith "Labor Markets and Health Care Reform: New Results," American Action Forum, May 27, 2010, http://americanactionforum.org/sites/default/files/OHC_LabMktsHCR.pdf.
Independent StudiesObama administration actuary Rick Foster:
• $120 billion in fines for companies and individuals
• Government spending will increase by $311 billion
• Many on Medicare will have trouble getting care
CBO:
The law will raise some family premiums by $2,100 in 2016 above what they would have been without the reform law
Richard S. Foster, Chief Actuary, “Estimated Financial Effects of the Patient Protection and Affordable Care Act, as Amended,” U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of the Actuary, April 22, 2010, www.cms.gov/ActuarialStudies/Downloads/PPACA_2010-04-22.pdf. Congressional Budget Office and the Joint Committee on Taxation, “An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act,” November 30, 2009, www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf.
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The AMA and practicing physicians
• The SGR Medicare payment fix was its key bargaining chip
• The chance for a permanent fix is missed; the president got the AMA endorsement for an empty promise
• Budget concerns in the Congress mean
short-term fixes are likely to continue
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Physician concerns
• Questions about Accountable Care Organizations
• Authority of HHS Secretary to set new rules for quality of care
• Regulatory requirements that make private practice much more difficult
• More burdensome record-keeping
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Anna Wilde Mathews, “When the Doctor Has a Boss,”, The Wall Street Journal Nov. 8, 2010, http://online.wsj.com/article/SB10001424052748703856504575600412716683130.html.
CRS previews impact of health law on physicians
Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, “Medicare Provisions in the Patient Protection and Affordable Care Act, (PPACA): Summary and Timeline,” November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.
PPACA has the potential to change fundamental aspects of how physicians organize, practice, and deliver care in the future.
• Some of these provisions create new structures and entities, like the CMS Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute
• Others seek to develop alternatives to traditional fee-for-service payment, such as the National Pilot Program on Payment Bundling, the shared savings program (including the accountable care organization, or ACO, model), or the value-based payment modifier under the physician fee schedule
In the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers.
Specific changes to watch
• IPAB — the Independent Payment Advisory Board
• Patient-Centered Outcomes Research Institute
• Physician Quality Reporting Initiative
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Action items
• Government requirements for use of EMR
• Comparative effectiveness “guidelines”
• Payment policies that penalize those with the top 10% of charges
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Predictions of the Medicare actuary
“House Budget Committee Hearing Highlights,” House Budget Committee, July 13, 2011, http://paulryan.house.gov/News/DocumentSingle.aspx?DocumentID=251972. “Statement of Actuarial Opinion,” 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medicare Insurance Trust Funds, May 13, 2011, https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf.
Under current law, CMS actuary Richard Foster says Medicare is on track to pay physicians less than Medicaid does, and this would lead to “severe problems with beneficiary access to care.”
He predicts many Medicare providers will go bankrupt if policies are unchanged. More than 40% eventually would end up “shifting to negative profit margins” and will either go out of business or stop seeing Medicare patients altogether.
Push-back coming from
• Doctors and patients
Losing control over medical decisions
• Small businesses and big employers
New taxes, penalties, and mandates
• States
Higher costs for Medicaid
• Consumers
Higher costs for insurance and fewer choices
• Seniors
Cuts to Medicare
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Some realities
Health care in 2012
• LegislationChallenges to the law: 1099, CLASS and IPAB
• Regulation12,000+ pages so far
• LegalU.S. Supreme Court decision in late June
• Political2012 campaigns and elections
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Europeans going the other way
• Consumerism
• Value of private enterprise and competition
• Doctor-patient relationship
• Decentralized decision-making
• NHS reforms
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Caution ahead
• Political criticism, resistance, no matter what the Court decides
• Physicians and hospitals will remain the central players and your participation in health reform will be vital to successful reform.
Source: http://www.towersperrin.com/tp/jsp/masterbrand_webcache_html.jsp?webc=HR_Services/United_States/Press_Releases/2007/20070522/2007_05_22.htm&selected=press
The future?
• The global move toward consumerism is real, driven by greater patient demand for more control over decisions.
• Health overhaul is law and will fundamentally change the U.S. health sector. But I believe it will be amended significantly before 2014.
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A not-for-profit health and tax policy research organization
/GalenInstitutewww.galen.org
Grace-Marie Turner
Galen Institute
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