january 8 ckahu
TRANSCRIPT
A not-for-profit health and tax policy research organization
/GalenInstitutewww.galen.org
Health Reform: Where are we now?
Grace-Marie TurnerJanuary 8, 2013Central Kentucky Association of Health Underwriters
www.galen.org
www.galen.org
www.galen.org
www.galen.org
Source: Ari Melber,”POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,” The Nation, July 4, 2012, http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
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.
www.galen.org
Americans’ views of health law after Supreme Court decision
• Americans say it will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance.
• Opposition to the law higher after Supreme Court decision.
Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBS News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July 2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
Source: “Kaiser Health Tracking Poll: July 2012,” The Henry J. Kaiser Family Foundation, July 31, 2012, http://www.kff.org/kaiserpolls/8339.cfm.
Source: Jeffrey M. Jones, “Now Against Gov't Healthcare Guarantee,” Gallup Politics, November 28, 2012,http://www.gallup.com/poll/158966/majority-against-gov-healthcare-guarantee.aspx.
Majority of Americans OpposeGovernment Health Care
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 2011 2012
64 62 6259
64
58
6964
54
47 47
50
44
3134 35
3934
38
2833
41
50 50
46
54
% Government responsibility % Not government responsibility
Gallup asked: Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage,
or is that not the responsibility of the federal government?
Source: Avik Roy, “Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012, http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
The health law in one graph
Why ObamaCare isn’t settled
38% of Americans supported the law in the last major poll before the November elections
Of the 50.6% who voted for President Obama…
12% said they wanted the law repealed
The election was not about ObamaCare
Source: “Kaiser Health Tracking Poll: October 2012,” The Henry J. Kaiser Family Foundation, October 31, 2012, http://www.kff.org/kaiserpolls/8381.cfm.
ObamaCare Resistance Movement
Governors: No exchanges or Medicaid expansion
Citizens: Pay fine rather than buy insurance
Employers: Seeking ways to avoid finesCongress: Delay, defund, dismantle, do strict
oversightLegal challenges: 40 and counting, including
challenge to religious liberty
State Actions to Address Health Insurance Exchanges
Source: “State Actions to Address Health Insurance Exchanges,” National Conference of State Legislatures, December 20, 2012, http://www.ncsl.org/issues-research/health/state-actions-to-implement-the-health-benefit-exch.aspx.
Pursuing state-run exchange: enacted legislation
State plans to partner with federal government
State has not declared their plan to HHS
Pursuing state-run exchange: executive branch
State not establishing a state-run exchange
Source: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012, http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.
Exchange bureaucracy
ObamaCare’s New Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012, http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
More ObamaCare Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012, http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.
Source: “Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,” Mercer LLC, August 8, 2012, http://www.mercer.com/press-releases/1472805.
Mercer: Employers planning workforce changesw Mercer study on what employers expect
Employer mandate penalties
For companies with +50 employees
• $2,000 per year per full-time employee for not providing coverage (minus first 30)
• $3,000 per year for any employee getting insurance through the Exchanges
* If an employer offers employee-only coverage that’s “affordable” to the worker, family members are not eligible for Exchange subsidies
www.galen.org
SCOTUS Success Boot Camp
Some things to think about
1. Employers with <50 FTE EE’s have no 3k/2k penalty
2. But employers offering qualified and affordable coverage may actually be hurting their employees
Example
Generous Subsidies in ExchangesExamples:
• A person earning $42,000 a year with a family of 4 qualifies for $14,759 in new health insurance subsidies
• A single person earning $20,600 qualifies for $5,156 in new health insurance subsidies
But only if employer doesn’t offer coverage or if it’s not “affordable” (ie costs >9.5% of income)
www.galen.org
But employee share still steep
Examples:
• A young family earning $35,000 a year would have to pay up to $5,555 in total health costs for a $12,130 Silver plan ($1,388/prem.; $4,167 OOP)
• A slightly older family earning $85,000 would have to pay up to $16,408 in total health costs for a $15,116 Silver plan ($8,075/prem.; $8,333 OOP)
Source: Estimates based upon the Kaiser Family Foundation’s Health Reform Subsidy Calculator, http://healthreform.kff.org/subsidycalculator.aspx.Grace-Marie Turner, “ObamaCare: Pain 2.0,” New York Post, December 27, 2012, http://tinyurl.com/ag92fgv.
www.galen.org
Some realities:
What we know for sure
• CHOICE: Americans value innovation, diversity and choice to accommodate 300 million people
• VALUE IN HEALTH SPENDING: To realize the promise of personalized medicine and achieve overall cost saving, break down payment silos
• FOCUS ON THE PATIENT: They want doctors and patients, not government, to make health care decisions
Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012, http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
A market-based solution“Defined contributions” for health coverage
A system that puts doctors and patients in charge of medical decisions
Restructuring financing for a 21st century health sector
• Medicare
• Medicaid
• Private Insurance
States have a big role
Seek ways improve their markets
• Enhance competition for more choices of affordable coverage
• Better safety net with functional high-risk pools
• Private exchanges?
• What suggestions can you present?
www.galen.org
Even Europeans going the other way
• Consumerism
• Value of private enterprise and competition
• Doctor-patient relationship
• Decentralized decision-making
www.galen.org
The future?• The global move toward
consumerism is real, driven by greater patient demand for more control over decisions.
• People will seek more affordable options outside the ACA’s centralized control.
Search for your opportunities!
Why ObamaCare Is Wrong for America
How does the health care law drive up costs?
Is your doctor really in charge of your health care decisions?
Are your Constitutional rights threatened?
Discover the law’s impact on
your life in a new book from four nationally recognized health policy experts
Published by Broadside Books, an imprint of HarperCollins www.WrongForAmericaBook.com
www.galen.org
A not-for-profit health and tax policy research organization
/GalenInstitutewww.galen.org
Grace-Marie Turner
Galen Institute
703-299-8900
twitter.com/GalenInstitute
facebook.com/GalenInstitute
Subscribe to our free email alerts at www.galen.org/subscribe