Ramnik Dhaliwal, MD/JDPGY-2 EM/IM Residency

Hennepin County Medical Center

Sources Of Funds Percentage of Total Amount Per Person

Total “Private” 52% $8,459

Total Govt (Medicare, Medicaid, VA&DOD)

48% *

US Population of 310 million, from US Office of the Actuary, National health Projections, http://www.cms.gov/NationalHealthExpenData/

Top 10 %

Approx 64% of spending

Total US Top 1% Next 9% 11-49%

People

(millions)

310 3 28 124

Health Care spending (millions) 2,624,400 582,617 1,112,746 845,057

Average per person$ 8,459 187,809 39,855 6,810

Birth of The BluesBlue Cross

In 1929 Baylor University offered 21 days of hospital care to 1500 Dallas area teachers who paid $6 a year

Blue ShieldAround 1900 mine and

logging owners in the Pacific Northwest paid medical service bureaus for care of workers

Government Sponsored Health CareJuly 30, 1965 Lyndon

Johnson signs Social Security Act creating Medicare and Medicaid

First Medicare enrollee, Former President Harry S Truman

Blue Cross and Blue Shield merged in 1982 and is now an association of 39 separate franchisees providing insurance to more than 1/3 of Americans

•Insurers •Profits •Patients•Risk pooling

•Providers•Increased demand and regular payment

Medicare: FederalIn partnership with states

MedicaidChildren’s Health Insurance

Health Insurance portability standards, quality standards in long term care facilities, Clinical Lab Improvement

A social insurance program which acts as a single payer for health insurance for people who qualify

To Qualify:Legal residents of the US for at least 5 years

and over 65* Or:

On Social Security Disability for at least 24 months or

Receive disability pension from Railroad Retirement Board and meet certain criteria or

Have ALS, or Have permanent kidney failure requiring

dialysis or a kidney transplant.

* If neither you nor your spouse has paid income tax for at least 40 quarters you may have to pay a monthly premium

Medicare Part A Inpatient hospital

stays Including room, food,

tests and doctor feesBrief stays in a skilled

nursing facilityPart B

Covers physician and outpatient services

Premium payment by beneficiaries

$96.40 per month in 2009

Medicare Advantage “Part C”A combination of parts

A and B allows them to be administered by private companies

Part D: Prescription Drug

plans, only provided through private insurance companies that have contracts with government.

Direct Medical EducationWages and benefits for US residents $ 2.7 billion in 2008

ž Indirect Medical EducationSubsidy to teaching hospitals that provide

residency education$ 5.7 billion in 2008

ž Has been frozen since 1996

Means-tested, needs-based health insurance program for eligible individuals and families with low incomes and resourcesJointly funded by the states and federal

government, and is managed by the statesIn 2008 49 million persons enrolledž

About 1/2 of those receiving benefits are children2010 spending $419 billion,

Approx 57%coming from federal fundsAccounts for approx 17% of states general fund

spending

Created in 1997Provides matching funds to states for health

insurance for children in families with income modestly above the Medicaid eligibility

ž $40 billion spent over first 10 years

Medicaid expansion to 138% of the federal poverty level ($15,415 for an individual and $31,809 for a family of four in 2012) for individuals under age 65

The creation of health insurance exchanges

Regulation to prevent health insurers from denying coverage to people for any reason, including health status, and from charging higher premiums based on health status and gender;

The requirement that most individuals have health insurance beginning in 2014; and

The penalties to employers that do not offer affordable coverage to their employees, with exceptions for small employers.

Florida filed lawsuit challenging the constitutionality of the individual mandate and the Medicaid expansion; Was joined by 25 other states.

š

ACOs?•Accountable Care Organizations

•Part of ACA

•New form of payment delivery system

•Meant to improve quality

•Bend the Cost Curve

Washington State Denies Medicaid Payments–Use final diagnosis to decline payment–Ignores Federal Prudent Layperson Standard–Jeopardizes access to care–EMTALA

SUCCESS:Governor halted programAdoption of Best Practices