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© 2012 by the Catholic Health Association of the United States© 2012 by the Catholic Health Association of the United States
© 2012 by the Catholic Health Association of the United States
Long overdue
Serious problems in current system
Cost
Scope
Structure
System quality
Cost of medical education
Quality of life of M.D.
Impact on national economics
2
Health Care in the U.S.Health Care in the U.S.
New ERA in Health Care
© 2012 by the Catholic Health Association of the United States
Unsustainable
Unfair
Inefficient
The overall U.S. health care system was:
3
No question it had many pockets of excellence
National Health ReformNational Health Reform
© 2012 by the Catholic Health Association of the United States
More than 50 million uninsured
Millions more underinsured
2000-2007 net cost of family premium 91%
Personal health costs 65%
Earnings 24%
2003-2010 employees share of premium 63%
4
Health Care in the U.S.Health Care in the U.S.
U.S. Health Care Statistics
© 2012 by the Catholic Health Association of the United States
18,000 unnecessary deaths per year according to the Institute of Medicine
More than 50% of personal bankruptcies due to health expenses
16-18% GDP on health care
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U.S. Health Care Statistics (continued)
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 6
Access to Health Insurance
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 7
Access to Health Insurance
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 8
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 9
Employer Premiums as Percentage of Median Household Income for Under-65 Population 2003 and 2010
2010
2003
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 10
AUS CAN GER NETH NZ UK USOVERALL RANKING (2010) 3 6 4 1 5 2 7Quality Care 4 7 5 2 1 3 6Access 6.5 5 3 1 4 2 6.5Efficiency 2 6 5 3 4 1 7Equity 4 5 3 1 6 2 7Long, Healthy, Productive Lives 1 2 3 4 5 6 7Health Expenditures/Capita 2007 $3,357 $3,895 $3,588 $3,837* $2,454 $2,992 $7,290
Country Rankings
1.00–2.33
2.34–4.66
4.67–7.00
Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).
How the Performance of the U.S. Health Care System Compares Internationally
The Need for Health ReformThe Need for Health Reform
© 2012 by the Catholic Health Association of the United States
Reform
Technology
Scientific advances
Major Drivers of Change
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Health Care in the U.S.Health Care in the U.S.
Photo Credit: Scripps Health
© 2012 by the Catholic Health Association of the United States 12
Historic Health Reform Signed into Law – March 23, 2010
As significant as the 1965 signing of the Medicare and Medicaid law
Photo Credits: www.ssa.gov Courtesy LBJ Presidential Library / WH.GOV
National Health ReformNational Health Reform
© 2012 by the Catholic Health Association of the United States 13
Reform legislation passed
Upheld by the U.S. Supreme Court
Voted down 33 times by the U.S. House
Now what?Photo Credit: WH.GOV
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
© 2012 by the Catholic Health Association of the United States 14
National Health ReformNational Health Reform
What will reform mean to the American people and American health providers?
© 2012 by the Catholic Health Association of the United States
Adult children up to 26 can stay on their parents’ policy
Pre-existing conditions in children cannot be denied coverage
No lifetime limit on benefits
Companies must prove fraud to cancel a policy
Must allow an appeal before denying a claim
What’s Working for the American People Already?
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
15
© 2012 by the Catholic Health Association of the United States
Preventive services must be available without a co-pay for Medicare and private insurance
Free choice of a primary care M.D., including OB-GYN and pediatrician, must be allowed
Mandatory benefit package
Insurance companies must spend 80 to 85 percent of the insurance dollars for medical care and quality
Monitoring of rate increases
What’s Working for the American People Already? (continued)
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
16
© 2012 by the Catholic Health Association of the United States
New coverage for working uninsured is projected to be 30-32 million
Medicaid eligibility will increase and is 100 percent federally funded
Medicaid payment for primary care will increase to Medicare rate for first 3 years
What’s Going to Work in the Future for the American People?
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
17
© 2012 by the Catholic Health Association of the United States
Health insurance exchanges
Estimated that 16 million small business employees will qualify
Federal subsidies employer tax credits and employee contributions
Decreased expense due to volume purchasing
More quality data available for providers and consumers
Clinical effectiveness/innovation studies
What’s Going to Work in the Future for the American People? (continued)
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
18
© 2012 by the Catholic Health Association of the United States 19
What is working in California?
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
© 2012 by the Catholic Health Association of the United States 20
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care ActWhat’s working for California?
1,481,491 Californians on Medicare have already had preventive services without cost
214,650 Californians on Medicare received a $250 rebate for “the donut hole”
California has a pre-existing condition insurance plan run through the California Pre-Existing Health Plan
Small businesses in California are eligible for a tax credit up to 35%
© 2012 by the Catholic Health Association of the United States 21
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 22
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 23
Challenging Issues from Reform
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
MEDPAC IPAB
Does increased coverage happen?
How fast? – compared to rate reductions
Transparency and accountability requirements
Medicare penalties
Fraud and abuse monitoring
Disproportionate share cuts
© 2012 by the Catholic Health Association of the United States 24
Other Challenging Issues
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
Accountable Care Organizations – now 154
Special populations
Medicare readmission policy
More Medicaid patients
© 2012 by the Catholic Health Association of the United States 25
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care ActCritical Issue for This Year – Exchanges
© 2012 by the Catholic Health Association of the United States 26
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
© 2012 by the Catholic Health Association of the United States 27
Medicaid Decision by the Supreme Court
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
What it means
To patients
To providers
To economic health of the State
© 2012 by the Catholic Health Association of the United States 28
Some Myths / Misinformation
The Patient Protection and The Patient Protection and Affordable Care ActAffordable Care Act
The Affordable Care Act will add trillions to the deficit
The health care law puts the federal government between you and your doctor
The law cuts $500 billion from Medicare beneficiaries
© 2012 by the Catholic Health Association of the United States 29
Another Driver of Change
Technology
Medical
Communication
Research
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 30
Most Promising and Challenging Driver
Scientific Advances
Genome
Stem Cells
Drugs
Health Care in the U.S.Health Care in the U.S.
© 2012 by the Catholic Health Association of the United States 31
Critical that Providers Play a Major Decision Making Role
Good of the patient
Good of the system
Good of individual providers
Health Care in the U.S.Health Care in the U.S.
The next 3-5 years will have major decisions that will influence health
care for decades
© 2012 by the Catholic Health Association of the United States 32
Health Care in the U.S.Health Care in the U.S.
We must make the care of the sick a great
profession to be part of – professional life
and personal life.
© 2012 by the Catholic Health Association of the United States© 2012 by the Catholic Health Association of the United States
