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HEALTH CARE REFORM HEALTH CARE REFORM – Implications for – Implications for

PatientsPatients

Kenneth W. Kizer, MD, MPHAlaska State Hospital and Nursing Home Association

Fairbanks, AKSeptember 7, 2010

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Presentation ObjectivePresentation Objective

To consider some of the implications of To consider some of the implications of health care reform for patients. health care reform for patients.

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Implications for Patients Will Depend Implications for Patients Will Depend Primarily On:Primarily On:

1.1. If you do not have health insuranceIf you do not have health insurance2.2. If you have health insurance, who is your If you have health insurance, who is your

insurerinsurer3.3. Who you work forWho you work for4.4. What are your health care needsWhat are your health care needs5.5. Where you liveWhere you live6.6. What is your incomeWhat is your income

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Other Factors That Will Shape Other Factors That Will Shape PPACA’s Implications for PatientsPPACA’s Implications for Patients1.1. The economy in general The economy in general 2.2. The capacity to accommodate the influx of The capacity to accommodate the influx of

newly insured persons newly insured persons 3.3. How private insurers respond to the new rules How private insurers respond to the new rules 4.4. How providers respond to the changes in How providers respond to the changes in

reimbursementreimbursement5.5. The ability of providers to access capital to The ability of providers to access capital to

pay for infrastructure needs pay for infrastructure needs 6.6. Additional legislative changesAdditional legislative changes

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If You Do Not Have Health InsuranceIf You Do Not Have Health Insurance

All individuals required to have “minimum essential coverage” by 2014 or are subject to penalties

Increased insurance availability through state exchanges

Tax credits and cost sharing measures are available on a sliding scale based on family size and income (133% to 400% FPL)

Early retiree reinsurance and a voluntary program for insurance for community living assistance services will be available through employers

Specified exceptions to the mandate

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If You Have Health Insurance, Who If You Have Health Insurance, Who is Your Insureris Your Insurer

Persons who maintain qualified coverage are considered to meet the individual requirement

Having a government-sponsored plan (e.g., VA, Medicare, Medicaid, DoD/TRICARE, IHS) will meet the individual mandate

Government-sponsored plans are not materially affected, but there will be indirect effects resulting from changes in reimbursement and other things

Indeterminate effects on private plan offerings resulting from the changes in insurance practices, but a high likelihood that there will be effects

Greater attention will be focused on coordination of benefits

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Who You Work For Who You Work For Will depend on what your employer does to offer

insurance Tax credits available for small businesses The state of the economy

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What Are Your Health Care Needs What Are Your Health Care Needs Increased availability of information about

coverage and quality of care Increased provider attention on quality and

coordination of care Increased coverage for and availability of disease

prevention and health promotion services Increased availability of home care and community

services and supports, as well as long term care insurance

Indeterminate and variable effects resulting from expected increased demand for services and local care capacity constraints, transportation, etc.

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Where You Live Where You Live Indeterminate and variable effects depending on

availability of caregivers, health care facilities, medical culture, Medicare and Medicaid payment rates, the local economy and other factors

High likelihood of unplanned events and unintended consequences occurring somewhere

In the aggregate, probably good for rural communities

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What is Your Income What is Your Income Tax credits and cost sharing measures are

available on a sliding scale based on family size and income (133% to 400% FPL)

An increase in Medicare payroll taxes for individuals with earned income over $200,000, $250,000 for families (effective 2013)

A 40-percent nondeductible excise tax on coverage plans above a high-dollar threshold (effective 2018)

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Overall, health care reform will have Overall, health care reform will have considerable and generally considerable and generally

positive effects on patients, many positive effects on patients, many of which will not manifest for of which will not manifest for

several years as the legislation is several years as the legislation is implemented, but as is always the implemented, but as is always the

case for complex adaptive case for complex adaptive systems, there will be unplanned systems, there will be unplanned

occurrences and unintended occurrences and unintended consequences consequences