David N. Sundwall, M.D.Professor, Public Health (clinical)

University of UtahSchool of Medicine

“Health Reform” in the U.S.A.

Where are we in the quest for a more fair and

affordable health care system?

Presentation Outline

1. Historical perspective 2. The Patient Protection and

Affordability Care Act (PPACA)

3. Utah’s version of Health Reform

PP (ACA) – “Obamacare”

I. Policies a. Promises

b. Problems

II. Politicsa. Republicanb. Democratc. “Tea party”

III. Prognosis

Policies

#1 Priority – Expand health insurance coverage (32 million more?) starting in 2014NOTE: Does not strive for universal coverage, but if implemented as intended, 95% of legal U.S. residents would have coverage by 2016.

HOW ? Expand Medicaid (increase to 138% of FPL)Subsidies to help lower income individuals and families pay for private insuranceHealth Insurance Exchange (HIE) – make shopping for health insurance easier

Policies – cont.

“Mandate” – starting in 2014 “almost every American” will need to carry insurance or pay a fine.

Insurance Regulations – 1. Sharp restriction or “recissions”2. Can no longer deny coverage to children with preexisting conditions3. No longer able to impose limits on lifetime benefits paid out4. By 2014 prevent insurance companies from denying policies to people with preexisting conditions. (Temporary bridge, “High Risk Pools - HIP)

Policies cont.

Public Health ProvisionsFocus on preventing chronic disease and reduce the rate of death from our “top killers”:

Heart diseaseCancerStrokeChronic respiratory diseaseDiabetes

Policies cont.

How ?New Prevention and Public Health Fund (increase from $100 million “Preventive Health Services Block Grant” to $2 billion by 2015) - HRSA

School based health centers - HRSA Community transformation grants - CDC Increase funding for immunizations - CDC Improve capacity and technology of public health labs -

CDC Fund home visits in maternal and child health (MCH)

program, etc. up to $1.5 billion dollars (in addition to the $635 million/yr. appropriated for the MCH Block Grant.

Policies cont.

Health care work forceIncrease number and geographic distribution of the

nation’s “health work force” – doctors, nurses, dentists, and other health professionals.

How ?Increase payment for primary care servicesStrengthen and expand the National Health Service Corps

(NHSC) Fund pilot project related to “medical homes”, e.g. for

pediatric special needs patientsAnd others . . .

Utah’s version of “health reform”

Rely on private health insurance market

Promote personal responsibility

Ensure “transparency” and value

Maximize tax advantages

Optimize public programs, e.g. “Medicaid reform”.

“Defined Contribution Market”

Keep all payments “pre-tax”

Employees cannot be penalized for health status

Guaranteed issue ( same options for all employees )

Utah Health Insurance Exchange

Internet-based information portal – start with businesses , eventually make available to individuals.

Connects consumers to vital information re: private health insurance plans available:

single shopping point with reliable information, side-by side comparison

Consumers make personal and informed choices, “electronically”.

Politics

We are in the process of an intense national debate related to health care in the United States – what should be provided, and how to pay for it. The outcome will redefine the roles of governments ( federal and states) and the private sector in our health care enterprise.

“Fasten your seatbelts – it’s going to be a bumpy night [ride]”.Betty Davis – All About Eve

Supreme Court Decision – July 2012

Most of the ACA upheld, i.e. “the law of the land”.

•This included the “mandate” on individuals and businesses employing

more than 50 people to have or provide health insurance.

•Monkey wrench – states can’t be required to expand Medicaid ( made

optional)

Current Challenges: Medicaid – “ to expand [coverage] of not to expand, that is the question”.

Utah – what do you think? What do you think the legislature will do? [ a study has been

commissioned by the UDOH to determine cost, impact, etc.]

Arkansas - use federal $ to purchase private insurance for those who would be eligible for Medicaid expansions?

“Health Insurance Exchanges” – federal version or “Avenue H”?

Very different views on how best to facilitate expansion of health insurance coverage…..

Prognosis…. PPACA – “guarded”, i.e. while currently the law of

the land, it will inevitably be modified.

For health care - good for most, but we need to revisit how we provide care for the most vulnerable among us and how to make it affordable for all over the long run.

NOTE: Social Security-Medicare trustees voice doubt abut that the federal government could maintain its financial commitments to pay the bulk of the Medicaid expansions through 2020. “ Mercatus” – March, 2013.