Fixing what ails healthcare in America today

Fixing what ails healthcare in America today

People Over Politics

Frequently Asked QuestionsSupplement to “People Over Politics” presentation.

Last updated 1/26/2012.

Frequently Asked QuestionsSupplement to “People Over Politics” presentation.

Last updated 1/26/2012.

FAQ slides• Who is paying for this?• Details for business• Details for individuals• Why pay for people who are unhealthy?• Why no single payer system?• Is this socialized medicine? • What about primary care?• What about hospitals?• What about lawsuits?• Who is Doctors for America?• How is Doctors for America funded?• Will Doctors for America endorse candidates?

• Who is paying for this?• Details for business• Details for individuals• Why pay for people who are unhealthy?• Why no single payer system?• Is this socialized medicine? • What about primary care?• What about hospitals?• What about lawsuits?• Who is Doctors for America?• How is Doctors for America funded?• Will Doctors for America endorse candidates?

Who is paying for this?Who is paying for this?

If you make more than $200,000 (or you and your spouse make more than $250,000),

for every extra $1,000

you pay $9 more in Medicare taxes.

If you make more than $200,000 (or you and your spouse make more than $250,000),

for every extra $1,000

you pay $9 more in Medicare taxes.


A single person who makes

$250,000 a year in wages

will pay $450on the extra $50,000

A single person who makes

$250,000 a year in wages

will pay $450on the extra $50,000


A couple that makes

$1,000,000 a year in wages,

will pay $6,750on the extra $750,000.

A couple that makes

$1,000,000 a year in wages,

will pay $6,750on the extra $750,000.


If you make more than $200,000

and you make money from investments,

you pay 18.8% instead of 15% on the investment income.

If you make more than $200,000

and you make money from investments,

you pay 18.8% instead of 15% on the investment income.


If your health insurance from your employer

is worth more than $27,500

you pay your regular tax rate

for the extra cost(starts in 2018).

If your health insurance from your employer

is worth more than $27,500

you pay your regular tax rate

for the extra cost(starts in 2018).


Bottom Line:

People who make more than $200,000(or families that make more than $250,000)

will pay extra taxes.

Bottom Line:

People who make more than $200,000(or families that make more than $250,000)

will pay extra taxes.


Bottom Line:

If you make less than $200,000(or your family makes less than $250,000)

no increase in taxes

Bottom Line:

If you make less than $200,000(or your family makes less than $250,000)

no increase in taxes


. . . unless

you have really expensive insurance

or

you like tanning salons

(10% tax increase)

. . . unless

you have really expensive insurance

or

you like tanning salons

(10% tax increase)


If you are a health care corporation, you pay extra fees and taxes:

Insurance companies: $60 billion

Drug companies: $27 billion

Some medical devices: $20 billion

If you are a health care corporation, you pay extra fees and taxes:

Insurance companies: $60 billion

Drug companies: $27 billion

Some medical devices: $20 billion

Details for BusinessesDetails for Businesses

60% of businesses offer insurance

40% of businesses do not

If everyone offers insurance, it will level the playing field.

60% of businesses offer insurance

40% of businesses do not

If everyone offers insurance, it will level the playing field.

Small BusinessesSmall Businesses

50% subsidy for insurance bought on the exchange starting 2014

35% subsidy for insurance now

50% subsidy for insurance bought on the exchange starting 2014

35% subsidy for insurance now


To qualify, a business must:

•Have fewer than 25 full-time employees (FTE’s)

•Pay average annual wages below $50,000 per FTE

•Contribute at least 50% of each employee's premium

To qualify, a business must:

•Have fewer than 25 full-time employees (FTE’s)

•Pay average annual wages below $50,000 per FTE

•Contribute at least 50% of each employee's premium


For more information, visit smallbusinessmajority.org





Large BusinessesLarge Businesses

Any company with more than 50 employees:

•If any employee needs public assistance to afford insurance (Medicaid or insurance exchange subsidies), the company will be fined $2000 per person.

Note: in Massachusetts, employers insurance went up because of the individual mandate.

Any company with more than 50 employees:

•If any employee needs public assistance to afford insurance (Medicaid or insurance exchange subsidies), the company will be fined $2000 per person.

Note: in Massachusetts, employers insurance went up because of the individual mandate.

Details for IndividualsDetails for Individuals

# in your family

Lowest income for Subsidies

Subsidies if premiums are more than . . .

Top Income for Subsidies

Subsidies if premiums are more than . . .

1 $14,404 $288.08 $43,320 $4,245.36

2 $19,378 $387.56 $58,280 $5,711.44

3 $24,352 $487.04 $73,240 $7,177.52

4 $29,327 $586.54 $88,200 $8,643.60

5 $34,301 $686.02 $103,160 $10,109.68

Note: These are the 2011 numbers and will be slightly higher for 2014.

Lowest income = 133% of the federal poverty levelBelow this, people qualify for Medicaid.

Highest income = 400% of the federal poverty level




Pre-existing Condition Insurance Plans•For individuals who have been uninsured for at least 6 months due to pre-existing conditions•Temporary insurance through 2014•Rates similar to health individuals of the same age

PCIP.gov (or healthcare.gov)

Pre-existing Condition Insurance Plans•For individuals who have been uninsured for at least 6 months due to pre-existing conditions•Temporary insurance through 2014•Rates similar to health individuals of the same age

PCIP.gov (or healthcare.gov)


Why should I pay for people who don’t take care of themselves?


Photo courtesy of http://www.flickr.com/photos/yourdon/3855923910

/

http://www.flickr.com/photos/yourdon/3855923910/





You already do.

Insurance:

The lucky many (the healthy)

pay for

the unlucky few (the unhealthy).

You already do.

Insurance:

The lucky many (the healthy)

pay for

the unlucky few (the unhealthy).



If we decide to only cover those who behave in a “healthy” way,

there might not be anyone left to insure.

If we decide to only cover those who behave in a “healthy” way,

there might not be anyone left to insure.



We need to focus on prevention

so we all live healthier lives.

We need to focus on prevention

so we all live healthier lives.

Large differences in public opinion on:

•free market solutions

•government solutions

Strong advocates on both sides, from public, physicians, health care industry, other industry, legislators.

Large differences in public opinion on:

•free market solutions

•government solutions

Strong advocates on both sides, from public, physicians, health care industry, other industry, legislators.

Why no single-payer system?

Laws are passed by votes in Congress.

Need 218 Members of the House and 60 Senators to pass a law.

There have never been enough members of Congress to vote for single payer.

Laws are passed by votes in Congress.

Need 218 Members of the House and 60 Senators to pass a law.

There have never been enough members of Congress to vote for single payer.


Affordable Care Act is a law that combined approaches to pass a solution in 2010:

•Government solutions

•Market-based solutions

•Public-private partnerships






States can experiment with single-payer and other systems as long as they:

•Get to the same coverage and affordability

•For the same cost to the federal government.

Vermont is working on a single-payer system.

States can experiment with single-payer and other systems as long as they:

•Get to the same coverage and affordability

•For the same cost to the federal government.

Vermont is working on a single-payer system.










Is this socialized medicine?

It expands the private insurance market.

The government is not taking over any hospitals, doctor offices, doctors, etc.

The law focuses on making fair and better rules for everyone.

It expands the private insurance market.

The government is not taking over any hospitals, doctor offices, doctors, etc.

The law focuses on making fair and better rules for everyone.

Is this socialized medicine?

What’s happening with Primary Care?


The Affordable Care Act creates 16,000 more primary care providers by 2015.

We need 25,000-30,000 more.

And we need 125,000 more physicians across specialties by 2025.

The Affordable Care Act creates 16,000 more primary care providers by 2015.

We need 25,000-30,000 more.

And we need 125,000 more physicians across specialties by 2025.



Adding just 1 primary care physician for every 10,000 Americans could save 127,617 deaths every year.

Adding just 1 primary care physician for every 10,000 Americans could save 127,617 deaths every year.



Payment to Primary Care•Medicare: 10% payment bonus for physicians who bill >60% primary care codes (2011-2015)

Payment to Primary Care•Medicare: 10% payment bonus for physicians who bill >60% primary care codes (2011-2015)



Payment to Primary Care•Medicaid: family medicine, general internal medicine, and pediatrics are reimbursed at 100% of Medicare levels (2013-2014)

Payment to Primary Care•Medicaid: family medicine, general internal medicine, and pediatrics are reimbursed at 100% of Medicare levels (2013-2014)



National Health Service Corps•Loan repayment for physicians who work in underserved areas•Expanded from previous program, and allows some teaching time to qualify for full-time clinical work•$1.5 billion more funding for thousands of additional spots

National Health Service Corps•Loan repayment for physicians who work in underserved areas•Expanded from previous program, and allows some teaching time to qualify for full-time clinical work•$1.5 billion more funding for thousands of additional spots



Training•Increased primary care residency slots•Teaching Health Centers for clinic-based residency training

Training•Increased primary care residency slots•Teaching Health Centers for clinic-based residency training

What about lawsuits?What about lawsuits?

Problems:

1.Medical errors happen.

2.Many people are suing for bad reasons.

3.Most people who are harmed by true medical errors don’t get any compensation.

4.The decision on two identical cases often is different depending on the lawyers and jury.

5.Many doctors are doing more to patients because they are afraid of getting sued.

6.Doctors in some specialties pay very high malpractice insurance, and some are dropping high-risk areas entirely (like obstetrics).

7.Current malpractice system does not improve patient safety.

Problems:

1.Medical errors happen.

2.Many people are suing for bad reasons.

3.Most people who are harmed by true medical errors don’t get any compensation.

4.The decision on two identical cases often is different depending on the lawyers and jury.

5.Many doctors are doing more to patients because they are afraid of getting sued.

6.Doctors in some specialties pay very high malpractice insurance, and some are dropping high-risk areas entirely (like obstetrics).

7.Current malpractice system does not improve patient safety.


The Affordable Care Act set up a $50 million fund for states and local groups to figure out

better solutions.

The Affordable Care Act set up a $50 million fund for states and local groups to figure out

better solutions.


Comprehensive malpractice reform:

2nd wave of national reformsor

State-by-state reforms

What happens to hospital payments?


Changing Payments to Improve Quality

Decrease Medicare payments to hospitals by 1%.

If hospitals meet or exceed national average,

get incentive payments.


Decrease Medicare payments to hospitals by 1%.

If hospitals meet or exceed national average,

get incentive payments.




Hospitals that do not meet the average get help improving their quality.


Hospitals that do not meet the average get help improving their quality.




Improve Care QualityHospital Value-Based Purchasing Program (VBP)

Multiple quality measures

Decrease 30-day Hospital Readmissions For 2012: CHF, Acute MI, Pneumonia

Decrease Healthcare-Associated ConditionsFor 2012: Decubitus ulcers, falls, line infections


Improve Care QualityHospital Value-Based Purchasing Program (VBP)

Multiple quality measures

Decrease 30-day Hospital Readmissions For 2012: CHF, Acute MI, Pneumonia

Decrease Healthcare-Associated ConditionsFor 2012: Decubitus ulcers, falls, line infections

Who is Doctors for America?Who is Doctors for America?

A national movement of doctors and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high-quality health care.

A national movement of doctors and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high-quality health care.

Who is Doctors for America?Who is Doctors for America?

• 15,000 doctors and medical students in all 50 states

• Average experience = 10 years after training

• 50% private practice

• 50% primary care, 50% specialists

• 15% medical students

• 15,000 doctors and medical students in all 50 states

• Average experience = 10 years after training

• 50% private practice

• 50% primary care, 50% specialists

• 15% medical students

Who is Doctors for America?Board 2011-2012

Who is Doctors for America?Board 2011-2012

Dr. Vivek Murthy, MD MBAInternal Medicine Hospitalist

Boston, Massachusetts

Carol DuhMedical Student

Nashville, Tennessee

Dr. Chris Lillis, MDPrivate Practice Internal Medicine

Fredericksburg, Virginia

Dr. Alice Chen, MDInternal Medicine Hospitalist

Los Angeles, California

Dr. Mona Mangat, MDSolo Practice Allergist/Immunologist

St. Petersburg, Florida

Dr. Evan Saulino, MD PhDFamily Practice

Portland, Oregon

Who is Doctors for America?More Faces of Doctors for America

Who is Doctors for America?More Faces of Doctors for America

How is Doctors for America funded?How is Doctors for America funded?

• Foundation grants– Including Nathan Cummings Foundation, Herman and

Frieda L. Miller Foundation

• Individual donations– Physicians and medical student members– Additional individual supporters

• Our work is done by many dedicated volunteers supported by 2 full-time staff.

• Foundation grants– Including Nathan Cummings Foundation, Herman and

Frieda L. Miller Foundation

• Individual donations– Physicians and medical student members– Additional individual supporters

• Our work is done by many dedicated volunteers supported by 2 full-time staff.

It’s an election year. Will Doctors for America endorse candidates?

It’s an election year. Will Doctors for America endorse candidates?

No.

We operate under 501(c)(3) non-profit, non-partisan rules.

No.

We operate under 501(c)(3) non-profit, non-partisan rules.

To Learn MoreTo Learn More

• Doctors for America: www.drsforamerica.org• Official Information: www.healthcare.gov • Kaiser Family Foundation: healthreform.kff.org/ • Commonwealth Fund:

www.commonwealthfund.org • New England Journal of Medicine: www.nejm.org

/health-policy-and-reform

• Doctors for America: www.drsforamerica.org• Official Information: www.healthcare.gov • Kaiser Family Foundation: healthreform.kff.org/ • Commonwealth Fund:

www.commonwealthfund.org • New England Journal of Medicine: www.nejm.org

/health-policy-and-reform

http://www.drsforamerica.org/

http://www.healthcare.gov/

http://healthreform.kff.org/

http://www.commonwealthfund.org/

http://www.nejm.org/health-policy-and-reform



http://www.drsforamerica.org/

http://www.healthcare.gov/

http://healthreform.kff.org/

http://www.commonwealthfund.org/




Contact UsContact Us

• Have additional questions or suggestions?

• Catch inaccuracies in these slides?

• Want to learn more about being a part of the Doctors for America One Million Campaign?

Contact us at [email protected]

• Have additional questions or suggestions?

• Catch inaccuracies in these slides?

• Want to learn more about being a part of the Doctors for America One Million Campaign?

Contact us at [email protected]

www.1millioncampaign.orgwww.1millioncampaign.org

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Fixing what ails healthcare in America today