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Health care reform:Will it ever happen?
Kathy Galarneau
Senior Vice President
Actuarial and Underwriting
February 16, 2009
Agenda
• How we got here• Why reform is important• What causes high health care costs• What reform will accomplish• What’s next?
2
A (very) brief history of health care reform
1949
1965
1971
1973
1986
Truman: proposes reform in Fair Deal
LBJ: signs Medicare/Medicaid into law
Nixon: backs national health care reform
Nixon: signs law creating HMOs
Reagan: signs COBRA into law
3
From Truman to Reagan: 30+ years
A (very) brief history of health care reform
1993
1996
1997
2006
2007
2009
Clinton: fails to achieve reform
Clinton: Strengthens privacy laws (HIPAA)
Clinton: Enacts CHIP (bi-partisan sponsors)
Bush: Signs Medicare Part D
Bush: twice vetoes CHIP expansion
Obama: expands CHIP
4
From Clinton to Obama: 15+ years
5
Timeline of key events
2008• In June, Finance Committee
Summit
• In November, Obama elected, promises health care reform
2008• In June, Finance Committee
Summit
• In November, Obama elected, promises health care reform
2nd Quarter 2009• Finance Committee Roundtables
• House and HELP release
bills and begin mark-ups
1st Quarter 2009• In February, Obama sets October deadline for reform bill
• In March, 2010 budget includes $634B health care reserve
• In March, White House holds Summit on reform
Outlook for reform positive
6
Timeline of key events
4th Quarter 2009• November 7: House passes bill (220-215)
• Leiberman says he’ll vote against a bill with a public option
• December 24: Senate passes bill (60-39)
3rd Quarter 2009• July 15: Senate HELP approves bill
• July 17: Two House panels pass bills
• August: Debate gets hostile at summer Town Halls
• September 9: Obama addresses Congress
• September 16: Finance Committee releases bill
1st Quarter 2010• Closed door talks
• Dems lose 60th vote
• January 27: State of the
Union deadline missed
• February 25: Obama meeting to “rescue” reform
Outlook For reform unclear
Overview of IBC and “the Blues”
1 in 3 people have “Blue” health coverage
Blues strongly support comprehensive, bi-partisan health care reform
Independence Blue Cross Non-profit organization Largest health plan in five-county region 3.2 million members 48,000 employer customers Partner with 36,000 health professionals,
160 hospitals
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Why is health care reformso important?
8
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Why is health care reformso important?
10
Costs are out of control 1 in 6 dollars is spent on health care Employer premiums doubled in last 10 years Medicare now pays out more than it collects in taxes
Why is health care reformso important?
11
Costs are out of control 1 in 6 dollars is spent on health care Employer premiums doubled in last 10 years Medicare now pays out more than it collects in taxes
Quality inconsistent U.S ranks #1 in the world in health care spending —
$7,500 per capita — yet ranks 20th in life expectancy and 27th in infant mortality
More people in America die after heart attacks in higher-spending regions compared to lower spending regions
Why is health care reformso important?
12
Costs are out of control Health care spending is 17.3% of GDP, or $2.5 trillion By 2020, spending projected to be $4.5 trillion. Employer premiums doubled in last 10 years Medicare now pays out more than it collects in taxes
Quality inconsistent U.S ranks #1 in the world in health care spending —
$7,500 per capita — yet ranks 20th in life expectancy and 27th in infant mortality
More people in America die after heart attacks in higher-spending regions compared to lower spending regions
Too many shut out 46 million uninsured 80% of uninsured come from working families
Why is health care reformso important?
Adding up the 46 million uninsured: who should not be counted
____ Illegal immigrants
____ Can afford, don’t buy
____ Young adults
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Adding up the 46 million uninsured: who should not be counted
6 million Illegal immigrants
____ Can afford, don’t buy
____ Young adults
14
Adding up the 46 million uninsured: who should not be counted
6 million Illegal immigrants
5 million Can afford, don’t buy
____ Young adults
15
Adding up the 46 million uninsured: who should not be counted
6 million Illegal immigrants
5 million Can afford, don’t buy
3 million Young adults
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6 million + Illegal immigrants
5 million + Can afford, don’t buy
3 million + Young adults
Adding up the 46 million uninsured: who should not be counted
14 million
17
6 million + Illegal immigrants
5 million + Can afford, don’t buy
3 million + Young adults
Adding up the 46 million uninsured: who should not be counted
46 -14 = 32 million uninsured
14 million
18
19Source: PriceWaterhouse Coopers, 2008
Why costs go up How can reform help?
20Source: PriceWaterhouse Coopers, 2008
Why costs go up
Unhealthy lifestyles are expensiveWe’re not getting any younger
We want the latest and the best care — but don’t always get itWe all pay for the uninsured
How can reform help?
• Incentives for healthy living
• Better care for chronically ill
• Sin taxes(Wishful thinking)
• Health IT funding • Evidence-based care• Pay for performance
Expand access to care
21Source: PriceWaterhouse Coopers, 2008
Why costs go upWhen Uncle Sam does not pay, we doDoctors get pay raises, too
Fear of malpractice suits
How can reform help?
Avoid more cost shifting
• Pay for performance• Fund medical school for PCPs
Tort reform and limiting jury awards
Health care profits overstated
According to Fortune Magazine’s recent industry profitability rankings, in 2008, health plans had a profit margin of 2.2% and are 35th on the list:
1 Network & Communications Equipment 20.4%
2 Internet Services and Retailing 19.4%
3 Pharmaceuticals 19.3%
28 Specialty Retailers 3.2 %
32 Beverages 2.9 %
35 Health Care: Insurance & Managed Care 2.2 % 22
23
Key stakeholdersAmerica’s Health Insurance Plans
Congressional Budget Office (CBO)
American Medical Association
U. S. Chamber of Commerce
American Labor
24
What health care reform aspires to do…
…and how legislation gets us there.
• Expand coverage
• Require all to participate
• Make care more affordable
• Change insurance practices
• Increase choice, competition
• Improve quality of care • Reduce costs
25
Expands coverage to 29 - 36 million more Americans, or 94% - 96% of the population.
26
Individual • “Shared responsibility” (mandates)• Penalties: start at $95/year to 2.5%
of adjusted gross income
Employer• Pay some or all of subsidy, or up to
8% of payroll
27
Premium assistance• Individual subsidies: up to 400% of FPL, or ifcoverage costs more than 12% of income• Employer tax credit: less than 25 workers,
with wages under $40,000
Expand Medicaid• Cover 15 million more people• 133% to 150% of poverty level
28
• Eliminate denials based on preexisting conditions or health status
• Prohibit annual/lifetime caps• Change age bands: 2:1 or 3:1 ratio
29
• Public option: with or without state opt out
• Exchanges: state-based or national
30
• Delivery system reforms• Initiate clinical effectiveness projects• Establish support for medical homes
• Wellness and prevention
• Eliminate cost sharing for Medicare preventive services
• Add smoking cessation programs • Workforce investment
• Increase pay for primary care physicians• Expand scholarship and loan programs
31
CMS study: Costs will rise $289B by 2019CBO: Fails to lower premiums for some, lowers deficit by $130B by 2019BCBSA study: Individual premiums will raise on average 54% after reform
Who pays?
32
Price tag: $848 billion to $1.05 trillion
Savings Cut Medicare Advantage: $144B
Reduce growth rate $180B
New revenue Tax high income earners: $460B
Tax Cadillac plans: $200B Fees on industry: $133B Insurers ($70B) Pharma ($23B) Medical device makers ($40B)
Penalties on individual/employer$167B
What’s next? (Anyone have a crystal ball?)
Obama convening televised, bipartisan meeting on Feb. 25 to “rescue” reform
How Congress could pass a reform bill Attempt to pass with budget reconciliation Scale down bills for easier passage Start over
Do nothing
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Questions?
Visit ibx.com for more information