Healthcare Reform

J Rush Pierce Jr, MD, MPHDept of Internal Medicine, Univ of New Mexico

Medical Economics and Leadership ElectiveOctober, 2010

Agenda

• Disclosures, general comments• Why Healthcare Reform?• Major Provisions for the Patient Protection

and Affordable Care Act (PPACA) of 2010• Implications of Healthcare Reform for various

groups

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Disclosures

• I am on the full-time faculty at University of New Mexico School of Medicine

• University of New Mexico Hospital pays part of my salary

• I am on Governing Council of the New Mexico Chapter of the American College of Physicians

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Healthcare Reform – general observations

• A very emotional issue for many Americans• Not easy or fun for Congress• Complicated• Misconceptions and misinformation

commonplace

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Why Healthcare Reform?

1. Large number of uninsured

2. America’s sub-par performance on population health measures

3. Predicted future costs are unsustainable

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America’s Uninsured

• Who is currently covered?– Medicaid – covers all poor kids– Medicare – covers all citizens > 64 years old– Employer-based insurance (large employers) –

subsidized coverage for employees +/- dependents– Special groups: poor Veterans, permanently

disabled, poor pregnant women

• So who is not covered?

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America’s Healthcare Report Card

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Mortality amenable to healthcare, deaths/100,000

Source: WHO

US Healthcare Expenditures

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Projected Solvency of Medicare

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Source: CBO

Major Provisions of the PPACA

• Insurance reform• Coverage for the uninsured• Expansion of workforce• Payment reform and cost containment• Liability reform

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Insurance reform

• Limitations on exclusions– Can’t cancel (2010)– No pre-existing conditions (phase-in)– Children to age 26 on parent's policies (2010)– No annual or life-time limitations (phase-in)

• Limit administrative costs (2011)• Required coverage for preventive svcs (phase-in)• Restriction of premium differentials (2014)

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Coverage for the uninsured

• Expand community health centers (2010)• Expand small business tax credits (2010)• Tax credits to individuals (2014)• Health insurance exchanges (2014)• Fine if do not purchase (2014)• Expanded Medicaid (2014)• Will result in coverage of all but 12M - 95% of

citizens10/04/2010 Healthcare Reform 12

Expansion of Workforce

• More funding for primary care residencies (2010)

• More loan forgiveness programs (2010)• Reallocation of unfilled residency positions to

primary care (2011)

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Payment Reform

• Closure of “donut hole” (phase out)• More payment to community clinics (2010)• 10% bonus to primary care doctors (2011)• Increase Medicaid rates (2013)• Pilot programs to look at new payment

models (begins 2011)• Mandatory quality reporting (2011)• Independent Payment Advisory Board (2014)10/04/2010 Healthcare Reform 14

Liability Reform

• Pilot programs (2011)• Liability protection for workers in free clinics

(2010)

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What does this mean for me?

• Implications for patients– Will access to my doctor change?– Will my insurance premiums go up?– Will my benefits be limited?– Will my taxes go up?

• Implications for doctors• Implications for hospitals• Implications for young people

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Questions and Comments

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