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Public Policy and the
Primary Care Physician
Senator Irene Aguilar, MD
Case Report
CHS/ Single Payer
Solutions for a Health CO
Better Health Care for CO
A Plan for Covering CO
Commission’s 5th Proposal
Author HCACCO Assn of State HealthUnderwriters
SEIUCommittee for
CO Health Solutions
208 Commission
Remaining Uninsured 0 138,000 487,000 108,600 106,600
Health Spending ($1,400 M) $271 M $595 M $1,289 M $861 M
Medicaid/CHP Obsolete Expand Expand Expand Expand
SubsidiesProgressive
Premium 250% FPL 300% FPL 400% FPL 400% FPLBenefit Floor Comprehensive Less than
current lawBasic Comprehensi
veBasic
Benefit Cap None $35,000 $35,000 None $50,000Mandates Individual
EmployerIndividual None Individual
EmployerIndividual
Lewin Analysis of Health Proposals for ColoradoSeptember 2007
ORIGINAL BY: John A. Nyman, PhDUniversity of Minnesota
5
US v. Other G7 Countries Updated
Canada France Germ. Italy Japan UK Avg USA
MD visits (2009)per capita
6.5 6.9 8.2 NA 13.2* 5.0 6.3 3.9
Hosp dischargesper 100 pop (2009)
8.4 17.0 26.3 NA NA 13.3 16.0 13.1
Avg hospitalLOS (2009)
7.7 5.2 7.5 NA NA 6.8 5.9 5.4
Hospital days per 100 population
144.0 83.2
HC spending (2010)
per capita (PPP)
$4,445
$3,974
$4,338
$2,964
NA $3,433
$3,831
$8,232
HC spending as % of GDP (2010)
11.4 11.6 11.6 9.3 NA 9.6 10.6 15.8
LE at birth (2010)
80.8 (08)
80.2 80.5 82 (09) 83 80 81.1 78.7
Infant deaths per 1000 live births (2010)
NA 3.6 3.4 3.4 2.3 4.2 3.4 6.1OECD website : http://stats.oecd.org/index.aspx
The spending per capita numbers were converted from the currency of the country to US dollars by a PPP index.
IOM: Best Care at Lower Cost
9.8%
7.2%
27.5%
17%
13.7%
24.8%
INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste
$ 765 Billion
Determinants of Health
2011 U.S.
Healthcare Spending:
$2.7 Trillion
Health Reform in Colorado
2011 Bipartisan legislation to establish a health care exchange: Connect for Health
2013 Medicaid Expansion endorsed by Legislature and signed by Governor
Moving forward: focus on Payment Reform
Brings together buyers and sellers of insuranceCompare health insurance options and shop for
coverage that will take effect as early as January 1, 2014
Choice of up to 150 different private health insurance plans from ten carriers
Financial assistance based on income available to close to 500,000 Coloradans
As of October 28th
316,326 visitors
44,945 accounts created
30,862 calls to Service Center
3164 purchases
Table 2: Estimate of ACA Effect, 2016
No Reform With ACA ACA Impact
ESI 2,630,000 2,600,000 -30,000
Small Firm ESI (1-50 employees) 560,000 540,000 -20,000
Other ESI 2,070,000 2,060,000 -10,000
Unreformed Non-group 340,000 60,000 -280,000
Reformed Non-group 0 620,000 620,000
Tax Credit Recipients 0 470,000 470,000
Non-Recipients 0 150,000 150,000
Public Insurance 550,000 710,000 160,000
Uninsured 860,000 400,000 -460,000
Total 4,390,000 4,390,000→ →
→
Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011
Source: The Dartmouth Atlas of Health Care.
DENOMINATOR DEFINITION:A 20% random sample of the enrollment file for beneficiaries age 65-99 enrolled in both Medicare Parts A and B, selected on the basis of the terminal digits in the Social Security number. Patients enrolled in risk-bearing health maintenance organizations (HMOs) are excluded.ADJUSTMENTS:Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard. Gender-specific rates are age and race adjusted; race-specific rates are age and sex adjusted.
Medicare Payments per Enrollee, by Hospital Referral Region, 2009
Research shows significant variation in health care spending.
Massachusetts: Private, Medicare & Medicaid Payment for Professional Procedures
MinPrice
Max Price
Office Visit
$45 $330
MRI Brain
$104 $646
Colon-oscopy
$203 $1,045
Private Payer Payment Variation
Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost Trends: Price Variation in Massachusetts Health Care Services, May 2011.
Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included.
Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Household Component, 2009.
Concentration of Health Care Spending in the U.S. Population, 2009
(≥$51,951) (≥$17,402) (≥$9,570) (≥$6,343) (≥$4,586) (≥$851) (<$851)
Perc
ent o
f Tot
al H
ealth
Car
e Sp
endi
ng
Cooperative would put Colorado on sustainable path: Spending growing no
faster than the GSP
Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation
Figure 4. Share of Colorado population without health insurance coverage, alternative funding
programs, 2015-24.
21
If you’re not at the table, you’re on the menu