Post on 13-Aug-2020
Presentation Designed & Developed by Witte Design, LLC ©2012-2018 • Tucson, Arizona
www.ConnectTheDotsUSA.com
Med
icaid
/CH
IP
19% 62 Mil
Med
icare
14%
=45 M
illion
7% =
22 MilPlan
s
The
Uninsured28
Million9% =
1%
Veterans
Non-G
roup
Employer Plans
49% = 157 Million
2016
Tricare
1%
©2012
©2012
TM
Source: Kaiser Family Foundation (kff.org) based on Census Bureau March 2016 CPS-ASEC (census.gov)Hierarchy for sorting multi-covered people into only one category: Medicaid, Medicare, Employer, VA/Tricare, Non-Group
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/11/18
“Crazy-Quilt” metaphor by T.R. Reid, 2009
Med
icaid
/CH
IP
19% 62 Mil
Med
icare
14%
=45 M
illion
7% =
22 MilMilPlan
s
The
UninsuredThe
Uninsured28
Million28
Million9% =
1%
Veterans
Non-G
roup
Employer Plans
49% = 157 Million
2016
Tricare
1%
U.S. Healthcare
System
Skilled Providers
State-Of-The-Art
Technology
Accessible
Affordable
Efficient
©2012
Source: Kaiser Family Foundation (kff.org) based on Census Bureau CPS-ASEC (census.gov)Hierarchy for sorting multi-covered people into only one category: Medicaid, Medicare, Employer, VA/Tricare, Non-Group
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/8/18
Despite Improvements,ACA Still Leaves 28 Million Uninsured
And Millions More Underinsured
Despite Improvements,ACA Still Leaves 28 Million Uninsured
And Millions More Underinsured
VA & Tricare
2016
Medicare14% =
45 Million
Non-Gro
up
7% = 22 Mil
Un
insu
red
9% =
28
Mil
Medicaid/CHIP
19% =62 Million
Employer Plans49% =
157 Million
VA & Tricare
2010
Medicare13%
Non Group
5%
Medicaid/CHIP16%
Uninsured16%
Employer Plans49%
Total Population: 306 Million
Total Population:320 Million
Source: Organization for Economic Cooperation Development, Health at a Glance 2017, Feb 2018Fig 7.3 on pg 135 and Fig 7.1 on pg 133 (oecd.org) and OECD Health Expenditures and Financing (stats.oecd.org)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated12/4/18
Health Spending By Country 2016Health Spending By Country 2016
Japan
10.9%$4,519
Austra
lia
9.6%$4,708
Finla
nd
9.3%$4,033
OECD Avg
9.0%$4,003
Norway
10.5%$6,647
United
Kingdom
9.7%$4,192
Denmark
10.4%$5,205
Switzerla
nd
12.4%$7,919
Canada
10.6%$4,753
Germany
11.3%$5,551
Sweden
11.0%$5,488
France
11.0%$4,600
USA
8.5%
8.7%
17.2%$9,892
Private Expenditure
Public (Govt) Expenditure
$ Spending Per Capita (USD PPP)
U.S. spends far more overall($3.5 trillion in 2017), spends fargreater % on private, but still leaves 28 million uninsured and many underinsured.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%% of GDP
Health Spending Per Capita By CountryHealth Spending Per Capita By Country
Source: Organization for Economic Cooperation Development –Health Expenditures and Financing (stats.oecd.org)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 12/5/18
Pu
rch
asin
g P
ow
er P
arit
y (P
PP
) Ad
just
ed
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015NIXON FORD CARTER REAGAN BUSH 1 CLINTON OBAMABUSH 2
USA: $10,209 (Crazy Quilt)
U.K.: $4,246 (Socialized Medicine)
Overall CPI Inflation (US)
Switzerland: $8,009 (Regulated Privatewith Mandate)
Canada: $4,826 (Single Payer)
Denmark: $5,183 (Single Payer)
America’s Healthcare “Crazy Quilt” system is costly and inefficient: We now spend more than twice the per person average of all other industrialized countries.
OECD Avg:$4,003 (2016)
2014 ACA: 20 Million more Americans begin to get coverage.
Source: Kaiser/HRET Employer Health Benefits Survey, Oct 3, 2018, Figures 5 & 2 (kff.org)Family of 4 avg total health spending: 2018 Milliman Medical Index, May 2018 (milliman.com)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 12/5/18
Runaway Health Premiums Eat AwayAt Wages & Burden Employers
Runaway Health Premiums Eat AwayAt Wages & Burden Employers
0%
50%
100%
150%
200%
250%
300%
’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ’17 2018
+ 68%+ 51%34%
29%
Cumulative IncreasesTotal Avg Family Premium(Employer Plan)
Worker Contribution
Employer Contribution
Workers’ Earnings
Overall Inflation
+ 239%+ 259%
119%1999 Total: $5,791Worker: $1,543Employer: $4,247
2018 Total: $19,616
Worker: $5,547Employer: $14,069
+ 231%
117%120%
In 2018, avg Total Health Spending for
Family of 4was $28,166!
(Premiums &Out-of-Pocket)
Source for 1995-2013: Blue Cross Rate Sheets for Preferred PPO, Pima County AZ, $1,000 Deductible & 20% CoinsuranceSource for 2014-2018: Healthcare.gov for Pima County AZ, Gold Plan: $1,000 to $1,400 Deductible
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/30/18
Individual Plan Health Premiums: Costs Were Skyrocketing Long Before ACA
Individual Plan Health Premiums: Costs Were Skyrocketing Long Before ACA
$170
100
$ 0
200
300
400
500
600
700
800
900
1,000
1,100
1,200
1995 ’96 ’97 ’98 ’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ’17 ’18 2019
Monthly Premiums(Based on “Gold Level Plan”:approx $1,000 to $1,400 Deductible& 20% coinsurance)
64 yr Male54 yr Female Female Aging 31 to 55 yrs Overall Inflation
ACA Marketplaces Open 2014:Pre-existing conditions & essential benefits must now be covered;No annual or lifetime caps; 80% of enrollees get tax credits that greatly defray these retail prices.
$382$382$403
$140
$457
$215
$587$587
$1,078$1,078
$696
$300
$120$120$121
Projectio
n w/o
ACA
$73 8 in
sure
rs &
119
pla
ns
On
ly 1
insu
rer
& 4
pla
ns
3 in
sure
rs &
16
pla
ns
AC
A P
asse
sM
arch
201
0
80/2
0 R
ule
Take
s Ef
fect
$73 On
ly 1
insu
rer
& 2
pla
ns
$418$418
$801$801
$767$767
Sources: International Federation of Health Plans, “2015 Comparative Price Report,” July 19, 2016 (ifhp.com)“The U.S. Pays a Lot More for Top Drugs than Other Countries,” Bloomberg News, Dec 18, 2015 (bloomberg.com)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/13/18
••••••••••••••••••••••••••••••••••••••••••••••••••••••$78,318$78,318
avgUSA
$24,059U.K.
$32,480NEW ZEALAND
$765AUSTRALIA
$2,142NEW ZEALAND
HIP REPLACEHIP REPLACE
$29,067$29,067avgUSA
$6,757SPAIN
$16,335U.K.
MRI SCANMRI SCAN
$1,119$1,119avg
USA$503
AUSTRALIA$215
SWITZERLAND
BABY DELIVERYBABY DELIVERY
$10,808$10,808avg
USA
$1,950SPAIN
$5,312AUSTRALIA
HOSPITALSTAY (1-DAY) HOSPITALSTAY (1-DAY)
CORONARY BYPASSCORONARY BYPASS
Because U.S. has a wide range of prices for same procedures, average prices are shown here; Dollars are $US
$155USA $155USA
$74CANADA
$74CANADA
$38GERMANY
$38GERMANY
ADVAIRADVAIR (30-DAY SUPPLY)
$5,220$5,220avgUSA
U.S. Prices Are Too Darn High!U.S. Prices Are Too Darn High!
©2012
Sources: Chris Rock, “Bigger & Blacker,” 1999 and“Wall Street Admits Curing Diseases Is Bad For Business,” Lee Camp, April 24, 2018 (truthdig.com)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 5/25/18
— Chris Rock
“There ain’t no money in the cure; the money’s in the medicine.
That’s how you get paid — on the comeback. That’s how a drug dealer makes his money — on the comeback.”
Curing Diseases Is Bad For BusinessCuring Diseases Is Bad For Business
For more on this topic, see Wendell Potter, Deadly Spin: An insurance company insider speaks out on how corporate PR is killing health care and deceiving Americans, 2010
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/29/17
PRE-EXISTING
CONDITION
EXCLUSIONS
LOSE
YOUR JOB;
LOSE YOUR
COVERAGE
POLICY
RESCISSIONS
& CLAIM
DENIALS
SMALL
BUSINESS
PURGING
COVERAGE
GAPSPRICED
OUT OF
MARKET
CRAZY
HIGH
DEDUCTIBLE
PLANS
LIFETIME
& ANNUAL
CAPS
OUT OF
NETWORK
Bef
ore
AC
A
ACA plugged some ofthe worst holes, but more work to be done!
©2012
©2012
©2012
20% –25%Drain:
Admin, Ads, Profits,Excessive Executive
Pay & Bonuses
For more on this topic, see Wendell Potter, Deadly Spin: An insurance company insider speaks out on how corporate PR is killing health care and deceiving Americans, 2010
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/29/17
“We at Big Insurance will even kick sick children to the curb, but we pay a nice juicy dividend to our share-holders (aka our real customers). At least our death panels turn a profit. The more people and claims we deny and delay, the more money we make. The system works for us!”
ACA Banned Cherry-Picking Only The HealthyACA Banned Cherry-Picking Only The Healthy
Source: “What Health Insurance Does Cover, and Doesn’t,” New York Times, April 20, 2011 (NYTimes.com)Based on a report on employer-sponsored health insurance coverage from the Department of Labor
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/29/17
0% 10 20 30 40 50 60 70 80 90 100
Physician Office Visits Hospital Room & Board
ER VisitsOutpatient Mental
Inpatient Drug RehabPhysical Therapy
Durable Medical EquipMaternity Care
AmbulanceOb/Gyn Exams
ProstheticsOrgan/Tissue Transplants
Infertility TreatmentKidney Dialysis
Diabetes ManagementSterilization
Outpatient Drug Rehab
100%99%
91%85%
79%78%
70%67%66%
64%60%
46%45%
27%27%27%26%
2011:% of PrivateEmployer-SponsoredHealth Plansthat Cover a Given Service
“Covered,” benefits often still involve deductibles,copays and cost-sharing
Read The Fine Print: Before ACA,Read The Fine Print: Before ACA,Having Insurance Having CoverageHaving Insurance Having Coverage
Sources: Uninsured–U.S. Census Bureau Report 2011 (census.gov); Deaths – “Health Insurance and Mortality in US Adults,”American Journal of Public Health, Dec 2009; Bankruptcies –“Medical Bankruptcy in the U.S. 2007,” American Journal of Medicine, Aug 2009
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/29/17
©2012
50,000,00050,000,000in U.S. Had No Health Insurance
44,000/yr44,000/yr
600,000/yr600,000/yrWent Bankrupt Due to Medical Bills
Died Because of Lack of Insurance
Before ACABefore ACA
Source: Organization for Economic Cooperation Development, Health at a Glance 2017, pg 59 (oecd.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/8/18
Infant deaths per 1,000 of live birthsin 2015
U.S. Spends The Most, But Has High Infant Mortality Rate
U.S. Spends The Most, But Has High Infant Mortality Rate
Turkey
10.7
Chile7.
2China
9.2
Unit
ed Sta
tes
5.8
Poland4.
0Hungary
4.2
New Zealand5.
0
United Kingdom
3.9
Canada4.
8
Switzerla
nd3.
9
Netherla
nds3.
3
Australia
3.2
Belgium3.
3
France
3.7
Germany
3.3
Denmark
3.7
Italy
2.9
Ireland
3.4
Greece
4.0
Austria
3.1
Portugal
2.9
Sweden2.
5Spain
2.7
Norway
2.3
Finland1.
7Ja
pan2.
1
Iceland2.
0
Mexico12
.5
Source: Organization for Economic Cooperation Development, Health at a Glance 2017, pg 49 (oecd.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/15/18
U.S. Spends The Most, But Has Lower Life Expectancy Than Peers
U.S. Spends The Most, But Has Lower Life Expectancy Than Peers
2015 Health Spending Per Person(U.S. dollars, purchasing power parity)
Life
Exp
ecta
ncy
201
5
$2,000 $4,000 $6,000 $8,000 $10,00070
YEARS
75
80
85
USA
©2012
HUNGARYBRAZIL LITHUANIA
COLUMBIALATVIA
RUSSIA
SLOVAKIAPOLAND
ESTONIA CZECH REPUBLIC
DENMARK
AUSTRIA
NORWAY SWITZERLANDFRANCE
AUSTRALIA
BELGIUM
NETHERLANDS LUXEMBOURG
IRELANDFINLAND
CANADAUK
JAPANITALYSPAIN
NEW ZLD
ICELAND
PORTUGALCOSTA RICA SLOVENIA
GREECEKOREA
ISRAEL
MEXICO
TURKEY
CHILE
CHINA
SWEDEN
GERMANY
Sources: Health Financing – stats.oecd.org; Uninsured Rate and Employer Plan Premium – kff.org Deaths – Extrapolated from Amer. Journal of Public Health, Dec 2009; Bankruptcies – Amer. Journal of Medicine, Aug 2009
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/24/18
Current U.S. Heathcare “Crazy Quilt”Is Complex, Costly And Cruel
Current U.S. Heathcare “Crazy Quilt”Is Complex, Costly And Cruel
31MILLIONUNINSUREDand millions more
underinsured (2017)
600THOUSANDGO BANKRUPT
per year due to medical bills
500BILLIONPAPERWORKwaste per year due to too many payers
28THOUSANDUNINSURED DIE
per year due to lack of insurance
3.3TRILLIONSPENT IN 2016
= 18% of economy; 2/3 is tax-financed
$ 10THOUSANDPER PERSON= more than twice
the OECD avg
$ 19.6THOUSAND2018 PREMIUMemployer family plan(employee paid 28%)
$ 50TRILLION
2019-2028estimated cost
over next decade
$
$©2012
Source: “Premium Support Is the Wrong Direction for Medicare,” AARP Public Policy Institute, Oct 2017 (aarp.org) Note: See cartoon on this theme on the color slides
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 6/15/18
“It’s a vision that says America can’t afford to keep the promise we’ve made to care
for our seniors. It says that ten years from now, if you’re a 65-year-old who’s eligible
for Medicare, you should have to pay nearly $6,400 more than you would today.
It says instead of guaranteed health care, you will get a voucher. And if that voucher
isn’t worth enough to buy insurance, tough luck — you’re on your own.”
“Put simply, it ends Medicare as we know it.”— President Obama (April 2011)
Cost Shifting Is No Solution
Cagle Cartoon: © 2011 Copyright Dave Granlund. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
Cos
t Shi
ft
Sol
utio
n
For more on this topic: David Sirota, Hostile Takeover: How Big Money & Corruption Conquered Our Government – And How We Take It Back,, 2007, pgs 154-204
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/27/17
Pay Your Doc Chickens!
Death Panels: Govt Bureaucrats Ration Care • It’s profit-obsessed private insurers who regularly deny people and claims.
Buy Insurance Across State Lines• Race-to-bottom to avoid even meager state regulations.
Everyone Gets Care: Just Go To ER!• ER only mandated to stabilize patient: No chemo in the ER!• Most expensive care: Leads to bankruptcies and cost shifting.
High-Risk Pools For Sick People• Premiums way too high, govt subsidies grossly inadequate, coverage skimpy
Health Savings Accts & Even Higher Deductibles• Only suited for relatively wealthy and healthy with extra disposable income.
Tort Reform For “Crisis Of Junk Lawsuits”• Defensive medicine = only 1% to 2% of total health spending. • Capping damages at $250,000 limits patient protection and victims’ rights.
1
2
3
5
6
4
GO
P M
yths
& N
on-S
olut
ions
GO
P M
yths
& N
on-S
olut
ions
Source: U.S. Dept of Health & Human Services, Medical Expenditure Panel Survey,Statistical Brief #455, Oct 2014 (meps.ahrq.gov)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/18/17
of Patientsof PatientsFiguring out how to
take care of the chronically sick is the trillion dollar question.
Preventive care, coordinated care, education, and getting everyone insured will help decrease costs.
of Costsof Costs
©2012
Source: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/19/17
March 2010: Patient Protection & Affordable Care Act (aka ACA) March 2010: Patient Protection & Affordable Care Act (aka ACA)
Preventive Services Must Be Free (No Copay/Deductible)
Young Adults Under 26 Yrs Eligible To Stay On Parents’ Policy
Banned Policy Cancellations When You Get Sick
Banned Lifetime Caps & Gradually Phased Out Annual Caps By 2014
Banned Pre-Existing Condition Discrimination:Began in 2010 for Children Under 19 Yrs Began in 2014 for Everyone Else
Provisions In Effect Since 2010 (or 2014)
Slide 1 of 2
12
34
5
Source: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 12/16/17
Other Provisions Since 2010 (or 2014)ACA: But Wait, There’s More!ACA: But Wait, There’s More!
6
7
8
9Slide 2 of 2
$3,7
50
$8,4
18
At Least 80% Of Premium Dollars (85% In Large Group Plans) Must Be Spent On Actual Health Services
Small Biz Health Insurance: 35% Tax Credits (50% In 2014)
50% Discount For Seniors Who Fall Into Rx Drug “Donut Hole”; Closes Hole By 2020
2014: Medicaid Expansion and Tax Credits for Individuals & Families to Buy Private Insurance
Source: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/4/17
Jan 1st 2014 (aka “Liberation Day”)Jan 1st 2014
(aka “Liberation Day”)
HEALTH INSURANCEEXCHANGESAH
BEAH
BE
SHOPSHOP
• Companies Compete For Your Business: Easy Comparison Shopping
• Policies Must Meet Minimum Standards (No Junk Allowed!)
• Individuals, Families & Small Biz Welcome
• No Discrimination Based On Health Status, Gender, Job, Etc. *
*Rates can vary only by Geography, Age (3:1) & Tobacco Use (1.5 :1)
Affordable Care Act
©2012-2017 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
NEED TNEED TAXREVENUESREVENUESNEED TAX
REVENUES
GOVTSUBSIDIESSUBSIDIES
GOVTSUBSIDIES
FREE-FREE-RIDERRIDER
PROBLEM
FREE-RIDER
PROBLEM
It’s All Connected:Why Piecemeal Doesn’t Work
It’s All Connected:Why Piecemeal Doesn’t Work
Or go Medicare-For-All:Pay for healthcare like we
pay for roads and military — through the tax system.©2012
ENDENDPRE-EXISTINGRE-EXISTING
CONDITIONDISCRIMINATION
ENDPRE-EXISTING
CONDITIONDISCRIMINATIONGUAR
ANTE
EDIS
SUE MANDATE TO INSURANCE
CO’S
INDIVIDUALMANDATE
INDIVIDUALMANDATE
1993
G
OP ORIGINAL
1986 Emergency Medical Treatment and Active Labor Act (EMTALA) was signed by President Reagan©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
THE ONE-SIDEDTHE ONE-SIDEDTHE ONE-SIDED
Just Shifts Costs To OthersJust Shifts Costs To Others
Cost Shift = Avg $1,000/yr Per Family
1986 Federal mandate that ERs provide stabilizing
treatment to everyone regardless of ability to pay
shifts costs of unpaid services for the uninsured to
hospitals, which then shift the costs to the insured.
Sources: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/28/18
FREE
-RID
E
EMPLOYER
*Exemption for small businesses with
fewer than 50 employees. Subtract first
30 employees from payment calculation.
ANNUAL TAX PENALTY:$2,000 per Full-Time Employee
ACA Tickets To Free-Ride
ACA Tickets To Free-Ride
FREE
-RID
E
INDIVIDUAL
ANNUAL TAX PENALTY: Greater of...
2014: $95/adult or 1% of income
2015: $325/adult or 2% of income
2016: $695/adult or 2.5% of income
Children under 18 yrs are half-price
*Exemptions for religious objections or if cost
of insurance exceeds 8.0% of annual income
after subsidies; No penalty if uninsured less than
3 months of year.
Began Jan 1, 2014
Responsibility Mandates
Responsibility Mandates
Began Jan 1, 2015 for +100 employees & Jan 1, 2016 for 50-99 employees.
GOP made penalty $0 starting 2019 (effectively repealing it)
For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/29/18
Began Jan 1, 2014
Affordable Care Act:Help With Access & Affordability
Affordable Care Act:Help With Access & Affordability
Expands Medicaid Eligibility(Program For Low-Income)
Expands Medicaid Eligibility(Program For Low-Income)Up To 138% Federal Poverty Level
Individuals with incomes below $16,753 (for 2019)
Families (of four) with incomes below $34,638 (for 2019)
Individuals with incomes$12,140 to $48,560 (for 2019)
Families (of four) with incomes $25,100 to $100,400 (for 2019)
To avoid burdening States,expansion of Medicaid*
100% financed by Federal govt 2014 thru 2016. Then phases down to
90% by 2020.
These households will pay as little as 2.08% and no more than
9.86% of income to buy mid-levelinsurance on the exchanges.
Max out-of-pocket costs capped at $7,900/individual and $15,800/family
or lower (2019).
Pre-existingConditionProtection
Hoorayfor ACA!
We’reCovered!
Sliding Scale Of Tax Credits For Low- & Middle-IncomeSliding Scale Of Tax Credits For Low- & Middle-Income
100% To 400% Federal Poverty Level
*Per Supreme Court June 2012 decision, States can opt out of Medicaid expansion. 36 states + D.C. have opted into the expansion as of Nov 2018.
Source: Kaiser Family Foundation, as of Nov 26, 2018 (kff.org)Per Supreme Court June 2012 decision, states can opt out of Medicaid expansion. In 2014, 25 states opted out.
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/30/18
GOP Blocking Medicaid ExpansionIn 14 States — Where Most NeededGOP Blocking Medicaid Expansion
In 14 States — Where Most Needed
Accepting (36 + DC)
Rejecting (14)
MedicaidExpansion
Status
WAMT ND
MN
IA
MO
AR
LA
IL
WIMI
IN OHPA
NY
ME*
NHMA
CTNJ
DE
DCMD
RI
VT
KYTN
MS AL GA
FL
SCNCVA*WV
SD
NE*
KS
OK
ID*
NV
AZ
UT*CO
NM
TX
CA
OR
WY
AK
HI
*4 states approved in 2018 to begin in 2019. Maine approved by ballot in 2017 but was blocked by recently termed-out GOP governor.
©2012©2012
Sources: Incomes as % of FPL (FamiliesUSA.org); Premium calculator (kff.org/interactive/subsidy-calculator) For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/29/18
100%FPL
$12,140
$16,460
$20,780
$25,100
$29,420
138%FPL
$16,753
$22,715
$28,676
$34,638
$40,600
150%FPL
$18,210
$24,690
$31,170
$37,650
$44,130
200%FPL
$24,280
$32,920
$41,560
$50,200
$58,840
250%FPL
$30,350
$41,150
$51,950
$62,750
$73,550
300%FPL
$36,420
$49,380
$62,340
$75,300
$88,260
350%FPL
$42,490
$57,610
$72,730
$87,850
$102,970
400%FPL
$48,560
$65,840
$83,120
$100,400
$117,680
HOUSEHOLDSIZE
1
2
3
4
5
TABLE 1: Incomes as Percentage of 2018 Federal Poverty Level (FPL)
100%FPL
2.08%$21 /mo
$29 /mo
$36 /mo
$44 /mo
$51 /mo
138%FPL
3.42%$48 /mo
$65 /mo
$82 /mo
$99 /mo
$116 /mo
150%FPL
4.15%$63 /mo
$85 /mo
$108 /mo
$130 /mo
$153 /mo
200%FPL
6.54%$132 /mo
$179 /mo
$227 /mo
$274 /mo
$321 /mo
250%FPL
8.36%$211 /mo
$287 /mo
$362 /mo
$437 /mo
$512 /mo
300%FPL
9.86%$299 /mo
$406 /mo
$512 /mo
$619 /mo
$725 /mo
350%FPL
9.86%$349 /mo
$473 /mo
$598 /mo
$722 /mo
$846 /mo
400%FPL
9.86%$399 /mo
$541 /mo
$683 /mo
$825 /mo
$967 /mo
HOUSEHOLDSIZE
Based on Max Annual Premium You Pay as a % of Your Household Income
Base
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ere.
For general informational purposes only; provided without warranty or guarantee. Consult Marketplace at HealthCare.gov.
TABLE 2: Maximum Monthly Premium You Pay For Benchmark Silver Plan(Federal govt pays any balance of non-smoker Silver premium owed to insurance co.)
12345
In 32 states + D.C. opting in, households below 138% of FPL will qualify for Medicaid expansion instead.
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ax C
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ays
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For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)Premium calculator: kff.org/interactive/subsidy-calculator; FPL = Federal Poverty Level
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/29/18
Marketplace Plans: The Metal LevelsMarketplace Plans: The Metal Levels
Higher Premiums& Lower Consumer
Cost-Sharing
Lower Premiums& Higher Consumer
Cost-Sharing
100% to 250% FPL also Eligible for Cost-Sharing Subsidies to Reduce Out-of-Pocket Costs. Must enroll in Silver plan for cost-sharing subsidies.
Platinum 90% 10%
Gold 80% 20%
Silver 70% 30%
Bronze 60% 40%
Plan TypePlan Pays
% of Total CoveredExpenses (on Avg)= Actuarial Value
Consumer Paysfor Deductibles,
Co-pays & Coinsurance(on Average)
Max out-of-pocket annual limit of $7,900 individual / $15,800 family(excluding premiums). Lower for households < 250% FPL
Source: Health Tracking Poll: Nov 28, 2018, Kaiser Family Foundation (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/28/18
ACA Provisions Very PopularACA Provisions Very Popular% Support(Note: ACA = ObamaCare)
Can stay on parents’ insurance until age 26
Insurance exchanges to compare prices & benefits
Govt financial assistance to help buy coverage
Closes donut hole in Medicare Rx drug plans
No out-of-pocket costs on preventive services
Medicaid expansion to cover more low income people
Large employer mandate to provide health insurance
Bans pre-existing condition discrimination
Increases Medicare payroll tax on high incomes
Favorable opinion of ACA/ObamaCare overall
82%
82%
81%
81%
79%
77%
69%
65%
65%
53%
Quote by T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2010, pg 251 ©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
For All?“(The Affordable Care Act) should extend insurance coverage to
millions of Americans who are uninsured now and end some of the insurance companies’ harsher practices. But the sad truth is
that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the
most inequitable health care system of any developed nation.”
Quotes: Steven Brill, “The Bitter Pill: Why Medical Bills Are Killing Us,” Time Special Report, March 4, 2013 ©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • www.ConnectTheDotsUSA.com • Updated 2/9/14
U.S. Healthcare Is No MarketplaceU.S. Healthcare Is No Marketplace“(We) are powerless buyers in a seller’s market
where the only sure thing is the profit of the sellers.”
— Steven Brill, “The Bitter Pill”
“Unless you are protected by Medicare,
the health care market is not a market at all.
It’s a crapshoot. People fare differently
according to circumstances they can neither
control nor predict... (T)hey have little
visibility into pricing, let alone control of it...
They have no idea what their bills mean,
and those who maintain the chargemasters
couldn’t explain them if they wanted to.”
Sources: HealthOverProfit.org; Fix It: Healthcare at the Tipping Point (documentary), 2016 (FixitHealthcare.com) Calculate your savings with “Expanded & Improved Medicare For All Act” (HR 676) at hcfat.org
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 8/21/17
Medicare-For-All:Healthcare Is A Right1
2
3
4
5
Universal & Comprehensive: Enhances and extends Medicare to all.
Simple & Cost-Effective: Ends maze of for-profit insurance costs, medical bills/debt; Negotiates lower drug prices.
Freedom & Choice: Go to any doctor or hospital in the entire U.S.
Good for Business: Gets insurance burden off backs of businesses; Frees entrepreneurs from job lock.
Big Savings for 95% of Americans
©2012
©2012
©2012
©2012
$$$$$$$$$$
$$$$$$$$
$$
Source: Congressional Budget Office, “Cost Estimate: American Health Care Act,” Mar 13, 2017, Table 2 (pgs 32-33) (cbo.gov)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 3/20/17
Ends Medicaid Expansion & Guts Original Medicaid Thru Fed Caps
Skimpier Insurance Premium Tax Credits ($361 B instead of $673 B)Hits older, lower-income, rural and sick Americans especially hard;Ends cost-sharing subsidies that help lower deductibles, co-pays, etc.
Ends Small-Employer Tax Credits
–($ 880 B)
–($ 312 B)
–($ 6 B)
2017-2026
2017-2026
Repeals 0.9% Add. Medicare Payroll Tax on High IncomesRepeals 3.8% Capital Gains Medicare Tax on High Incomes
>$200,000 single/>$250,000 married currently subject to Medicare payroll tax of 3.8% instead of 2.9%; includes investment income over that threshold.Medicare Part A (Hospital) Trust Fund will run out 3 yrs earlier (by 2025)
Repeals Taxes on Big Insurance, Big Pharma & Medical Device Cos.Repeals Insurance Mandate (Individual = $38 B; Employer = $171 B)
More Tax Deductions for Health Savings & Flexible Spending Accts
–($ 117 B)–($ 158 B)
–($ 189 B)–($ 209 B)–($ 37 B)
24 Million Low/Mid-Income Lose Coverage
Wealthy Get HUGE Tax Breaks
Trump/Ryan/GOP “WealthCare” Trump/Ryan/GOP “WealthCare”
©2012
©2012
(in $ Billions)
Sources: Congressional Budget Office, Cost Estimate of AHCA, Mar 13, 2017, Table 4 (pg 34); Cost Estimate of BCRA, June 26, 2017, Table 5 (pg 48) (cbo.gov); Medicare-For-All calculator (hcfat.org)
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/13/18
The
Bes
t Pla
n Is
So
Sim
ple!
The
Bes
t Pla
n Is
So
Sim
ple!
*GOP Plans allow insurance co. to charge 64yr old 5x more than 21yr old (ACA capped this at 3x more).**GOP Plans end ACA cost-sharing subsidies that lower deductibles, co-pays, co-insur. for 100% to 250% FPL.
House GOP Plan = AHCA (aka Ryan/TrumpCare)21 yr old40 yr old64 yr old
$3,900$6,050
$19,500*
$2,450$3,650$4,900
$1,450 (= 5.5%)
$2,400 (= 9.1%) $14,600 (= 55.1%)
65% = Bronze**
HIGH deductible,co-pays, co-insur.)
Senate GOP Plan = BCRA (aka McConnell/TrumpCare)21 yr old40 yr old64 yr old
$4,100$6,400
$20,500*
$1,900$3,400
$14,000
$2,200 (= 8.3%)
$3,000 (= 11.3%)
$6,500 (= 24.5%)
70% = Silver**
MEDIUM deductible,co-pays, co-insur.
Current Law = ACA (aka ObamaCare)21 yr old40 yr old64 yr old
$5,100$6,500
$15,300*
$3,400$4,800
$13,600
87% = Gold**
LOW deductible,co-pays, co-insur.
$1,700 (= 6.4%)
$1,700 (= 6.4%)
$1,700 (= 6.4%)
Medicare-For-All (= Single-Payer)Household pays 3.0% of income (employer payroll tax) $795 (= 3.0%)
100% CoveredNo cost-sharing
Single Individual With Annual Income of $26,500 in 2026Annual Retail
PremiumAge Premium
Tax Credit
Net PremiumPaid by Enrollee(and as % of income)
Actuarial Valueof Plan
(higher % is better)
Cagle Cartoon: © 2011 Copyright Dave Fitzsimmons. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
Cagle Cartoon: © 2009 Copyright Dave Fitzsimmons. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012
Other Resources: Compare health care systems around the world: international.commonwealthfund.org T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2010
©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/29/18
Medicare-For-All: Action Plan!Medicare-For-All: Action Plan!Learn More: ResourcesConnectTheDotsUSA.com: Medicare-For-All presentationKaiser Family Foundation: kff.org (general health data)Physicians for a National Health Program: pnhp.orgHealthOverProfit.org and hcfat.org (HR 676 Calculator) FixItHealthcare.com Show Up: Push Medicare-For-All Into The Debate
Litmus Test: Must Pledge To Co-Sponsor Medicare-For-All For Your Vote; Support JusticeDemocrats.com Candidates
1
2
3
Former Rep. Alan Grayson quote from email of Jan 4, 2012©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/13/18
“For God’s sake — every single other industrialized country in the entire world has universal health care. Why can’t we?
How many more people have to die? How many more sacrifices on the altar of Almighty Greed?
Any health care system that denies necessary care on the basis of wealth is evil. It doesn’t matter how
you micromanage it, or tinker with it. It’s evil... End of story.”
— Former U.S. Representative Alan Grayson
PEOPLEOver ProfitsOver Profits
©2012
©2012
©2012
ConnectTheDotsUSA.com
CIVICS AND POLICY BASICS F O R T H E B U S Y M A J O R I T Y ™
“Busy Majority” said by Jon Stewart, Sept 2010 ©2010-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com
Presentation updated 12/6/18
Graphic updated 2/26/18
©2010
JOBSWAGESECONOMY
HEALTHCARE
©2012
BUDGETTAXES
©2011
VOTING
FRAMING
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