A Roadmap for Achievable Health Care

ReformKaren IgnagniPresident and CEO

America’s Health Insurance Plans

November 13, 2007

Access ChallengesUninsured Trends

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2005, Census Bureau.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

General Population Low Income (<$25,000)

Moderate Income($25,000 to $49,999)

Upper ModerateIncome ($50,000 to

$74,999)

Growth in Uninsured Rate from 2004 to 2005 (Percentage Points)

Bumps in the Road: Quality Gaps

Evidence Based Medicine: Immediate Improvements Necessary Results of Studies on the Adoption of Evidence Based Medicine

24% Diabetics who received recommended blood-sugar tests over a

2-year period

65% Hypertensive patients who received recommended care

68% Patients with coronary artery disease who received

recommended care

45% Patients with myocardial infarction who received beta-

blockers

64% Elderly patients who received or were offered a

Pneumococcal vaccine

Source: America’s Health Insurance Plans Issue Brief: Making Evidence-Based Medicine The Cornerstone of the U.S. Health Care System

Source: Congressional Budget Office Analysis of Medicare Spending Based Upon the Dartmouth Atlas

Quality ChallengesVariation in Medical Practice

TrendsHow Rising Costs Affect Coverage

0

2

4

6

8

10

12

14

16

18

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Pe

rce

nt

Source for Premiums and Expenditures: Centers for Medicare and Medicaid Services, National Health Expenditures by Type of Service and Source of Funds. Source for uninsured: U.S. Census Bureau.

Uninsured Rate

National Health Expenditures

Private Health Insurance Premiums

Sources: NIH Data Book; Research!America, Investment in U.S. Health Research 2001, 2002, 2004 and 2005

Cost ChallengesTechnology Spending

U.S. Investment in Health Research and Development ($ Billions)

$0

$20

$40

$60

$80

$100

$120

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

Source: The Factors Fueling Rising Healthcare Costs 2006; PricewaterhouseCoopers; 2006

Cost ChallengesCost and Utilization of Care Drive Premium Growth

Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October 2007

Why is U.S. Health Care Spending So High Compared to Other Nations?

0%

10%

20%

30%

40%

50%

60%

HeartDisease

High BloodPressure

Cancer Diabetes Obese NeverSmoked

Prevalence of Diseases and Lifestyle Choices

United States Europe

Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October 2007

Why is U.S. Health Care Spending So High Compared to Other Nations?

0%

20%

40%

60%

80%

100%

Heart Disease High Blood Pressure Chronic LungDisease

High Cholesterol Asthma

Proportion of Prevalent Cases Reporting Medication Use Associated with the Condition

United States Europe

What We Have ProposedAddressing Access

SCHIP up to 200% FPL

Medicaid up to 100% FPL

Child Health Credit up to 300% FPL

Universal Health Account with subsidies up to 400% FPL

State Performance Grant

What Voters Think of These ProposalsWhat Voters Think of These Proposals

Question: Now I am going to read some different ideas that some people have proposed for providing health care coverage for people who are currently uninsured. Would you please

tell me if you support or oppose each idea.

Question: Now I am going to read some different ideas that some people have proposed for providing health care coverage for people who are currently uninsured. Would you please

tell me if you support or oppose each idea.

Giving a federal tax credit to low and moderate income parents

Increasing funding for health insurance program for children

Providing grants from the federal government

Having the federal government match contributions

Giving federal tax deduction for purchase of private insurance

Expanding the federal government’s Medicaid program

Establishing a tax-free Health Account for all Americans 65%

69%

69%

69%

71%

77%

85%

Ranked by Percent “Support”

83%

65%

63%

75%

54%

66%

59%

88%

89%

77%

68%

82%

65%

82%

83%

75%

67%

69%

67%

64%

69%

Rep Ind Dem

Create a new entity for comparative effectiveness

Set a national research agenda to address gaps in evidence

Accelerate efforts to give patients and their physicians the necessary information to make value-based decisions

Emphasize the adoption of best practices

Develop innovative tools to help physicians and patients manage chronic conditions

Create a new medical dispute resolution system to resolve disputes fast, fairly, and effectively

What We Have ProposedAddressing Quality

Disease management, care coordination and prevention programs

Pay for performance

Investments in health information technology

More information regarding the cost and quality of care

Consideration of a reinsurance program to help pay for experimental therapies to make emerging therapies more accessible

Medical liability reform

What We Have ProposedAddressing Costs

The challenges are palpable to the public

Health care is number one domestic policy issue among voters

Solutions must appeal to red, blue and purple electorate

Must address costs, quality and access together to enact effective reform

Conclusion