Affordable Care Act: A strategy for effective implementation 2012 Budget: $26 million U.S. PIRG...
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Transcript of Affordable Care Act: A strategy for effective implementation 2012 Budget: $26 million U.S. PIRG...
Affordable Care Act:A strategy for effective implementation
2012 Budget: $26 million
U.S. PIRGOctober 12, 2012
Objective
1972 – Universal coverage
2010 – Affordable Care Act enacted
Coverage for 95% of all Americans by 2020
What the law does
Improves quality and control costs
Promotes public health
Expands health care workforce
Covers nearly all Americans
Subsidies Exchanges Medicaid expansion Insurance reforms Individual mandate
ACA Coverage Framework
Targeted State
Strategy
Technical
Assistance
MonitoringConsumer Engagement
Successful Implementation in Target States
National Programs
State-Based Programs
Strategy – 2011-2014
AlabamaColoradoMarylandMichiganMinnesotaNew Mexico New YorkOregonRhode Island Virginia
RWJF 10 States
State Health Reform Assistance Network
Princeton University, Woodrow Wilson School
Focus on coverage expansions.
Theory of change: help diverse group of states develop and disseminate successful implementation models
Technical Assistance approach: • Multi-disciplinary team • Operational level technical assistance• Meet states where they are• Peer-to-peer learning• Inform federal policymaking• Sustained and nimble
Consumer Engagement
9
Insurers
Labor
ProvidersBusiness
Political parties
Consumer Engagement
10
Insurers
Labor
Providers
Consumers
Business
Political parties
Consumer Engagement
Health AffairsSeptember 2011
Challenges
• Complexity of the law
• Problems with the law
Remaining uninsured
Medicaid-eligible,
8.5M37%
Undocumentedimmigrants,
5.2 M23%
Exempt from individual mandate,
4.1M 18%
Not exempt from individual
mandate, 5M22%
23 million
Source: Urban Institute’s Health Insurance Policy Simulation Model (HIPSM).
Challenges
• Complexity of the law
• Problems with the law
• Partisanship
Partisanship
219 0 60 0
34 178 0 39
yeas
nays
Ds Rs D/Is Rs
House Senate
This is a problem . . .
Challenges
• Complexity of the law
• Problems with the law
• Partisanship
• Public opinion
• Legal challenges
Supreme Court Decision
• Individual mandate constitutional
• Medicaid expansion constitutional, but now a state option
Challenges
• Complexity of the law
• Problems with the law
• Partisanship
• Public opinion
• Legal challenges
• Budget debate
• Election
Direction on Health Care Awaits Verdict of Presidential RaceBy ABBY GOODNOUGH and ROBERT PEAR
Thursday, October 11, 2012
When Americans go to the polls, they will cast a vote for one of two profoundly different visions for the future of the country’s health care system.
• Partisan rhetoric heightened
• State implementation stalled
• Repeal possible
Election
Progress Establishing Exchanges
Michigan
California
Nevada
Washington
Arizona
Utah
Idaho
Montana
Wyoming
Nebraska
MaineVermont
North Carolina
Georgia
South Carolina
FloridaAlabama
Mississippi Louisiana
Texas
Oklahoma
Pennsylvania
Wisconsin
North Dakota
Ohio West Virginia
South Dakota
Arkansas
Kansas Missouri
Iowa
Illinois Indiana
Alaska
Hawaii
Tennessee
Kentucky
DelawareNew Jersey
Connecticut
Massachusetts
Virginia Maryland
Rhode Island
New Hampshire
States with exchanges by executive order or legislation
State with exchange grants
New York
Minnesota
Colorado
New Mexico
Oregon
Progress Establishing Exchanges
We have heard today that the reason for state inactivity is lack of guidance from HHS. But [then]one would expect the leading states to be confronting the most barriers and complaining the most loudly. . . In reality, the opposite is true. Those states are seizing the flexibility afforded them to pursue innovative approaches. Indeed, the primary factor contributing to this variation is the political climate in the states.
Heather HowardTestimony, House Ways and Means Subcommittee on HealthSeptember 12, 2012
Scenarios
Obama wins
Romney winsRepublican Senate
Romney winsDemocratic Senate
Law preserved
Law repealed
Law preserved
Questions
ACA preserved Change or modify strategy? Change states? Leading states? Middle tier? Hopeful? Focus on certain issues? Dissemination approach?
ACA repealed Stick with coverage? Explore what can be preserved, built on? Address other coverage-related issues? E.g., specific
populations? Innovative insurance models? Safety net?