COLORADO’S HEALTH CARE SYSTEMUnderstanding the Basics

Boomer’s Leading Change in Health Advocacy Course

©

Tonight’s Agenda

I. Introduction – The Big PictureII. Coverage optionsIII. A look at Colorado’s UninsuredIV. Healthcare Reform and

Implementation

Why do we need to know about how our health care system works?

Consider:

Is there a connection between a healthy population and a Nation’s strength?

We all need access to health care at some point in our lives.

What influences our health?

Our Actions

(exercise, diet,

smoking)

IncomePreventive Services

(immunizations, screenings)

Public Infrastructure

(hospital certification,

insurance commission, regulations)

Access to Quality

Health Care Public Health

(clean air, clean water, sanitation)

Social Factors

Some illnesses or injuries are unavoidable

How do we manage the risk?

Health Coverage!

What’s the role of Health Insurance? What is the role of the safety net? What to expect with reforms?

A unique system

Source: Kaiser Family Foundation

A growing gap

Health care costs have changed

Health insurance costs are rising rapidly for businesses and families

Average premium for employee coverage in Colorado doubled during the decade between 1996 and 2006

Colorado families spend 19%

of their income on health insurance Source: Center for Financing, Access and Cost

Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2001-2006.

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Why is it so darn expensive now?

Technology Drug Pricing Imbalance in market power between

patient and provider; insurer and purchaser

Administrative Overhead Profit-driven system (For-profit insurers &

hospitals) Defensive Medicine Misaligned provider incentives Demographics (e.g. aging population)

Suggested Solutions to Reduce Cost Better Information about systems (payment

reform) Better Use of Technology --Reduce Medical

Errors Evidence-Based Medicine Enabling Healthier Lifestyles Greater Emphasis on Public Health and

Environmental Conditions Explicit Assessment of Costs and Benefits of

Expensive New Treatments and Technologies Encourage Written Instructions for End of Life

Care

Cost shifting - a big problem

That Brings Us to the Safety Net

“Those providers that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients”

- Institute of Medicine

Why do we need a Safety Net?

Rate of employer sponsored health insurance

State Medicaid eligibility rules Number of undocumented immigrants Participation rate of private providers in

charity care Legal requirements (EMTALA, State and

local laws)

Types of Safety Net Providers

Public Hospitals Local Health Departments Community Health Clinics

Variety of sponsors FQHCs qualify for federal grants and enhanced

Medicaid reimbursement Physicians

Majority have some Medicaid patients in practice Many provide reduced cost or free care Combined charity exceeds that provided in clinics Physician participation in Medicaid and charity care decreasing

over time

Who Really Pays for the Safety Net?

Federal Enhanced hospital payments: Disproportionate Share

Hospital (DSH) / Indirect Medical Education (IME) Veterans Administration (VA) Community Programs: Indian Health Service (IHS),

HIV/AIDS, Maternal/Child, clinic grants, National Health Service Corps

State/local Tobacco settlement, general and/or designated tax funds

Cost shifting from paying patients Charity

Private contributions Volunteer health care providers

Sources of Uncompensated Funding, 2008

Source: Hadley et al, Health Affairs, 2008

)

Return to KaiserEDU.org

Total = $57.4 billion

Medicaid/ Medicare (DSH/IME

funds)

Community Programs

(IHS, HIV/AIDS,

Maternal/Child, Clinic,

NHSC)

VA

Charity 11%

Private Physicians

State/Local

32%

16%9%

18%

14%

Impacts of Health Reforms on Safety Net

How Does Availability of Safety Net Care Compare to Insurance? Both contribute to

improving access Health insurance has a

bigger impact on access than availability of a safety net

Health insurance is a more expensive strategy

Is the Safety Net Necessary with Universal Health Insurance? Segregating the poor in the

safety net may contribute to lower quality care

However: Safety net is an innovator in

care of vulnerable populations Safety net likely to remain an

important source of providers Immigrants, homeless and

others may not be eligible for universal programs

Colorado’s Uninsured TodayWho are they?

About 829,000 Coloradans are uninsured And this number is growing according the Colorado

Health Access Survey by Colorado Health Institute 150,000 Uninsured children (19% of our uninsured) 70% of uninsured families have at least 1 full-time

job An additional 15% have a part-time job

Challenges for employees who work for small business, are seasonal, in service sector, etc.

88% of uninsured cite cost as a major barrier to accessing health care

Underinsurance is also a big problem

Examples: High annual deductible Inadequate coverage levels Exclusions

1.5 million Coloradans are either uninsured, or underinsured

That’s 1 in 3 Coloradans

BUT The Winds are A-Changin’

Colorado has enacted several major state-level health reform efforts in the last few years HB09-1293 – Hospital Provider fee HB10-1330 – All Payer Claims Database HB10-1008 – Prohibiting Gender Rating SB11-08 – Medicaid Alignment for Children SB11-128 – Child only health plans SB11-200 – Health Benefit Exchange

The Federal Changes

In March 2010, the Patient Protection and Affordable Care Act was signed into law

How will the Affordable Care Act change our health care system?

Responsibility for individuals and employers More people in the pool

Health Care Exchange More competitive plans

Guaranteed Issue and elimination of caps Don’t have to be afraid to get sick

Insurance reforms Insurers will have to spend more on health care services

Improvements to Health Care Delivery – Both Public and Private

These are only a few things, for more information go to www.healthcare.gov or www.colorado.gov/healthreform

Other Resources to Check Out

Federal Government Sites: www.healthcare.gov, www.Medicaid.gov, www.medicare.gov, www.VA.gov

State Sites: www.getcoveredco.org, www.colorado.gov Kaiser Family Foundation – www.kff.org Colorado Health Access Survey -

http://www.cohealthaccesssurvey.org/ Colorado Health Institute -

http://www.coloradohealthinstitute.org/ America’s Healthcare Safety Net: Intact but Endangered.

Institute of Medicine http://www.nap.edu/catalog.php?record_id=9612

Bureau of Primary Health Care http://bphc.hrsa.gov/ National Association of Community Health Centers

http://www.nachc.org/research-data.cfm National Association of Public Hospitals

http://www.naph.org/ National Association of County and City Health Officials

http://www.naccho.org/

YOU ROCK! You made it to the end!

Thanks!Ashley WheelandPolicy AssociateColorado Consumer Health Initiative1536 Wynkoop St, Ste 102 (see what I did here!!!! )303-839-1261Awheeland@cohealthinitiative.org