Health Care Reform Update

Ruth T. Perot, MATManaging Director, NHIT Collaborative

Executive Director, SHIREHealth IT Resource Technology Teach-In

October 29, 2009

National Health Expenditures per Capita, 1990-2018

Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (Historical data from NHE summary including share of GDP, CY 1960-2007, file nhegdp07.zip; Projected data from NHE Projections 2008-2018, Forecast summary and selected tables, file proj2008.pdf).

$8,160(2009)

$13,100(2018)

$2,814(1990)

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Per Capita

Projected Per Capita

Actual Projected

SHIRE

SHIRE

HOUSE AND SENATE LEGISLATIONSHIRE

HR3200, America’s Affordable Health Choices Act

S 1796, America’s Healthy Future ActS 1679, Affordable Health Care Choices Act

SELECT HOUSE AND SENATE SIMILARITIES• Insurance Reforms:

– Create an essential health care benefits package, available in health plans.– Prohibit exclusion from insurance due to pre-existing conditions– Prohibit insurers for charging cost-sharing for preventive services

• Access Reforms:– Expand Medicaid to all individuals with incomes up to certain limits (up to 133% of

poverty in the House and Senate Finance, 150% in the HELP Committee bill).– Create an Exchange/Gateway where individuals will purchase insurance– Create web-based tools that allow people to access information on the insurance plans

and eligibility for subsidies.• Quality Reforms:

– Allow Medicare providers to create Accountable Care Organizations (ACOs) that have characteristics of the patient-centered medical home: primary care and specialists accountable for the overall care of the Medicare beneficiaries, promotion of evidence-based medicine, quality reporting.

– Develop a national strategy to improve health through investment in prevention and wellness programs.

– Establishes a Center within the Agency for Healthcare Research and Quality to conduct research on the effectiveness and outcomes of health care services and procedures.

– Require enhanced collection of data on race, ethnicity and primary language.

SHIRE

HOUSE AND SENATE DIFFERENCES• Public Option– Available

• If so, payments linked to Medicare , Medicare + 5 percent, or negotiated rates

– Available with state opt-out– Available following a trigger– State public options, with opportunity for multi-state

collaboration• Malpractice Reform– Mandatory arbitration in “health courts”– Caps on punitive damages

• Antitrust exemption for health insurance companies• Tax treatment of employer-sponsored plans

SHIRE

SELECT HOUSE AND SENATE DIFFERENCES

• HOUSE:– Create the Health Choices Administration, an independent agency to be headed by

a Health Choices Commissioner. Establishes the Health Insurance Exchange within the Health Choices Administration, to provide individuals and employers access to health insurance coverage choices, including a public health insurance option.

• SENATE:– Develop interoperable standards for using HIT to enroll individuals in public

programs and give grants to states to adopt and implement enrollment technology (Senate HELP)

– Medicare Advantage providers could be eligible for bonus payments for achieving certain performance levels for evidence-based care management and quality improvements. It is likely that providers will use software to achieve the performance levels. (Finance)

– Create CMS Innovation Center to test and evaluate ideas to foster patient-centered care, quality improvement and slow costs (Finance)

– Create a Patient-Centered Outcomes Research Institute. One of its goals would be the monitoring of new medical technologies, including the use of EHRs and other digitized components. (Finance)

SHIRE

Legislative ProcessSHIRE

Debate anticipated the week of November 2nd

Continuing through NovemberFinal passage – December?

Health Insurance Coverage in the U.S., 2008

Employer-Sponsored Insurance

52%

Uninsured15%

Private Non-Group5%

Medicare14%

Medicaid/Other Public

13%

NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.9% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2009 CPS

Total = 300.5 million

SHIRE

Percent of Nonelderly Women Reporting No Doctor Visit in Past Year Due to Cost, by Race/Ethnicity

Hispanic

American Indian/ Alaska Native

Black

White

Asian and NHPI

27.4%

21.9%

25.7%

14.7%

12.1%

Data: BRFSS, 2004-2006.Source: The Kaiser Family Foundation, Putting Women’s Health Care Disparities on the Map, available at: www.kff.org/womensdisparities/.

SHIRE

THE COMMONWEALTH

FUND

THE COMMONWEALTH

FUND

SHIRE

Test Results or Medical Record Not Available at Time of Appointment, by Race/Ethnicity, Income, and Insurance Status,

2007

1715

20 20

12

23

14

23

0

10

20

30

Total White Black Hispanic Aboveaverage

Belowaverage

Insured allyear

Uninsuredany time

Race/ethnicity Income Insurance status

Data: 2007 Commonwealth Fund International Health Policy Survey.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

SHIRE

Percent reporting test results/records not available at time of appointment in past two years