Repealed: Patient Protection and Affordable Care Act

• The expansion of Medicaid coverage to include most non-elderly people with income below 138% of the FPL;

• The penalties on certain employers if any of their workers obtain subsidized coverage through the exchanges; and

Republican Plans for PPACA

• The tax credits for small employers that offer health insurance.

Patient Protection and Affordable Care Act (continued)

• It would repeal the Community Living Assistance Services and Supports (CLASS) program for long-term care insurance, as well as a number of mandatory grant programs including funds for so-called high-risk pools, reinsurance for early retirees, and prevention & public health activities.

• The proposal would repeal the provisions that created the Independent Payment Advisory Board and that expanded subsidies for the “coverage gap” in Part D (a range of spending in which many enrollees have to pay all of their drug costs, sometimes called the doughnut hole).

Most of the other changes that PPACA and the Reconciliation Act made to the Medicare program would be retained.

Tea Party, er, I Mean Republican Plans for Old People & the Rest of Us

Defined Benefit vs. Defined Contribution

Defined Benefit

• Participation in Medicare Part A is Automatic

• Benefits are Usually Clearly Delineated & Understood

• Medicare Program Bears Risk of Future Cost Increases,

• Benefit Changes Can be Made only by New Legislation

Defined Contribution

• Participation Options Vary with Beneficiaries Having to Make More Choices

• Benefits are Not Definitive & Will Vary According to Investment Returns & Future Costs

• Beneficiaries Bear Risk of Future Cost Increases

• Benefit Changes May be Made by Regulation and/or by Private Insurer Unilateral Contract Revisions

The Nuclear Option ???

Lobbyist Full-Employment Act of 2010

K Street to rake in healthcare cash; 'Lobbyist Full-Employment Act'By Jeffrey Young -K Street looks like a winner if healthcare reform reaches President Barack Obama’s desk. Even though more than one lobbyist described healthcare reform as once-in-a-generation legislation, lobbyists speaking on background predicted a busy 2010 & beyond.

Health Care Provider, Vendor & Insurance Industry Lobbying

Anti-Reform Chart, “What PPACA Look Like”

“What Medical Care Looks Like Today, Seriously”

What Happens If We Do Repeal “Obamacare” and Let Things Continue Down The Same Road They

Have Been On?

Rapidly rising health insurance costs have strained U.S. families & employers in recent years. The Commonwealth Fund examined data

from all states on changes in private employer premiums & deductibles for 2003 & 2009. Premiums for businesses & their

employees increased 41% across states from 2003 to 2009, while per-person deductibles jumped 77% in large as well as small firms. If these

trends continue at the rate prior to enactment of the Patient Protection & Affordable Care Act, the average premium for family coverage will rise 79 percent by 2020, to more than $23,000. The study describes how health reform offers the potential to reduce

insurance cost growth. If reforms succeed in slowing premium growth by 1 percentage point annually in all states, by 2020 employers & families together will save $2,323 annually for family coverage,

compared with projected premiums.

Rapidly rising health insurance costs are straining U.S. families &

employers

Employer Premiums as Percentage of Median Household Income has Grown

Rapidly

– Heritage On Romney’s Individual mandate: “Not an unreasonable position, & one that is clearly consistent with conservative values.” http://www.heritage.org/Research/Commentary/2006/01/Mitts-Fit

– Heritage On President Obama’s Individual mandate: “Both unprecedented & unconstitutional.” http://blog.heritage.org/2009/12/09/the-individual-mandate-in-obamacare-is-unconstitutional/

– Heritage On Romney’s Insurance Exchange: An “innovative mechanism to promote real consumer choice.” http://www.heritage.org/Research/Reports/2006/04/Underst&ing-Key-Parts-of-the-Massachusetts-Health-Plan– Heritage On President Obama’s Insurance Exchange: Creates a “de facto public option” by “grow[ing]” government control over healthcare.” http://www.heritage.org/Research/Reports/2010/03/Top-10-Disasters-of-Obamacare

–Heritage On Romney’s Medicaid Expansion: Reduced “the total cost to taxpayers” by taking people out of the “uncompensated care pool.” http://www.heritage.org/Research/Commentary/2006/01/Mitts-Fit

– Heritage On President Obama’s Medicaid Expansion: expands a “broken entitlement program,” providing a “low-quality, poorly functioning program.” http://docs4patientcare.org/_blog/Resources/post/Heritage_Foundation_Obamacare_&_You,_Part_5_October_16,_2009/

Heritage Foundation, A Conservative “Think Tank” Compares Romneycare to Obamacare

–

THEY WERE GOOD IDEAS BEFORE THEY BECAME BAD IDEAS

Let’s Recap-

Insurance Exchanges: Before when they were Good: Great, innovative idea in Romney’s Massachusetts and in solidly red state Utah; Now they are Bad: de facto public plan in Obamacare.

Individual mandates: Before when they were Good: Republican Governors Romney and Schwarzenegger had a plan consistent with true conservative values; GOP Senators saw them as the only way to save private enterprise in healthcare. Now they are Bad: unconstitutional usurpation by Obama

Comparative Effectiveness: Before when it was Good: BRILLIANT, we should only pay for what works & not for what doesn’t; Now it is Bad: healthcare rationing, death panels and “killing granny” under Obama

expanding Medicaid: Before when it was Good: Reduces overall costs by taking people out of the uncompensated care pool; Now it is Bad: expands an entitlement without funding

Administrative Simplification: Before when it was Good: An idea to save billions when WEDi was established by George H. W. Bush in 1991 & HIPAA was passed by a GOP-Congress in 1996; Now when it is Bad; everyone on a government program will have to have a chip implanted in their bodies to track care.

Mitt RomneyJanuary 2003 to January 2007. Massachusetts has the nation’s lowest rate of people without health insurance. The rate dropped substantially under Mr. Romney, who signed a universal coverage law in 2006.

Rick PerrySince December 2000. Texas has the nation’s highest rate of people without health insurance. The uninsured rate has increased to 26 percent from 22 percent in the decade Mr. Perry has been in office.

Jon M. Huntsman Jr.January 2005 to January 2009. In Utah, the rate of people without health insurance fluctuated while Mr. Huntsman was governor, initially decreasing, then inching back up

The Tale of Three States … and their Governors

In pushing for his law, which features an exchange and requires insurers to cover pre-existing conditions, Romney championed an insurance mandate as the “ultimate conservative idea.” The targets of his “personal responsibility principle” were the free-riders who gambled by not buying policies and then relied on taxpayers, hospitals and the privately insured to cover the cost of their uncompensated care. The politics of the primaries have made toxic any consideration of once-conservative concepts like health insurance mandates and marketplace exchanges. But in a different day and environment, Romney in Massachusetts and Huntsman in Utah embraced those very devices as state solutions.

Prescient Jeanne

New York Times, Sunday, September 4, 2011

GOP ALTERNATIVES Sunday Talk Shows, January 16

Sell across state lines - Already in the through the health exchanges with regulatory approval by all involved states. What ISN'T in the bill: Basing operations in a US territory or state with very little insurance regulation & selling into states that are heavily regulated. Texas, for example, is the home base for more that 300 insurance companies already under investigation by other states… and oh, BTW, cut taxes.Make insurance 100% deductible - This is in the bill, too. But for those receiving subsidies, the insurance is not 100% deductible because the government is picking up all or part of the cost… and oh, BTW, cut taxes.Make health care costs 100% deductible - Wouldn't that be like the government picking up most of our health care costs by reimbursement on the back end? … and oh, BTW, cut taxes.Tort reform - The bill provides funding & incentives for states to innovate around liability & tort issues. Republicans should know that tort reform is a state-by-state issue. Jurisdiction for how torts are litigated belongs to the states, not the federal government… and oh, BTW, cut taxes.Not Included in the GOP Proposal - Anything about pre-existing conditions exclusions. Anything about lifetime caps. Anything about rescissions. Anything about stopping insurers from excluding children born with pre-existing conditions.

Future of US Health Care

Both President Obama and Senator John McCain promised that they would address

the issues of better managing chronic health care disease & thereby reducing

the costs.Wow, that’s a mouthful!

It remains to be seen if anything meaningful can be delivered on these promises, but an awful lot is at stake.

Obama said he could reduce the cost of an average family’s health insurance by

$2,500 annually. A big chunk of that projected savings came from savings

from disease management.

Medical Managers, Disease Management, Evidence-Based

Medicine and Preventive Health Care

Richard Simmons to be named personal health secretary to the nation, helping

all Americans to better health

through preventive health care, exercise

& diet

Special Bonus Feature

PPACA: The Timeline

Implementing PPACA … The Timeline

Up to 4 million small businesses are already eligible for tax credits to help

them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up

to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may

receive up to a 25% credit.

2010

Small Business Health Insurance

Tax CreditsEffective January 1, 2010