Public Policy and the

Primary Care Physician

Senator Irene Aguilar, MD

Case Report

CHS/ Single Payer

Solutions for a Health CO

Better Health Care for CO

A Plan for Covering CO

Commission’s 5th Proposal

Author HCACCO Assn of State HealthUnderwriters

SEIUCommittee for

CO Health Solutions

208 Commission

Remaining Uninsured 0 138,000 487,000 108,600 106,600

Health Spending ($1,400 M) $271 M $595 M $1,289 M $861 M

Medicaid/CHP Obsolete Expand Expand Expand Expand

SubsidiesProgressive

Premium 250% FPL 300% FPL 400% FPL 400% FPLBenefit Floor Comprehensive Less than

current lawBasic Comprehensi

veBasic

Benefit Cap None $35,000 $35,000 None $50,000Mandates Individual

EmployerIndividual None Individual

EmployerIndividual

Lewin Analysis of Health Proposals for ColoradoSeptember 2007

ORIGINAL BY: John A. Nyman, PhDUniversity of Minnesota

5

US v. Other G7 Countries Updated

Canada France Germ. Italy Japan UK Avg USA

MD visits (2009)per capita

6.5 6.9 8.2 NA 13.2* 5.0 6.3 3.9

Hosp dischargesper 100 pop (2009)

8.4 17.0 26.3 NA NA 13.3 16.0 13.1

Avg hospitalLOS (2009)

7.7 5.2 7.5 NA NA 6.8 5.9 5.4

Hospital days per 100 population

144.0 83.2

HC spending (2010)

per capita (PPP)

$4,445

$3,974

$4,338

$2,964

NA $3,433

$3,831

$8,232

HC spending as % of GDP (2010)

11.4 11.6 11.6 9.3 NA 9.6 10.6 15.8

LE at birth (2010)

80.8 (08)

80.2 80.5 82 (09) 83 80 81.1 78.7

Infant deaths per 1000 live births (2010)

NA 3.6 3.4 3.4 2.3 4.2 3.4 6.1OECD website : http://stats.oecd.org/index.aspx

The spending per capita numbers were converted from the currency of the country to US dollars by a PPP index.

IOM: Best Care at Lower Cost

9.8%

7.2%

27.5%

17%

13.7%

24.8%

INSTITUTE OF MEDICINE 2012: US Health Care Annual Waste

$ 765 Billion

Determinants of Health

2011 U.S.

Healthcare Spending:

$2.7 Trillion

Health Reform in Colorado

2011 Bipartisan legislation to establish a health care exchange: Connect for Health

2013 Medicaid Expansion endorsed by Legislature and signed by Governor

Moving forward: focus on Payment Reform

Brings together buyers and sellers of insuranceCompare health insurance options and shop for

coverage that will take effect as early as January 1, 2014

Choice of up to 150 different private health insurance plans from ten carriers

Financial assistance based on income available to close to 500,000 Coloradans

As of October 28th

316,326 visitors

44,945 accounts created

30,862 calls to Service Center

3164 purchases

Table 2: Estimate of ACA Effect, 2016

No Reform With ACA ACA Impact

ESI 2,630,000 2,600,000 -30,000

Small Firm ESI (1-50 employees) 560,000 540,000 -20,000

Other ESI 2,070,000 2,060,000 -10,000

Unreformed Non-group 340,000 60,000 -280,000

Reformed Non-group 0 620,000 620,000

Tax Credit Recipients 0 470,000 470,000

Non-Recipients 0 150,000 150,000

Public Insurance 550,000 710,000 160,000

Uninsured 860,000 400,000 -460,000

Total 4,390,000 4,390,000→ →

→

Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011

Source: The Dartmouth Atlas of Health Care.

DENOMINATOR DEFINITION:A 20% random sample of the enrollment file for beneficiaries age 65-99 enrolled in both Medicare Parts A and B, selected on the basis of the terminal digits in the Social Security number. Patients enrolled in risk-bearing health maintenance organizations (HMOs) are excluded.ADJUSTMENTS:Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard. Gender-specific rates are age and race adjusted; race-specific rates are age and sex adjusted.

Medicare Payments per Enrollee, by Hospital Referral Region, 2009

Research shows significant variation in health care spending.

Massachusetts: Private, Medicare & Medicaid Payment for Professional Procedures

MinPrice

Max Price

Office Visit

$45 $330

MRI Brain

$104 $646

Colon-oscopy

$203 $1,045

Private Payer Payment Variation

Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost Trends: Price Variation in Massachusetts Health Care Services, May 2011.

Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families, private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies; health insurance premiums are not included.

Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), Household Component, 2009.

Concentration of Health Care Spending in the U.S. Population, 2009

(≥$51,951) (≥$17,402) (≥$9,570) (≥$6,343) (≥$4,586) (≥$851) (<$851)

Perc

ent o

f Tot

al H

ealth

Car

e Sp

endi

ng

Cooperative would put Colorado on sustainable path: Spending growing no

faster than the GSP

Savings grow by “bending the cost curve” by reducing administrative share and restraining drug price inflation

Figure 4. Share of Colorado population without health insurance coverage, alternative funding

programs, 2015-24.

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