www.drsforamerica.org

What Is This?

Health care for the average American family $16,771 per year = a second house payment

Costs are rising 200-300% faster than wages or inflation

Skyrocketing Costs

Uninsured/Underinsured Americans

49 million Americans uninsured

14,000 more lose health insurance coverage every day

72 million Americans have coverage too flimsy to provide protection from major expenses

54,000,000 lives

47,000,000 lives

Economic Drag

5 businesses drop health benefits for employees every hour

50% of bankruptcies related to medical expenses

Looming Medicare bankruptcy in 2019

Legislative Action - America Divided by Fear and Politics

March 2009: Federal legislators make health care reform a top priority

August 2009: Raucous legislative town halls, divisive messaging begins

Spring 2009-Spring 2010: Twisted legislative path in the media/public spotlight

March 2010: Final health care reform legislation passes the US House and Senate, signed into law

The Patient Protection and Affordable Care Act

of 2010

What’s Really In The New Law?Expanded coverage Improved affordability of insurance Improved/increased insurance regulationShared responsibilityEfforts to control long-term costsEmphasis on prevention/primary careEfforts to improve effectiveness/value of medical care

deliveredSupport to expand training for the medical professional

workforce we need

Expanding Coverage30 million more Americans insured

Expansion of Medicaid eligibility to 133% of poverty – approx $29K for a family of four Financed 100% by federal money for first two

years, then 90% match for all states

Subsidies/Tax Credits for individuals/small businesses to buy insurance in a new “regulated market-place” or “Exchange”

State Health Insurance Exchanges Regulated Marketplaces

or“Supermarkets for health insurance”

Private insurers offer plans to American consumers – same as members of Congress

Insurance companies compete for business on more level playing field - market principles work better

Government regulates participating insurers, sets up a “minimum benefit” package

Open to individuals without health insurance/small business employees/some employees who can’t afford insurance offered by their employer

Begins in 2014 – or sooner in some states

AffordabilityExchange “affordability” subsidies

Sliding scale tax credits to help make premiums more affordable (max. approx. 2-9.5% of income)

Additional subsidies to lower out-of-pocket spending

Eligibility up to 400% of Federal Poverty Level ($43,320 for individuals; $88,200 for family of four)

Insurance RegulationProhibits pre-existing condition

exclusions/rescissionsProhibits price discrimination based on

genderProhibits lifetime limits on $ amounts of

coverage, limits annual out-of-pocket costs

Requires that at least 85% of premiums go towards medical care (small group/individual markets – 80%)

Full implementation by 2014

Real Stories, Real People: “Irene”Middle-aged working mother

with husband and 3 childrenPut off coming to see family

doctor despite concerning symptoms – knew about “pre-existing condition exclusions”

Thought she could wait the 6-month “probation period” at her new job

Her cancer caught her first

Shared ResponsibilityWhat is the “Individual mandate?”

Financial penalty/tax, for not having health insurance coverage

Is that fair? Helps eliminate “hidden tax” insured pay

when uninsured seek their care in the ER and can’t pay the bill

Difficult to incentivize young/healthy people to buy insurance – like car insurance mandates

“Everyone In” drives down the costs of insurance through larger risk pool - ”wholesale” approach

Subsidies should help Americans keep care and coverage affordable when they need that assistance.

Shared ResponsibilityEmployer responsibility

Employers not offering coverage pay financial penalty if employees receive public $ for Exchange subsidies or Medicaid coverage

Small businesses have exemptions/subsidies to pool purchasing power – should help keep insurance for owners and their workers more affordable

Real Stories, Real People: “Gerald”

• Small business owner – 8 employees

• Offers health benefits - puts him at competitive disadvantage

• Believes healthy employees are essential, employers should play a role

• Has to cut benefits every year to turn a profit

• Looks forward to this year’s tax credits

• Hopes further changes will let him keep benefits affordable and help keep employees healthy

Control Long Term CostsGetting More Value For Our Dollar

Invest in Primary Care – the right care at the right time saves lives and money

Pilot projects to innovate in payment/health care delivery - reorient incentives to produce better care

Patient-Centered Primary Care PreventionW

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Prevention and WellnessIncentivizing prevention and healthy choices

First dollar coverage for preventive care – includes Medicare, all new plans

Insurance premium discounts for participation in wellness programs

Requires chain restaurants to publish calorie/RDA information so consumers can make informed choices.

Breastfeeding accommodations for new mothers

Expansion of Public Health

Will There Be A Doctor or Nurse to See You?

More doctors in the places that need it most Increased funding for National Health Service

Corps Community Health Centers funding expanded

Increased funding/space for primary care training

Incentives for nursing instructors/training

MORE NEEDED!

How Are We Paying For This?New Income

High cost insurance plans (over $27K) will be taxed starting in 2018 Fees on tanning salons, certain device manufacturers, insurers Tax on unearned income over $250K Increased high income earners’ current Medicare tax/premium

Cutting payments to insurance companies Restructures wasteful payments to Medicare Advantage HMOs

(saving ~$150 Billion)

Cost Analysis By The Non-partisan CBO

Reduce deficit $124 billion over 10 years

Average premiums unchanged for majority of Americans who have employer-based health insurance

Costs should go down for those who buy in the Exchange and who qualify for subsidies

Where Do We Go From Here?Fixing the Root of the Problem:

COST ≠ VALUE

Our Journey Has Just Begun

We Hold Our Future In Our Hands

What You Can DOListen and Learn - Educate yourselfAdvocate for affordable health care that prevents

illness and delivers better healthPass it On - Talk with others in your family and

communityBecome a Health Care Voter - Your voice and your

vote are important!

Please visit www.drsforamerica.org to get more information

For more information, visit:www.drsforamerica.org

Many thanks to Dr. Evan Saulino who contributed greatly to creating this presentation

Most of the photos in this presentation were collected from 123rf.com