Achieving Real Health Care Reform. Fred Gluck Channel City Club November
|
|
- Barrie Brown
- 8 years ago
- Views:
Transcription
1 Achieving Real Health Care Reform Fred Gluck Channel City Club November
2 What s the Problem? The United States spends up to twice as much as other developed countries and these costs are increasing at a rate that is unsustainable Major problems driving costs are unnecessary administrative complexity and overutilization Current proposals will exacerbate the complexity problem and have little impact on the actual care delivered 2 Channel City Club Nov 12, 2009
3 What Would Real Health Care Reform Look Like? All Americans would have guaranteed access to an identical program of comprehensive, evidence based health care. This guaranteed level of care would cover the overwhelming majority of an individuals needs but would not cover marginally effective or experimental modalities Unnecessary complexity would be eliminated and administrative costs would be dramatically reduced All Americans would be free to seek additional care at their own expense. 3 Channel City Club Nov 12, 2009
4 Key Points Most Americans have access to health care now Insurance Self pay Emergency Rooms + other safety nets Problem is ensuring Americans receive the care they need not expanding the insurance system 4 Channel City Club Nov 12, 2009
5 Providing effective and efficient access to care Channel City Club Nov 12,
6 The objective of health care reform is to provide all Americans with with affordable access to comprehensive health care Patients ACCESS Providers 6 Channel City Club Nov 12, 2009
7 Direct Access (no middlemen) is simple and efficient for providers and motivates patients to make sensible Benefit/Cost decisions about seeking care Do I need this care and can I afford it? Costs proportional to amount of care provided Patients Money Care Providers Minimum Administrative Cost 7 Channel City Club Nov 12, 2009
8 But limits care to those with ability to pay Ability to pay Costs proportional to amount of care provided Patients Money Care Providers Minimum Administrative Cost 8 Channel City Club Nov 12, 2009
9 Direct subsidy is the most straightforward and least expensive way to guarantee access to a given level of care Ability to pay Subsidies for a given level of care Costs proportional to amount of care provided Patients Money Care Providers Minimum Administrative Cost 9 Channel City Club Nov 12, 2009
10 However, simply providing subsidies can distort the decision making process by Tempting subsidized patients to overuse access Motivating providers to over-provide to (subsidized) patients * * * Thus effective control of utilization becomes a priority for a system based on subsidies. 10 Channel City Club Nov 12, 2009
11 The costs of complexity Channel City Club Nov 12,
12 Our current insurance based approach to providing access is much more complicated Private insurers Medicaid Medicare SChip VA, Government Employees, Congress etc. $ Self Pay Care 12 Channel City Club Nov 12, 2009
13 And generates enormous administrative costs throughout the system Total costs proportional to complexity Substantial time to administer Administrative costs proportional to complexity $ Self Pay Care 13 Channel City Club Nov 12, 2009
14 These costs have been estimated to amount to about 30% of total spending or $750 Billion Drives $750 Billion in total system Administrative costs Private insurers Medicaid Medicare SChip VA, Government Employees, Congress etc. $ Self Pay Care 14 Channel City Club Nov 12, 2009
15 Regrettably, despite the enormous costs they create these complex bureaucracies add very little value Since all hospitals are required to provide emergency care regardless of ability to pay, most Americans now receive most of the care they need whether they have insurance or not Huge discrepancies in amount of care delivered from region to region ( the Dartmouth study) with little impact on outcomes is compelling evidence that these bureaucracies have little impact on overutilization as well 15 Channel City Club Nov 12, 2009
16 The Congressional proposals on the table are are even more complex 16 Channel City Club Nov 12, 2009
17 Summary: Real Health Care Reform The real problem in our health care system is not in access Nor is it in the way care is actually delivered by providers It s in our costs; primarily our non-productive administrative costs and overutilization * * * Bringing costs under control will require a dramatic reduction in complexity as well as improved control of utilization 17 Channel City Club Nov 12, 2009
18 Reducing complexity Channel City Club Nov 12,
19 Achieving guaranteed access can be achieved much more effectively and efficiently by a subsidized Guaranteed Access Program comprising three major components Our existing health care delivery system of privately owned and managed providers A national network of competing Reimbursement Managers to manage payments to these providers A federal National Health Security Agency (NHSA) designed along the lines of the Federal Reserve that would set health care policy 19 Channel City Club Nov 12, 2009
20 A Guaranteed Access Program, (a modified single payer system), would consist of a central agency (NHSA) and a network of Reimbursement Managers and Providers National Health Security Agency (NHSA) Specify GAP coverage and National Rate Card Reimburse Providers for care delivered 20 Channel City Club Nov 12, 2009
21 The National Health Security Agency (NHSA) would be an independent Federally funded agency It would be responsible for Specifying a single level of guaranteed coverage Determining the fees that would be paid to providers for each covered service (á la Medicare) Developing and overseeing the Reimbursement Manager network It would be structured along the lines of the Federal Reserve to insure independence and insulate it from short term political pressures The total cost of providing the care guaranteed by the GAP would be driven by these NHSA decisions 21 Channel City Club Nov 12, 2009
22 The complexity of the administrative system would be dramatically reduced by designing the guaranteed access around a single level of coverage and a National Rate Card The complexity in the administrative system is driven by complex product lines that create Unnecessary marketing and selling expenses Extraordinarily complicated reimbursement processes that are negotiation (people) intensive and very expensive But an effective Guaranteed Access Plan can be based on a providing a single level of coverage to all Americans which would not require marketing or selling and would greatly simplify the reimbursement process Similarly, since the Federal Government would assume the risk on a national community rated basis, a single rate schedule would be developed defining reimbursement rates to be applied nationwide (National Rate Card). This would enable an extremely simple reimbursement process involving no negotiation. It would also eliminate the problems of preexisting conditions and portability The overall impact of the single level of coverage and the National Rate Card would be to reduce the totality of the administrative task (outside those necessary for the providers to manage the actual delivery of care) to managing a much simpler reimbursement process 22 Channel City Club Nov 12, 2009
23 The Reimbursement Managers would be public (or private) companies competing on the cost of managing the reimbursement process Managing reimbursement requires Determining if the care was necessary (physician decision) Determining if the individual is covered Certifying that the care was delivered Processing the payments Because there is a single level of coverage the reimbursement process will be enormously simplified Decision on whether an individual is covered and for what is trivial (everyone is covered for the same access to care) Certification is well understood and routine Processing is well understood and routine 23 Channel City Club Nov 12, 2009
24 Controlling utilization Channel City Club Nov 12,
25 Controlling utilization will require motivating both patients and providers to behave in ways that reflect the Benefit/Cost implications of their decisions Decisions on what care will be provided can be thought of in two categories Patient driven: when to seek care (e.g. flu symptoms, chest pain, intestinal discomfort) Physician driven: what steps to take to deal with a particular medical condition (e.g. two aspirins and orange juice, open heart surgery, colon cancer surgery) 25 Channel City Club Nov 12, 2009
26 Potential for overutilization varies by category of care as does difficulty of controlling it and overall impact on costs Category of Care Physician Driven Benefit/Cost Ratio Potential for Overuse by Patients Potential for Overutilization by Providers Preventive High Low Low Minor Potential Impact of overutilization on Total Costs Emergency High Low Low Minor Chronic High Moderate Moderate Moderate End of life Tends to decrease with age and deterioration of health High (prolong the dying process) High (profitable market segment) High Patient Driven Routine Highly Variable High (patient makes the call) Moderate Moderate 26 Channel City Club Nov 12, 2009
27 Specification of the guaranteed coverage to reflect Benefit/Cost considerations will be most difficult for endof-life care Preventive care is generally inexpensive, well understood and supported by scientific evidence of the expected benefits The need for true emergency care is generally self-evident and highly dependent on the physician s judgment Chronic care is frequently expensive and emphasis will need to be on least-cost alternatives (e.g. generic drugs, least cost prosthetic devices) but the benefits are substantial and the outcomes usually return the patients to productive and satisfactory lives. Most chronic care should qualify for GAP Defining criteria for covering end-of-life situations will be more challenging because the expected outcomes are often less certain and frequently do not return the patients to productive or satisfactory lives but simply extend the dying process Nevertheless, some limiting criteria will need to be developed to prevent flooding the GAP system with increasingly marginal and very expensive modalities (continued) 27 Channel City Club Nov 12, 2009
28 Controlling patient driven utilization can be done by treating decisions to seek care as an out of pocket (OOP) expense with a safety net for low income households A Routine Access credit card could be issued to each household that would have a limit of,say $1,000, per rolling year, that could be used to pay for routine office visits. Patients could also choose to pay out-of-pocket The fees for the visits for which the credit card was used would be paid through the reimbursement system and would be reported to the IRS as income to the head of household. This would effectively provide a safety net for lower income people and represent an outof-pocket expense (proportional to tax rate) for higher income people ` (continued) 28 Channel City Club Nov 12, 2009
29 A realistic objective for determining the total coverage of the GAP program would be to Cover essentially all preventive, emergency and chronic modalities that meet Benefit /Cost criteria (emphasizing least cost alternatives) Cover all end-of-life care that returned patients to productive and/or satisfactory lives but apply stringent Benefit/Cost criteria to marginally effective modalities that simply extend the dying process Treat routine care as an OOP expense but provide a safety net * * * Optional, non-subsidized insurance or self-pay would be available for people prepared to pay for it 29 Channel City Club Nov 12, 2009
30 Administrative costs would be minimized NHSA Minimal costs Specification of Guaranteed Access and Rate Card Minimal administrative costs 30 Channel City Club Nov 12, 2009
31 And the cost of actually delivering the care would be controlled by the NHSA decision making process NHSA Specification of Guaranteed Access an Rate Card Minimal administrative costs Minimal administrative costs Costs of delivering the care driven by NHSA specifications 31 Channel City Club Nov 12, 2009
32 Recommended Program Channel City Club Nov 12,
33 Recommendation Create NHSA Specify level of access to cover approximately 90-95% of FDA approved modalities Develop equitable Rate Card to ensure maximum participation of physicians in Guaranteed Access Program and continued viability of private hospitals and other providers Manage reimbursement process through competitive Reimbursement Managers (role for downsized insurers) Encourage separate supplementary insurance market for extraordinary levels of care - 5 to 10% of total care (additional role for downsized insurers) (continued) 33 Channel City Club Nov 12, 2009
34 Recommendation (continued) Fund the program on a pay as you go basis through general revenues Identify each HoH s share of country s health care bill (equivalent to a health care tax) Manage Total cost of GAP program to a fixed percentage of GDP 34 Channel City Club Nov 12, 2009
35 Summary of Benefits Channel City Club Nov 12,
36 Summary of Benefits Guaranteed Access Program would replace all current public and private programs and be national in scope This would enable enormous savings in administrative costs Currently 30% of total cost ~ $750 Billion At 15% (Canada) ~ $375 Billion savings At 10 % ~ $500 Billion savings All Americans would be guaranteed access to care for the overwhelming majority of their lifetime medical needs and would not be charged directly (funding through general revenues) Effective methods of controlling utiliozation costs would be in place Since all Americans receive overwhelming majority of necessary care today cost of actually providing care would not be significantly affected (continued) 36 Channel City Club Nov 12, 2009
37 Summary of Benefits (continued) Total costs to government (and therefore to taxpayers) could be less than under current programs (depending on decisions of NHSA) Key challenge would be to ensure that National Rate Card adequately compensated physicians, hospitals and other health care professionals and facilities Program would dramatically downsize the insurance industry (limited to reimbursement management and to providing supplementary insurance) and preserve the private nature of the health care delivery system The role of government would be policy and would be restricted to the functions provided by the NHSA Determining level of guaranteed care Setting reimbursement rates Overseeing the reimbursement process 37 Channel City Club Nov 12, 2009
38 Funding the Guaranteed Access Program Channel City Club Nov 12,
39 Funding the Guaranteed Access Program Funding Equal Access would be done from general revenues Each head of household (HoH) would be charged a fee (determined by a formula based on income and household makeup) to cover its share of the total cost of the guaranteed access program. Higher income households would be charged a premium to cover discounts for lower income households so that total fees would cover the full cost of program. This would be equivalent to a separate tax to cover health care costs on a pay-as-you-g0 basis. Because of the dramatically reduced costs of the GAP most taxpayers would pay less than their current costs of taxes plus health insurance and out of pocket costs 39 Channel City Club Nov 12, 2009
40 Managing the transition Channel City Club Nov 12,
41 Managing the Transition: Setting up the NHSA Key first step in managing the transition will be to set up the NHSA and complete Definition of the level of access to be guaranteed Specification of the Rate Card 41 Channel City Club Nov 12, 2009
42 Managing the Transition: Creating Reimbursement Managers The next step would be to restructure the insurance industry Require all existing insurance policies to be structured in two parts Guaranteed Access Program (Required) Supplementary Insurance Coverage (Optional) Require insurers to manage the Guaranteed Access Program separately and, then, spin GAP divisions off as Reimbursement Managers Competition among Reimbursement Managers would be based on the cost of providing the required reimbursement services Allow the remaining insurers to compete for the supplementary insurance market if they so chose 42 Channel City Club Nov 12, 2009
43 Managing the Transition: existing insurers would be split into Reimbursement Managers for GAP and Supplemental Insurers Reimbursement Manger Existing Health Insurer GAP Insurer Supp Insurer Off the screen as far as GAP is concerned Supplemental Insurer 43 Channel City Club Nov 12, 2009
44 Managing the Transition: Funding the Guaranteed Access Program There would be a flash cut from a premium based system to a General Revenues based system Tax preferences for ESI would be eliminated Employees would receive the amounts of the premiums as wages (taxable income) This would generate an additional $300 Billion in Federal tax revenues Employers would continue to receive deductions for these wages These funds combined with the administrative savings from the restructuring of the insurance industry should be more than sufficient to fund the GAP If not Tax Tables would be redesigned to create the additional revenue to fund the GAP program. These redesigns would result in higher tax rates but for the great majority of Americans their total cost of taxes plus health care would decline Funds for the Guaranteed Access Program (GAP) would flow directly from General Revenues through the NHSA to the Reimbursement Managers and then to the Providers 44 Channel City Club Nov 12, 2009
45 Additional observations Channel City Club Nov 12,
46 Additional Observations The Guaranteed Access Program (GAP) would guarantee all Americans equal access to high quality medical care funded from general revenues It would result in lower total costs for health care in the United States (as well as lower costs for individuals) as a result of the elimination of enormous, non-productive and unnecessary administrative functions The patient care delivery system system (physicians, hospitals etc.) would be operated entirely by the private sector The NHSA would play a critical policy role but would have essentially no operational responsibilities Innovations in the delivery system (e.g. more Mayo clinic type operations, Wal-Mart outpatient clinics) - could be seamlessly integrated (continued) 46 Channel City Club Nov 12, 2009
47 Additional Observations (continued) Providers would be free to charge for higher levels of service or quality which would be paid by the patient. This would provide clear incentive to providers to compete on a Benefit/Cost basis Lower and middle class families would be freed from a major source of worry American industry would no longer be saddled with responsibility for health care costs and would become more competitive. Economic pressures would drive R&D spending in health care away from modalities to prolong the dying process and toward those directed at increasing productive life. 47 Channel City Club Nov 12, 2009
Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More informationBARACK OBAMA S PLAN FOR A HEALTHY AMERICA:
BARACK OBAMA S PLAN FOR A HEALTHY AMERICA: Lowering health care costs and ensuring affordable, high-quality health care for all The U.S. spends $2 trillion on health care every year, and offers the best
More informationLife & Health Insurance Advisor
Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals
More informationThe health care reforms proposed by President Obama and some Members of Congress would nationalize nearly 20 percent of the U.S. economy, and would
The health care reforms proposed by President Obama and some Members of Congress would nationalize nearly 20 percent of the U.S. economy, and would eliminate individual health care choices and delay or
More informationTax Expenditures for Health Care
Summary of Testimony for Senate Finance Committee Hearing: Health Benefits in the Tax Code: the Right Incentives July 31, 2008 Tax Expenditures for Health Care Edward D. Kleinbard Chief of Staff July 30,
More informationThe Financial Obligations of Liver Transplantation
The Financial Obligations of Liver Transplantation Planning for Financial Obligations There is a definite need to have a plan going into transplant. That need applies to the financial side of transplant,
More informationArizona Health Care Cost Containment System Issue Paper on High-Risk Pools
Arizona Health Care Cost Containment System Issue Paper on High-Risk Pools Prepared by: T. Scott Bentley, A.S.A. Associate Actuary David F. Ogden, F.S.A. Consulting Actuary August 27, 2001 Arizona Health
More informationTax Subsidies for Health Insurance An Issue Brief
Tax Subsidies for Health Insurance An Issue Brief Prepared by the Kaiser Family Foundation July 2008 Tax Subsidies for Health Insurance Most workers pay both federal and state taxes for wages paid to them
More informationOhio Health Benefits LLC. Your health insurance partner!!
December 16, 2014 Presented by Steve Clark & Scott Prior Patient Protection and Affordable Care Act of 2010 Obamacare or ACA or PPACA or Health Care Reform (HCR) Signed in to law on March 23, 2010 The
More informationCoinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.
Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
More informationSenate-Passed Bill (Patient Protection and Affordable Care Act H.R. 3590)**
Prevention and Screening Services Cost-sharing Eliminates cost sharing requirements for requirements for all preventive services (including prevention and colorectal cancer screening) that have a screening
More informationMedicare Cost Sharing and Supplemental Coverage
Medicare Cost Sharing and Supplemental Coverage Topics to be Discussed Medicare costs to beneficiaries Review Medicare premiums and cost sharing Background on Medicare beneficiary income Current role of
More informationFLORIDA HEALTH CARE COALITION
FLORIDA HEALTH CARE COALITION Orlando-based 501c3 non-profit, established 29 years ago Provide education, research and program development support to our members Focus on quality improvement, first and
More informationOverview of Policy Options to Sustain Medicare for the Future
Overview of Policy Options to Sustain Medicare for the Future Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy Kaiser Family Foundation jcubanski@kff.org Medicare NewsGroup Journalism
More informationThe Patient Protection and Affordable Care Act. Implementation Timeline
The Patient Protection and Affordable Care Act Implementation Timeline 2009 Credit to Encourage Investment in New Therapies: A two year temporary credit subject to an overall cap of $1 billion to encourage
More informationINDIVIDUAL HEALTH INSURANCE GUIDE. Introduction. What is the Health Insurance Marketplace?
INDIVIDUAL HEALTH INSURANCE GUIDE Introduction On November 15th, 2014, the second annual Open Enrollment Period for Individual Health Insurance begins. The Affordable Care Act (ACA) requires all US citizens
More informationMYTHS ABOUT SINGLE PAYER COMING TO VERMONT. For information on myths about single payer in general, please click here.
MYTHS ABOUT SINGLE PAYER COMING TO VERMONT For information on myths about single payer in general, please click here. MYTH 1: Physicians will leave the state if we enact single payer. This is the claim
More informationA Health Insurance Exchange in Maryland
A Health Insurance Exchange in Maryland A Presentation before the Joint Committee on Health Care Delivery and Financing June 14, 2007 Rex Cowdry, M.D. Executive Director MHCC Study MHCC has been asked
More informationVoters Health Care Platform
Voters Health Care Platform This Voters Health Care Platform is based on five years of research and dialog with thousands of Americans across the country. It draws on the ideas and wishes of Americans
More informationMedicare Economics. Part A (Hospital Insurance) Funding
Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),
More information2019 Healthcare That Works for All
2019 Healthcare That Works for All This paper is one of a series describing what a decade of successful change in healthcare could look like in 2019. Each paper focuses on one aspect of healthcare. To
More informationHealth Care Reform: What s in the Law
Health Care Reform: What s in the Law Professor Sidney D. Watson March 2013 On June 28, 2012, the United States Supreme Court upheld the Affordable Care Act, also known as ObamaCare. The Supreme Court
More informationHealth Insurance A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. HL-14-001 Rev. 08/2015
A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE The of Health Insurance wahealthplanfinder.org 1-855-WAFINDER 1-855-923-4633 HL-14-001 Rev. 08/2015 THE ABC S OF HEALTH INSURANCE: WHY IS HEALTH
More informationA GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. Health Insurance
A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE The of Health Insurance THE ABC S OF HEALTH INSURANCE: WHY IS HEALTH INSURANCE IMPORTANT? Even if you are in GOOD HEALTH, you will need to
More informationAffordable Care Act at 3: Strengthening Medicare
Affordable Care Act at 3: Strengthening Medicare ISSUE BRIEF Fifth in a series May 22, 2013 Kyle Brown Senior Health Policy Analyst 789 Sherman St. Suite 300 Denver, CO 80203 www.cclponline.org 303-573-5669
More informationImproving Medicare Part D. Shinobu Suzuki and Rachel Schmidt March 3, 2016
Improving Medicare Part D Shinobu Suzuki and Rachel Schmidt March 3, 2016 Future challenges require changes to Part D s original structure Designed to encourage broad participation by plans and beneficiaries
More informationAnalysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont
Analysis of the Costs and Impact of Universal Health Care Coverage Under a Single Payer Model for the State of Vermont Prepared for: The Vermont HRSA State Planning Grant, Office of Vermont Health Access
More informationNorth Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS
North Carolina Institute for Early Childhood Professional Development HEALTH INSURANCE: INFORMATION AND TIPS FOR CHILD CARE EMPLOYEES AND EMPLOYERS Often times in the early care and education field we
More informationManaging Health Care Reform Benefit Changes within your Own Organization
ICCMHC Winter Conference February 17, 2011 Managing Health Care Reform Benefit Changes within your Own Organization John F. Gause, President jgause@apexbg.com Overview Health Care Reform - Short Term Impact
More informationHealth Care Reform Frequently Asked Questions
Health Care Reform Frequently Asked Questions On March 23, 2010, President Obama signed federal health care reform into law, also known as the Patient Protection and Affordability Act. A second, or reconciliation
More informationHealth-Care Reform. Begley Insurance Group, Inc. Mary Angelo 5225 Old Orchard Rd. Skokie, IL 60077 800-867-7074
Begley Insurance Group, Inc. Mary Angelo 5225 Old Orchard Rd. Skokie, IL 60077 800-867-7074 Health-Care Reform August 14, 2012 Page 1 of 8, see disclaimer on final page One primary goal of the Patient
More informationGUIDE. Your. To Public Health Insurance Marketplaces. Find Coverage for You and Your Family
GUIDE Your To Public Health Insurance Marketplaces Find Coverage for You and Your Family We are Towers Watson s OneExchange We help you shop for a health plan. We hire and train licensed benefit advisors
More informationWhat is Healthcare Reform? Get a view of the future health care system in the US; learn. success factors for healthcare administrators?
What is Healthcare Reform? Get a view of the future health care system in the US; learn about primary resources and tools for the healthcare administrator, and what are the success factors for healthcare
More informationJUNE 2015 Consolidated Healthcare Plan
JUNE 2015 Consolidated Healthcare Plan A PHYSICIAN LED, PATIENT-CENTERED, FISCALLY RESPONSIBLE ALTERNATIVE TO THE AFFORDABLE CARE ACT Editing Author: CL Gray, MD Physicians for Reform wants to thank the
More informationTHE A,B,C,D S OF MEDICARE
THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION
More informationHealth Care Reform How it Will Affect Employers and their Group Health Plans. Benecon Comments and Observations
Health Care Reform How it Will Affect Employers and their Group Health Plans This Health Care Reform Summary applies to all employers (including government and church plans) that provide health coverage
More informationSecuring Health Insurance for the Retirement Journey MANAGING RETIREMENT DECISIONS SERIES
Securing Health Insurance for the Retirement Journey MANAGING RETIREMENT DECISIONS SERIES PEOPLE ARE LIVING LONGER in retirement than ever. Maintaining good health will help make those years vibrant. So
More informationUnderstanding the ObamaCare Health Insurance Plans in North Carolina Understanding Insurance and Affordable Care Act Terminology: ACA- Marketplace
Understanding the ObamaCare Health Insurance Plans in North Carolina As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with
More informationSummary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals
Summary of Federal SCHIP Reauthorization, Economic Stimulus, and Health Care Reform Bills and Proposals I. Children s Health Insurance Program (CHIP) Reauthorization Act of 2009 A. Funding for CHIP. The
More informationHealth Care Reform Frequently Asked Questions
Health Care Reform Frequently Asked Questions On March 23, 2010, President Obama signed federal health care reform into law, also known as the Patient Protection and Affordability Act. A second, or reconciliation
More information3/28/2014. Spencer Berthelsen, M.D. Texas Club of Internists
Spencer Berthelsen, M.D. Texas Club of Internists April 4, 2014 Cost The US spends twice as much per capita as the average of other industrialized nations Institute of Medicine 30% of healthcare dollars
More informationHR 3200, AMERICA S AFFORDABLE HEALTH CHOICES ACT FREQUENTLY ASKED QUESTIONS
HR 3200, AMERICA S AFFORDABLE HEALTH CHOICES ACT HOW WILL THIS AFFECT ME? FREQUENTLY ASKED QUESTIONS 1. Why do we have to wait until 2013 for it to start? Some of the reforms in the bill start earlier
More informationThe Affordable Care Act
The Affordable Care Act What does it mean for internists? Joshua Becker MD 10/14/2015 VII. 2015 Reforms and Beyond Payment Penalties under Medicare s Pay-for-Reporting Program Value-Based Payment Modifier
More informationThe Physician s Prescription for
Lee S. Gross, MD President Board of Directors Michael J. Koriwchak, MD Vice President Hal Scherz, MD Secretary Richard A. Armstrong, MD Treasurer John R. Ammon, MD Member The Physician s Prescription for
More informationStrengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.
Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access
More informationPresident Bush s Health Care Tax Deduction Proposal: Coverage, Cost and Distributional Impacts. John Sheils and Randy Haught
www.lewin.com President Bush s Health Care Tax Deduction Proposal: Coverage, Cost and Distributional Impacts John Sheils and Randy Haught President Bush proposes to replace the existing tax exemption for
More informationAccount Based Health Plan with Health Savings Account Guide
Account Based Health Plan with Health Savings Account Guide Lead the way Page 1 2016 ABHP with HSA Guide You re in control with an Account-Based Health Plan Philips believes an Account Based Health Plan
More informationA GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE. The. Health Insurance
A GUIDE TO UNDERSTANDING, GETTING AND USING HEALTH INSURANCE The of Health Insurance THE ABC S OF HEALTH INSURANCE: WHY IS HEALTH INSURANCE IMPORTANT? Even if you are in GOOD HEALTH, you will need to
More informationWomen and The New Health Care Law Trivia
Women and The New Health Care Law Trivia 1. How many women will be eligible to gain access to affordable insurance coverage options when the health care law is fully implemented in 2014? a. 6 million b.
More informationHealthcare Reform Provisions Unique to Small Employers/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014)
/Financial and Other Benefits Concerns for All Employers (updated May 2, 2014) Lisa L. Carlson, J.D., Area Senior Vice President, Compliance Counsel Gallagher Benefit Services, Inc. While most healthcare
More informationHealth Insurance Coverage for Direct Care Workers: Key Provisions for Reform
Health Insurance Coverage for Direct Care Workers: Key Provisions for Reform Introduction As an organization dedicated to our nation s 3 million direct-care workers and the millions of elders and people
More informationProblems with the Ways Hospitals Are Paid and Potential Solutions
320 Ft. Duquesne Boulevard Suite 20-J Pittsburgh, PA 15222 Voice: (412) 803-3650 Fax: (412) 803-3651 www.chqpr.org February 19, 2016 The Honorable Fred Upton, Chairman The Honorable Joseph R. Pitts, Chairman,
More informationImproved Medicare for All
Improved Medicare for All Quality, Guaranteed National Health Insurance by HEALTHCARE-NOW! Single-Payer Healthcare or Improved Medicare for All! The United States is the only country in the developed world
More informationMake an informed choice
Producer Information I Index Universal Life Insurance Make an informed choice Long Term Care or Chronic Illness Rider? As our population ages, obtaining financial protection against long term care (LTC)
More informationMedical Plan Comparison - Retirees Age 65 or Over
l Plan Comparison - Retirees Age 65 or Over Program Name U of M Retiree Plan with Group reblue SM Rx Group Platinum Blue SM Plan C withgroup reblue SM Rx Freedom Plan & Retiree National Choice Freedom
More informationPrescription Drugs as a Starting Point for Medicare Reform Testimony before the Senate Budget Committee
Prescription Drugs as a Starting Point for Medicare Reform Testimony before the Senate Budget Committee Marilyn Moon The nonpartisan Urban Institute publishes studies, reports, and books on timely topics
More informationTimeline of New Health Care Law and Its Impact on American Businesses
Timeline of New Health Care Law and Its Impact on American Businesses Summaries of the Patient Protection and Affordable Health Care Act (Public Law 111-148) Health Care and Education Reconciliation Act
More informationStandards for Quality, Affordable for Health Care for All:
Standards for Quality, Affordable for Health Care for All: Health Care for All New York (HCFANY) believes that every resident of New York State and the nation must have access to affordable and comprehensive
More informationStable and Secure Health Care for America: The Benefits of Health Insurance Reform: Table of Contents
Stable and Secure Health Care for America: The Benefits of Health Insurance Reform: Table of Contents HEALTH INSURANCE CONSUMER PROTECTIONS... 1 STABLE AND SECURE HEALTH CARE FOR AMERICA... 2 HEALTH INSURANCE
More informationImproved Medicare for All
Take Action: Get Involved! The most important action you can take is to sign up for Healthcare-NOW! s email list, so you can stay connected with the movement and get updates on organizing efforts near
More informationFederal Health Care Reform A Snapshot November 2009
Federal Health Care Reform A Snapshot Ruth Ehresman Director of Health and Budget Policy rehresman@mobudget.org www.mobudget.org Missouri Association for Social Welfare November 6, 2009 Where are we today?
More informationSingle Payer 101 Training Universal Health Care for Massachusetts
Single Payer 101 Training Universal Health Care for Massachusetts http://masscare.org What s Wrong With Our Health Care System? (the easy part) U.S. Has Lowest Life Expectancy in the Industrialized World
More informationResponse to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers
Response to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers Brief submitted by The New Brunswick Nurses Union April 2012 Background The New Brunswick
More informationyour guide to health INSURANCE reform
CURRENT LOGO your guide to health INSURANCE reform for This guide explains how Health Reform will affect Individual and Family health plans, helps you understand different types of health insurance and
More informationConnecticut Health Care Costs
How much does Connecticut spend on health care? Connecticut Health Care Costs In 2009 Connecticut spent $30.4 billion dollars on health care. That is $8,653.57 for every state resident. And those costs
More informationThe Continued Need for Reform: Building a Sustainable Health Care System
The Continued Need for Reform: Building a Sustainable Health Care System Sustainable reform must address cost and quality, while expanding coverage through a vibrant and functional marketplace As the largest
More informationTHE EFFECT OF THE TAX LAWS ON HEALTH INSURANCE AND MEDICAL COSTS. Statement by. Alice M. Rivlin Director Congressional Budget Office.
THE EFFECT OF THE TAX LAWS ON HEALTH INSURANCE AND MEDICAL COSTS Statement by Alice M. Rivlin Director Congressional Budget Office Before the Subcommittee on Oversight, Committee on Ways and Means and
More informationMandatory Private Health Insurance as Supplementary Financing
Chapter 12 SUPPLEMENTARY FINANCING OPTION (5) MANDATORY PRIVATE HEALTH INSURANCE Mandatory Private Health Insurance as Supplementary Financing 12.1 Mandatory private health insurance is where private health
More informationTHE 2008 PRESIDENTIAL CANDIDATES
THE 2008 PRESIDENTIAL CANDIDATES ON HEALTH CARE REFORM AUGUST 2007 (UPDATED JUNE 4, 2008) Prepared by: Victoria Craig Bunce, Director of Research and Policy, The Council for Affordable Health Insurance
More informationHealth care reform for large businesses
FOR PRODUCERS AND EMPLOYERS Health care reform for large businesses A guide to what you need to know now DECEMBER 2013 CONTENTS 2 Introduction Since 2010 when the Affordable Care Act (ACA) was signed into
More informationOutline of Coverage. Medicare Supplement
Outline of Coverage Medicare Supplement 2015 Security Health Plan of Wisconsin, Inc. Medicare Supplement Outline of Coverage Medicare Supplement policy The Wisconsin Insurance Commissioner has set standards
More informationTurning Logic and Evidence on it Head: Australia's Subsidy to Private Insurance
Turning Logic and Evidence on it Head: Australia's Subsidy to Private Insurance Jeremiah Hurley Centre for Health Economics and Policy Analysis Department of Economics McMaster University Thank Jamie Daw
More informationLWVSD UNIT PRESENTATION, SEPTEMBER, 2009 "HEALTHCARE: HELPING YOU FOLLOW THE DEBATE"
LWVSD UNIT PRESENTATION, SEPTEMBER, 2009 "HEALTHCARE: HELPING YOU FOLLOW THE DEBATE" Luncheons a) Tuesday, September 22nd - Retired State Senator Sheila Kuehl, "What's So Great About Single Payer Healthcare".
More informationHow To Get A Blue Cross Plan For Seniors
Medicare supplement plans Peace of mind from a name you trust Flexible plans backed by over 70 years of experience We ll be there for you Medicare supplement plans are designed to fill in the gaps that
More informationUnderstanding Group Health Insurance Anthem KeyCare 15+ Plan
Understanding Group Health Insurance Anthem KeyCare 15+ Plan January 12, 2010 Although it is the intent of the University to continue current benefit plans, the University reserves the right to modify,
More informationRising Health Care Costs What Factors are Driving Increases?
Rising Health Care Costs What Factors are Driving Increases? Rising health care costs and access to affordable coverage are prominent issues for Washington employers, health care providers, purchasers,
More informationIf I have a psychiatric disability. Will Health Reform Help Me?
If I have a psychiatric disability Will Health Reform Help Me? For consumers of mental health services, a review of the bills passed by Congress in 2009 This paper was written by Chris Koyanagi, policy
More informationHCR 101: Your Guide to Understanding Healthcare Reform
HCR 101: Your Guide to Understanding Healthcare Reform Are You Ready for Healthcare Reform? By now, you ve probably been hearing a lot about the Affordable Care Act (also known as healthcare reform or
More informationCelebrating Pork. The Dubious Success of the Medicare Drug Benefit. Dean Baker. March 2007
Celebrating Pork The Dubious Success of the Medicare Drug Benefit Dean Baker March 2007 Center for Economic and Policy Research 1611 Connecticut Avenue, NW, Suite 400 Washington, D.C. 20009 202 293 5380
More informationThe Medicare Drug Benefit (Part D)
THE BASICS The Medicare Drug Benefit (Part D) The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for Medicare
More informationOpen Enrollment. and Summary of Material Modifications. prepared for
2016 Open Enrollment and Summary of Material Modifications prepared for Medical/Vision, Dental, Disability, Life/AD&D, Flexible Spending Accounts, Employee Assistance Program 2016 Open Enrollment and Summary
More informationHealth care costs in retirement
NATIONWIDE INSTITUTE SM Health care costs in retirement Health care costs in retirement Getting to the heart of the matter Health care It will be one of your biggest expenses in retirement. Yet many people
More informationHEALTH CARE REFORM FREQUENTLY ASKED QUESTIONS
HEALTH CARE REFORM FREQUENTLY ASKED QUESTIONS Consumers When will the health care reform law take effect? The health insurance reforms adopted as part of the Patient Protection and Affordable Care Act
More informationSNHPI Safety Net Hospitals for Pharmaceutical Access
SNHPI Safety Net Hospitals for Pharmaceutical Access Why the 340B Program Will Continue to be Important and Necessary after Health Care Reform is Fully Implemented Since 1992, the 340B drug discount program
More informationFrequently Asked Questions
165 West 46th Street New York, NY 10036-2582 Phone: (212) 869-9380 or (800) 344-5220 Fax: (212) 869-3323 Website: www.equityleague.org We have heard from many Fund participants who have questions about
More informationHealth Reform and the AAP: What the New Law Means for Children and Pediatricians
Health Reform and the AAP: What the New Law Means for Children and Pediatricians Throughout the health reform process, the American Academy of Pediatrics has focused on three fundamental priorities for
More informationFormulary Management
Formulary Management Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective
More informationSmall businesses and the Affordable Care Act
Affordable Care Act Small Business Guide NATIONWIDE RETIREMENT INSTITUTE SM Small businesses and the Affordable Care Act Health insurance reform and insights into employer-sponsored benefits 84% of small
More informationSOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS
July 19, 2010 Contact: Stacey Pogue, pogue@cppp.org SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS Thanks to national health reform, Texas now has two separate high-risk pools that offer health
More informationImpact of the Health Insurance Annual Fee Tax
Impact of the Health Insurance Annual Fee Tax Robert A. Book, Ph.D. February 20, 2014 Executive Summary The Affordable Care Act's "annual fee on health insurance is a unique tax levied on health insurance
More informationDisplay and Categorization of Source of Funds Estimates in the National Health Expenditure Accounts: Incorporating the MMA
Display and Categorization of Source of Funds Estimates in the National Health Expenditure Accounts: Incorporating the MMA Prepared by the National Health Statistics Group (NHSG), Office of the Actuary
More informationTimeline: Key Feature Implementations of the Affordable Care Act
Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next
More informationMedicare Explained (For the rest of us!) A plain English version
Produced by & Not affiliated with any Government Agency A Brief History of Medicare Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees
More informationLABORPARTY. Financing Just Health Care Labor Party Briefing Paper. Revised February 2002. Key Components of Just Health Care Financing
LABORPARTY Financing Just Health Care Labor Party Briefing Paper Revised February 2002 The Labor Party proposes a national health insurance program for the United States that would provide universal coverage
More informationAn Economic Perspective on U.S. Health Reform
An Economic Perspective on U.S. Health Reform Mark E. Votruba Associate Professor of Economics and Medicine Weatherhead School of Management, CWRU and Center for Health Care Research & Policy at MetroHealth
More information6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series
6 Critical Impact Factors of Health Reform on Revenue Cycle Management Pyramid Healthcare Solutions Thought Leadership Series The healthcare industry is undergoing significant change in the face of the
More informationWaste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year
Waste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year By Roger Hickey & Jeff Cruz In cooperation with Dean Baker,
More informationHealth Insurance Part 1. Health Policy Eric Jacobson
Health Insurance Part 1 Health Policy Eric Jacobson Introduction The field of health care has made great strides during the last century. This increase in quality has been accompanied by a much greater
More informationthe Affordable Care Act: What Colorado Businesses Need to Know
22 About questions the Affordable Care Act: What Colorado Businesses Need to Know 1 What is the Affordable Care Act? Who is impacted (small, large businesses and self-insured)? The Patient Protection and
More informationHealth care reform at-a-glance. August 2014
Health care reform at-a-glance August 2014 Employer mandate Shared responsibility payment for failing to offer coverage to at least 95%* of all fulltime employees (FTE) and children if any FTE gets subsidy
More information