health care reform update
DESCRIPTION
Health Care Reform Update. Ruth T. Perot, MAT Managing Director , NHIT Collaborative Executive Director , SHIRE Health IT Resource Technology Teach-In October 29, 2009. SHIRE. National Health Expenditures per Capita, 1990-2018. $13,100 (2018). Actual. Projected. $8,160 (2009). - PowerPoint PPT PresentationTRANSCRIPT
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/.
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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