puller-surovell healthcare town hall with secretary bill hazel 3-22-14
TRANSCRIPT
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ClosingtheCoverageGap
Insurance StatusinVirginia Closing theCoverageGap
VirginiaPopulation 8,260,405
Insured:
Medicare,65andover(13%) 1,073,853
CurrentMedicaidEnrollment(FY2014) 1,147,800
Allotherinsured 5,008,752
Uninsured64
and
under 1,030,000
TOTALPopulation 8,260,405Uninsured Breakdown
Uninsured(above) 1,030,000
Inprivateexchange 470,700
EligibleforCoverageGap(estimated) 400,000(Remaininguninsuredindividualsmaynotbeeligibleforcoverageduetoa
numberof
reasons
such
as
immigration
status)
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Whereare
Virginias
Uninsured?
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The
vast
majority
(71.3%)arepartofworkingfamilies
Themajority(80%)are
UScitizens
Mostoftheuninsured(46%)areWhite,nonHispanic
Black/AfricanAmericanmakeup24%
andHispanic20%ofuninsured
Whoare
Virginias
Uninsured?
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ClosingtheVirginiaCoverageGap:
Whowould
be
eligible?
0%
20%
40%
60%
80%
100%
120%
Pregnant
Women
Children05 Children618 Elderly%
Disabled
Parents ChildlessAdults
FPL%
Optional400,000+Virginians
CurrentlyMedicaidEligible
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TheACAgivesVirginiatheoptiontoreceivefederalfundingtocoveran
estimated400,000eligibleindividualswithincomesunder133%FPL.
Basedonhistoricalaverages,anestimated248,000additionalVirginians
wouldenrollandreceivehealthcoverage. Statesthatexpandcoverage,
mustexpand
coverage
to
133%
FPL.
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2014Federal
Poverty
Level
(FPL)
Guidelines
Family Size
Annual Family Income
100% FPL 133% FPL 185% FPL 200% FPL
1 $11,670 $15,521 $21,589 $23,340
2 $15,730 $20,920 $29,100 $31,460
3 $19,790 $26,320 $36,611 $39,580
4 $23,850 $31,720 $44,122 $47,700
5 $27,910 $37,120 $51,663 $55,820
Source: 2014 Federal Poverty Guidelines, U.S. Dept. of Health and Human Services6
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HowwouldVirginiapaytocoverour
uninsured?
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Cost Breakdown
YearVirginia Federal
2014 - 2016 0% 100%
2017 5% 95%
2018 6% 94%
2019 7% 93%
2020 - Future Up to 10% At least 90%
TocovertheuninsuredinVirginia,thefederalgovernmentwouldpay100%of
thecostforthenewlyeligibleMedicaidenrolleesuntilJanuary2017,when
Virginiawouldbeginassumingaportionofthecosts.
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Closingthe
Coverage
Gap
and
the
ACA
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HowistheAffordableCareActfunded?
Howisthisfundingalready
affectingVirginia?
Isit
optional
for
Virginia
to
participateinfundingthe
AffordableCareAct?
NO.We
are
already
payingforitwithout
receivingthebenefits!
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TheAffordable
Care
Act
Funds
Itself
ThenonpartisanCongressionalBudgetOfficerecently
confirmedyet
again
that
federal
healthcare
reform
on
balancefundsitself.
Fundingsources:
1. Spendingreductions
on
public
health
programs
2. Taxrevenues
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Spending
Reductions
NewTax
Revenues
ACAFunding
for
State
Programs
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FundingSource#1:
Reductionsto
Medicare
Payments
ThelargestspendingreductionisinpaymentstohospitalsforMedicarepatients($196Bfrom20102019).
WhatdoesthismeanforVirginia? Financial
hit
to
Virginias
hospitals:
lossofover$1.5Billionfrom20142018
Jobloss
for
Virginia
citizens:
Nearly1,000jobshavealreadybeenlostoraffectedinVirginia.
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FundingSource#2:
Increasein
Federal
Taxes
ThelargestrevenuesourcefortheACAis$200Billionthatcomesfromunavoidabletaxincreases.
Federalpayrolltaxincreaseof0.9%andinvestmentincometaxincreaseof3.8%forhighincomeindividualsandfamilies($200,000&$250,000,respectively)
WhatdoesthismeanforVirginia?Each
year,
regardless
of
whether
or
not
we
cover
the
uninsured,Virginianswillpayout$2BillionintaxesandfeestosupporttheACA.
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Outflowof
Virginia
Dollars
NOTE:ThetaxanalysisisbasedondatafromtheJuly24,2012CBOletterreporttoSpeakeroftheHouseJohnBoehner.
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Thismoney
couldbe
used
rightherein
Virginiato
coverour
uninsured.$5Million
EveryDay
$2Billion
Every
Year
$10Billion
est.
over
5years
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Failingto
Close
the
Coverage
Gap
Ifwedonotclosethecoveragegap,effectivelyreinvestingthis
money
back
in
Virginia,
our
families
andbusinesseswillsendhardearnedtaxdollarsto
Washingtonwithoutthebenefits,jobs,orrevenue
returnedtoVirginia.
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$2BilliontoFederalGovernment
$0BacktoVirginia
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SystemicEffects
of
Coverage
Theeffectsofcoveringtheuninsuredcanbefeltbeyond
economicsandindividualandpublichealth.
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Coveringthe
Uninsured
MentalHealth
Education
BusinessPublicSafety
VeteransAffairs
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MentalHealthAnestimated77,000adultsinVirginiahavementalillnessesandnoinsurancetopayfortreatmentormedication.
PublicSafetyGainingaccesstotreatmentformentalhealthandsubstanceabusemayeasetheburdenonVirginiaslawenforcementcommunity.
EducationParentswhohavecoveragearemorelikelytogaincoveragefor
theirchildren.
Healthy
parents
equal
healthy
students.
BusinessVirginiasbusinessespayhigherpremiumsforemployeestocompensatefortheuninsured.Newbusinessesmaybelessinclinedto
cometoVirginia,createjobs,andinfuseoureconomy.
VeteransAffairsOfthemorethan30,000uninsuredveteransandtheirspouseswholiveinVirginia,nearly10,000uninsuredveteransandnearly
3,000oftheirspouseswillbeeligibleforcoverage.
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SystemicEffects
of
Coverage
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Whatare
other
states
doing?
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Highlights
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Whileanewprogramtocovertheuninsuredis
optional,the
new
taxes
to
cover
the
costs
of
funding
theACAarenot.
Virginiawilllose$2Billionannuallywithoutcreating
anew
program.
Medicaidisundergoingaseriesofreformsdesigned
tocontrolcostsandstreamlinecare.
Coveringthe
uninsured
in
Virginia
will
not
only
providehealthcoveragetoindividualsinthegap,itwill
havepositiveimpactsinpublicsafety,commerce,
education,and
mental
health.
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Medicaidin
the
44th District
Mt.Vernon&LeeCommunity
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CurrentMedicaidPopulation 12,532Medicaid/FAMISPopulation
16%of
44th District
Residents
Whoisthatpopulation?
748Adults
482Aged
432Other
633PregnantMothers
9,371Children
1in3Childreninthe44th District
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CostofCurrent44th DistrictPopulation
OverallCost$42,738,651
$6,634,997Acute
Care
$19,693,493 MCOPayments(ManagedCare)
$6,215,443 LongTermCarePayments
$9,628,692 PrimaryCarePayments
$540,001 Pharmacy
$237,417 Dental
Payments
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WhyisUninsuredCarein44th a
Problem?
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WhyIs
Uninsured
in
44
th
AProblem?
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FairfaxCountyEmergencyRoomLowAcuityVisitsByZip(Enlarged)
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MostUtilizedProvidersHospitals
INOVAFairfax
TheAlexandriaHospital
INOVAAlexandria
VAHospital
Center
Mt.VernonHospital
NursingFacilities Manor
Care
of
Alexandria,VirginiaLLC
Mt.VernonNursing
Center WoodbineRehabilitation
HealthCenterLLC
Leewood Health
Center ManassasHealth&
RehabilitationCenter
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WhatDoesClosingtheGapMeanforthe44th District?
UsingtheMedicaidChildPopulationasa
Proxy
44th Districthas1.33%ofallMedicaidchildrenin
VA
$24,349,859New
Spending
400NewJobs
5,337New
People
Provided
Health
Insurance
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VirginiaGeneralFundSavings MedicaidExpansionFreesup$280MillionThisBiennium DepartmentofCorrections
IndigentCareatStateTeachingHospitals
Community
Services
Boards FreeClinics
PregnantWomen
BreastCancer
FamilyPlanning
Howcouldthesesavingsbereappropriated? LawEnforcement HigherEducation
SecondaryEducation:
$27,636,012forFairfaxCounty $154.61perstudent 502NewTeachersat($55K/position)
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BOTTOMLINES ExpansionWouldSaveVATaxpayersHundredsofMillions WouldFreeUpGeneralFundMoneyforOtherPurposes WouldProvideLastUninsuredwithDignityofHealthInsurance WillCreate30,000VirginiaJobs WillBringVAFederalTaxDollarsBacktoVirginiaandStopVA
SubsidizingOtherStates WillControlExplodingPrivateMedicalInsuranceCosts
IsSupportedby: HealthCareIndustry VirginiaChamberofCommerce FairfaxCountyChamberofCommerce SenateofVirginia GovernorTerryMcAuliffe
IsOpposedby: VirginiaHouseRepublicanCaucus
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