A not-for-profit
 health and tax policy
research organization




                         Health Care Reform:
                         What To Do Now?

                         Grace-Marie Turner
                         September 21, 2012
                         Georgia Public Policy Foundation
   /GalenInstitute
   www.galen.org
www.galen.org
www.galen.org
www.galen.org
www.galen.org
Source: Ari Melber,”POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,” The Nation, July 4, 2012,
http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
Americans agreed on goals for health reform…

       • The U.S. needs health reform to:
                – make coverage more affordable
                – assure quality, and
                – expand access to insurance
       • Most people rate their own coverage as
         good or excellent
       • They want stability. Change is for
         others.

www.galen.org
Americans’ views of health law
                      after Supreme Court decision
• Americans say it will make things worse rather
  than better for taxpayers, businesses, doctors,
  and those who currently have health
  insurance.
• Health care will be an extremely or very
  important issue for 82% of Americans in
  deciding their vote for the president in
  November.
• Opposition to the law is higher now than
  before the Supreme Court decision.
Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-
Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBS
News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July
2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
What supporters highlight:

    – “Free” preventive care
    – Allowing “children” up to age 26
      on parent’s policies
    – Pools for pre-existing condition
      policies
    – $250 for seniors with high drug
      costs
The health law in one graph




Source: Avik Roy, “Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012,
http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
Generous Subsidies in
Examples: Exchanges
• A person earning $42,000 a year with a family
  of 4 qualifies for $14,759 in new health
  insurance subsidies
• A single person earning $20,600 qualifies for
  $5,156 in new health insurance subsidies

But only if employer doesn’t offer coverage or
if it’s not “affordable” (costs >9.5% of income)

www.galen.org
Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
Medical Practice Ownership

40% of
doctors
say they
will quit
practice
in 2014 if
the law
takes                     “When the Doctor Has a
                         Boss. More Physicians Are
                         Going to Work for Hospitals
effect                   Rather Than Hanging a
                         Shingle” By ANNA WILDE
                         MATHEWS. The Wall Street
                         Journal Nov. 8, 2010
Health care in 2012
   • Legislation
     Depends upon the outcome of the election
   • Regulation
     13,000+ pages so far
   • Legal
     Other court challenges continue
   • Political
     The voters will ultimately decide on Nov. 6


www.galen.org
Some realities




www.galen.org
Other nations move toward change

                Consumerism
                Value of private
                 enterprise and
                 competition
                Doctor/patient
                 relationship
                Decentralized
                 decision-making
What we know for sure
• CHOICE: Americans value innovation,
  diversity and choice to accommodate 300
  million people
• FOCUS ON THE PATIENT: They want
  doctors and patients, not government, to
  make health care decisions
• VALUE IN HEALTH SPENDING: To realize
  the promise of personalized medicine and
  achieve overall cost saving, we must break
  down payment silos
Starting a fresh conversation

     Engaging patients as
     partners in managing health
     costs and getting the best
     value for health care dollars
Growth of HSA-Qualified High-Deductible Health Plan
              March 2005 to January 2012




     Note: Companies reported enrollment in the large- and small-group markets according to their internal reporting standards, or by state-specific
     requirements for each state. The “Other Group” category contains enrollment for companies that could not break down their group membership into
     large- and small-group categories within the deadline for reporting. The “Other” category was necessary to accommodate companies that were able
     to provide information on the total number of people covered by HSA/HDHP policies, but were not able to provide a breakdown by market category
     within the deadline for reporting


Source: AHIP Center for Policy and Research (May 2012).
CDHC is many things…
• A constellation of offerings that give
  consumers more power and control over
  health care decisions
• New tools include:
  – HSAs, HRAs
  – New chronic care management programs
  – Consumer-focused centers such as
    MinuteClinics and RediClinics
  – Information support tools
CDHC plans are
     moderating costs
Consumer-directed   health plans
 show that realigning incentives
 can help states, employers, and
 consumers save money while
 boosting prevention and wellness
Source: Mercer's National Survey of Employer-Sponsored Health Plans; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April)
1990-2009; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1990-2009.
Options for states…
• Smart Medicaid reform
  – Healthy Indiana Plan
  – Florida’s Medicaid Reform Pilot
  – Rhode Island Global Waiver
• Vulnerable populations in danger
  – Those already on Medicaid face more
    competition for fewer physicians
  – More on Medicaid shifts costs to private
    payers, forcing more to drop coverage
Americans agreed on goals for health reform…

       • The U.S. needs health reform to:
                – make coverage more affordable
                – assure quality, and
                – expand access to insurance
       • Targeted subsidies for the uninsured
       • Portable insurance, equal tax treatment
       • More functional high-risk pools
       • Cutting Medicaid’s red tape

www.galen.org
The future?
    • The global move toward
      consumerism is real, driven
      by greater patient demand
      for more control over
      decisions.

    • Health overhaul is law and
      will fundamentally change
      the U.S. health sector. But I
      believe it will be amended
      significantly before 2014.
Grace-Marie Turner
   A not-for-profit
 health and tax policy
research organization
                         Galen Institute
                         703-299-8900
                         gracemarie@galen.org

                         twitter.com/GalenInstitute
                         facebook.com/GalenInstitute
                         Subscribe to our free email alerts at
   /GalenInstitute
   www.galen.org         www.galen.org/subscribe
Why ObamaCare Is Wrong for America
          How does the health care law
          drive up costs?

          Is your doctor really in charge of
          your health care decisions?

          Are your Constitutional rights
          threatened?



          Discover the law’s impact on
          your life in a new book from
          four nationally recognized
          health policy experts

          Published by Broadside Books,
          an imprint of HarperCollins          www.WrongForAmericaBook.com


www.galen.org

September 21 George Public Policy Foundation

  • 1.
    A not-for-profit healthand tax policy research organization Health Care Reform: What To Do Now? Grace-Marie Turner September 21, 2012 Georgia Public Policy Foundation /GalenInstitute www.galen.org
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
    Source: Ari Melber,”POLL:Half of Americans Don’t Know How Court Ruled on Healthcare,” The Nation, July 4, 2012, http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.
  • 16.
    Americans agreed ongoals for health reform… • The U.S. needs health reform to: – make coverage more affordable – assure quality, and – expand access to insurance • Most people rate their own coverage as good or excellent • They want stability. Change is for others. www.galen.org
  • 17.
    Americans’ views ofhealth law after Supreme Court decision • Americans say it will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance. • Health care will be an extremely or very important issue for 82% of Americans in deciding their vote for the president in November. • Opposition to the law is higher now than before the Supreme Court decision. Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law- Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBS News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July 2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf
  • 19.
    What supporters highlight: – “Free” preventive care – Allowing “children” up to age 26 on parent’s policies – Pools for pre-existing condition policies – $250 for seniors with high drug costs
  • 20.
    The health lawin one graph Source: Avik Roy, “Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012, http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
  • 23.
    Generous Subsidies in Examples:Exchanges • A person earning $42,000 a year with a family of 4 qualifies for $14,759 in new health insurance subsidies • A single person earning $20,600 qualifies for $5,156 in new health insurance subsidies But only if employer doesn’t offer coverage or if it’s not “affordable” (costs >9.5% of income) www.galen.org
  • 24.
    Source: Frank Hill,“The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012, http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.
  • 25.
    Medical Practice Ownership 40%of doctors say they will quit practice in 2014 if the law takes “When the Doctor Has a Boss. More Physicians Are Going to Work for Hospitals effect Rather Than Hanging a Shingle” By ANNA WILDE MATHEWS. The Wall Street Journal Nov. 8, 2010
  • 26.
    Health care in2012 • Legislation Depends upon the outcome of the election • Regulation 13,000+ pages so far • Legal Other court challenges continue • Political The voters will ultimately decide on Nov. 6 www.galen.org
  • 27.
  • 28.
    Other nations movetoward change Consumerism Value of private enterprise and competition Doctor/patient relationship Decentralized decision-making
  • 29.
    What we knowfor sure • CHOICE: Americans value innovation, diversity and choice to accommodate 300 million people • FOCUS ON THE PATIENT: They want doctors and patients, not government, to make health care decisions • VALUE IN HEALTH SPENDING: To realize the promise of personalized medicine and achieve overall cost saving, we must break down payment silos
  • 30.
    Starting a freshconversation  Engaging patients as partners in managing health costs and getting the best value for health care dollars
  • 31.
    Growth of HSA-QualifiedHigh-Deductible Health Plan March 2005 to January 2012 Note: Companies reported enrollment in the large- and small-group markets according to their internal reporting standards, or by state-specific requirements for each state. The “Other Group” category contains enrollment for companies that could not break down their group membership into large- and small-group categories within the deadline for reporting. The “Other” category was necessary to accommodate companies that were able to provide information on the total number of people covered by HSA/HDHP policies, but were not able to provide a breakdown by market category within the deadline for reporting Source: AHIP Center for Policy and Research (May 2012).
  • 32.
    CDHC is manythings… • A constellation of offerings that give consumers more power and control over health care decisions • New tools include: – HSAs, HRAs – New chronic care management programs – Consumer-focused centers such as MinuteClinics and RediClinics – Information support tools
  • 33.
    CDHC plans are moderating costs Consumer-directed health plans show that realigning incentives can help states, employers, and consumers save money while boosting prevention and wellness
  • 34.
    Source: Mercer's NationalSurvey of Employer-Sponsored Health Plans; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April) 1990-2009; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1990-2009.
  • 35.
    Options for states… •Smart Medicaid reform – Healthy Indiana Plan – Florida’s Medicaid Reform Pilot – Rhode Island Global Waiver • Vulnerable populations in danger – Those already on Medicaid face more competition for fewer physicians – More on Medicaid shifts costs to private payers, forcing more to drop coverage
  • 36.
    Americans agreed ongoals for health reform… • The U.S. needs health reform to: – make coverage more affordable – assure quality, and – expand access to insurance • Targeted subsidies for the uninsured • Portable insurance, equal tax treatment • More functional high-risk pools • Cutting Medicaid’s red tape www.galen.org
  • 37.
    The future? • The global move toward consumerism is real, driven by greater patient demand for more control over decisions. • Health overhaul is law and will fundamentally change the U.S. health sector. But I believe it will be amended significantly before 2014.
  • 38.
    Grace-Marie Turner A not-for-profit health and tax policy research organization Galen Institute 703-299-8900 [email protected] twitter.com/GalenInstitute facebook.com/GalenInstitute Subscribe to our free email alerts at /GalenInstitute www.galen.org www.galen.org/subscribe
  • 39.
    Why ObamaCare IsWrong for America How does the health care law drive up costs? Is your doctor really in charge of your health care decisions? Are your Constitutional rights threatened? Discover the law’s impact on your life in a new book from four nationally recognized health policy experts Published by Broadside Books, an imprint of HarperCollins www.WrongForAmericaBook.com www.galen.org