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THE ACA OF 2010 & REAL HEALTH CARE REDESIGN Cong. Michelle Bachmann Staff Briefing – 12/13/2010 Dave Racer, MLitt.

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Presentation on theme: "THE ACA OF 2010 & REAL HEALTH CARE REDESIGN Cong. Michelle Bachmann Staff Briefing – 12/13/2010 Dave Racer, MLitt."— Presentation transcript:

1 THE ACA OF 2010 & REAL HEALTH CARE REDESIGN Cong. Michelle Bachmann Staff Briefing – 12/13/2010 Dave Racer, MLitt

2 Health care: One among many  Is there a pattern here? What about health care? Banking regulation Cap and Trade Stimulus bills Tax reforms “Climate Change” Devaluation of the dollar Unaffordable: Make a list Gov’t subsidized Reduction in military spending “Green” Energy Federally imposed local programs Transportation Immigration Business regulation Federal education Federal farm programs Domestic security Is this the new organizing principle? 16 percent of GDP – Central Economic issue Touches everyone – But not to the same degree nor at the same time Perhaps more stakeholders (money is at risk) than any other single issue Public pays attention only when sick or injured, and cares only about medical relief The ideal focus for government control?

3 Poor results begin with wrong assumptions and bad facts  Quality of care  Are we really 37 th in the world?  Access to care  Do we spend months and years on wait lists?  Uninsured  Who are they and why are they uninsured?  Inefficiencies of private insurance  Efficacy and efficiency of European style (government- run) health care  Cost of health care  Total health care spending

4 Poor results begin with wrong assumptions and bad facts  Quality of care  Are we really 37 th in the world?  Access to care  Do we spend months and years on wait lists?  Uninsured  Who are they and why are they uninsured?  Inefficiencies of private insurance  Efficacy and efficiency of European style (government- run) health care  Cost of health care  Total health care spending

5 But They asked the question: “How do we get universal health insurance – everyone covered?”  We asked employers the question  If they did health care system reform, on which problem would they have focused?  Cost  Of insurance  Of health care

6 What if Congress had, instead, dealt with this problem?  “The annual cost of federal regulations in the United States increased to more than $1.75 trillion in 2008…”*  14% of the Gross Domestic Product  “One out of every three dollars earned in the U.S. goes to pay for or comply with federal laws and regulations…”  How much of the $2.5 Trillion spent on health care is the result of federal and state regulation? Copyright 2010: DGRCommunications, Inc. 6 * Crain & Crain. The Regulation Tax Keeps Growing, WSJ, 9/27/10

7 Private insurance companies the villain?  CBO Projected $2.5 trillion for 2009  16 percent of GDP  CMS says $879 billion is paid by private insurance  Canada at about 10 percent of GDP  What does that extra 6 percent get us?

8 “Insurance covered most of it.” What does the private health insurance system get us? 8 (c) freemarkethealthcare.com

9 What do Canadians get for 10% of GDP? (c) Alethos Press LLC “No doctors assessment, no CT scans, no x-rays, nothing. The paramedics just dropped them off at a hotel in White River. Welcome to Canadian health care.”

10 Thomas Sowell  “The first lesson of economics is scarcity: there is never enough of anything to satisfy all of those that want it.  The first lesson of politics is to disregard the first lesson of economics.”

11 Copyright 2010: DGRCommunications, Inc. 11 Patients as consumers: Insured and “uninsured” Doctors & hospitals Payers Provided care Decided what to buy and from whom – Options for low-income Paid catastrophic claims: They were insurance companies Paid the first dollars for their own health care How people with health insurance bought health care pre % Out of Pocket

12 Many pieces [sort of] fitting together 4/21/2015Copyright 2010: DGRCommunications, Inc. 12 ? ACA

13 What the President and liberal reformers believed they could accomplish over time

14 Neat, orderly, rigid, managed top down 4/21/2015Copyright 2010: DGRCommunications, Inc. 14 ? ACA

15 Copyright 2010: DGRCommunications, Inc. 15 Payers Physicians Hospitals Patients Entitled to care Decide coverages Mostly controlled by what is reimbursed May or may not comply But they will spend, spend, spend How people with health insurance Have bought health care since % Out of Pocket

16 A look at your future health care system 4/21/2015Copyright 2010: DGRCommunications, Inc. 16 ? ACA

17 Is this the logical destination? 4/21/2015Copyright 2010: DGRCommunications, Inc. 17 ACA United States Health Care Services After about 40 years

18 The Affordable Care Act of 2010 Copyright 2010: DGRCommunications, Inc. 18 “We have to pass the bill so that you can find out what is in it.” Speaker Nancy Pelosi

19 Meet the new health care CEOs 159 New commissions, boards, study groups, and grant makers Kathleen Sebelius Her title appears more than 3,000 times in the ACA.

20 Here’s one of those 3,000 mentions The secretary will… “…consider standardization of recipes and methods of preparation, reasonable variation in serving size and formulation of menu items, space on menus and menu boards, inadvertent human error, training of food service workers, variations in ingredients, and other factors, as the Secretary determines;” Sec Copyright 2010: DGRCommunications, Inc. Eating food may be hazardous to your health The Secretary Warning

21 Just cut the cost of insurance  Secretary, along with states, will approve and regulate insurance rates  Let’s just tell companies how to split up their premiums

22 Which entity is more efficient?  Private health plans?  Public health plans CMS says net admin cost of approximately 12.7% CMS says net admin cost of approximately more than 26% Myth of Medicare efficiency: CBO: Hidden government health care admin cost

23 The DHHS Secretary will define MLR  Medical Loss Ratio  How much must be paid out in claims vs. admin and marketing  80/20 – Individual and small group  85/15 large group  June 23 deadline for the initial rule  Found defining allowable claims nearly impossible and political  Initial rule launches January 1, 2011 (except for numerous waivers) Problem: Constitutional authority?

24 What should be the long term goal?  Strategically repeal the ACA in bits and pieces  Use the Constitution’s funding provisions to push off and kill key noxious portions

25 Recommendations  #A (added): Audit the imposed cost of regulation on health care  #1: Review the ACA for DHHS deadlines – demand accountability  #2: Determine which ACA DHHS tasks are receiving the strongest push back and pick them off  #3: Push off implementation at least in proportion to DHHS rule-making failures

26 But what does it not address? Copyright 2010: DGRCommunications, Inc. 26 The one reform that is actually working

27 1965 – 2009 Spending Trend  Since 1965:  Military spending has increased 1,177%  Federal and state public education spending has increased 2,950%  Spending on health care has increased 6,000% Copyright 2010: DGRCommunications, Inc cents a gal 1965 $16.80 a gal 2009

28 Reflecting the D.C. attitude  Pres. Obama appointed Dr. Donald Berwick CMS chief  Sample of Berwick quotes  “Please don’t put your faith in market forces.”  “A progressive policy regime will control and rationalize financing-- control supply.” 28Copyright 2010: DGRCommunications, Inc. “I cannot believe that the individual health care consumer can enforce through choice the proper configurations of a system as massive and complex as health care. That is for leaders to do.”

29 “Unintended” consequences  Sec requirement  $600 “aggregate” 29 Copyright 2010: DGRCommunications, Inc. Rosen’s Diversified, Fairmont, MN 30 minutes each = 3.5 “man” years

30 Recommendations  #5: Repeal Section 9007 in 2011  #6: Reset the financial thresholds that would bar low- and middle-income individuals from using HSAs and high deductible health plans (make them an option)

31 How does the ACA attempt to do this? ACA

32 ACA: Tries to find a way to manage doctors and other medical providers Copyright 2010: DGRCommunications, Inc. 32 Specialties Imaging & radiology General Surgeons Admin. Vendors Admin. Vendors Clinical Products Primary Care Specialty Surgeons Pharma Medical Devices

33 ACA: Tries to find a way to manage doctors and other medical providers Copyright 2010: DGRCommunications, Inc. 33 Specialties Imaging & radiology General Surgeons Admin. Vendors Admin. Vendors Clinical Products Primary Care Specialty Surgeons Pharma Medical Devices ACA

34 ACA to ACOs: Larger organizations 4/21/ Medicare ACOs Docs Diag- nostic Sur- geons Ven- dors Else Docs Diag- nostic Sur- geons Ven- dors Else Docs Diag- nostic Sur- geons Ven- dors Else Hospitals

35 Decentralized control does work!  310 million Americans  850,000 doctors  2.5 million nurses  5818 hospitals  Tens of thousands of government regulators

36 From 1,300 competing health insurance companies regulated by states Copyright 2010: DGRCommunications, Inc. 36 ABC Ins. Kids R Us Insurance Best Ins. Co. MyState Ins. NewNew Old and Steady Ins. Co. Innovative Ins. Local Ins. Biggy Ins. Co.

37 To a few large companies acting as federally regulated industries Copyright 2010: DGRCommunications, Inc. 37 Aetna Kids R Us Insurance Best Ins. Co. Cigna NewNew Blue Cross Blue Shield Innovative Ins. Princi pal United Health Group Kaiser Goes National, Co.

38 Recommendations  #7: ACOs are already underway: Look for any method by which to remove restrictions on smaller providers  Fee for Service is not the enemy  Profit is our friend  Medicare’s ubiquitous control of reimbursements  #8: Make the case: Fewer insurance companies leads to less competition

39 Herding Us Into Health Insurance Delivery Models The Exchange – 1/1/2014  The Individual Mandate to Buy Health Insurance Copyright 2010: DGRCommunications, Inc. 39 The Health Benefit Exchange

40 Herding Us Into Health Insurance Delivery Models The Exchange – 1/1/2014  Could be state, or could be federal, but “must be” Copyright 2010: DGRCommunications, Inc. 40 Individual Insurance Individual Insurance Small Group Insurance Small Group Insurance One Exchange for both Secretary of HHS State Government Individuals Small Groups All Subsidized Plans Gov’t Plans Comparative EffectivenessCMSInternal Revenue Service Assess penalties for uninsured Verification of financial data Collection of penalties Analyze health data Create practice guidelines Health Data from insurance companies Homeland Security INS

41 Ask the most basic question  Do states need a health benefit insurance exchange?  Will it serve to reduce uninsurance and drive down health care spending and insurance cost? One Exchange for both Increases costs

42 Coverage, by category*  Medicare, aged 65 and over  Medicare, under age 65  Medicaid, CHIP, Military, VHA, and other government programs  2009 CHIP Added  Total Covered - Gov  34 million  7 million  58 million  4 million  103 million * Congressional Budget Office-12/2008 US Population- Noon - 12/11/10: 310,891,207 Government-run health care

43 Additional covered gov’t care  Total number of federal, state, and local government employees and dependents  Total Covered and paid directly or indirectly by taxes  38.5 million*  103 million  million  million 43 Copyright 2010: DGRCommunications, Inc.

44 ACA “reducing the cost of insurance”  Subsidies – 400% of FPG  Expansion of Medicaid  To 133% of FPG - $22,050 family of four  About 48 million residents (11 million )  Key Issue 1: Threatens future state budgets Maintenance of effort State share – Can federal government match? Additional benefits  Key Issue 2: No asset test

45 Reducing the rate of those without health insurance through tax-paid subsidies  Poverty level-Family of 4  Two times FPL  82.3 million (31%)  Three times FPL  127 million (48%)  Four times FPL  million (62%)  Five time FPL  192 million (73%)  $22,050  $44,100  $66,150  $88,200  $110,250 Modified Adjusted Gross Income

46 Entitlement Copyright 2010: DGRCommunications, Inc. Today, three of every 10 are in the wagon

47 Federal subsidies for you and/or your neighbors Persons in FamilyPoverty Guideline400 Percent of FPG 1$10,830$43,320 2$14,570$58,280 3$18,310$73,240 4$22,050$88,200 Copyright 2010: DGRCommunications, Inc. 47 The 2009 Poverty Guidelines Qualified for Subsidy At $400% of FPG “Modified” Adjusted Gross Income

48 Federal subsidies for you and/or your neighbors Persons in FamilyPoverty Guideline400 Percent of FPG 1$10,830$43,320 2$14,570$58,280 3$18,310$73,240 4$22,050$88,200 5$25,790$103,160 6$29,530$118, ,270$133,080 Copyright 2010: DGRCommunications, Inc. 48 The 2009 Poverty Guidelines Qualified for Subsidy At $400% of FPG “Modified” Adjusted Gross Income

49 Making insurance affordable Policyholder’s Age Low Cost Area Annual Subsidy Med. Cost Area Annual Subsidy High Cost Area Annual Subsidy 35$0$1,036$2,763 45$1,264$3,480$5,695 55$4,689$7,761$10,834 60$7,360$11,100$14,840 “For most families, the cost of health insurance will go down.” Consider: Family of 4, with family income of $80,000 How? Shifting Cost to someone else. Kaiser Family Foundation: Health Reform Subsidy Calculator

50 Making insurance affordable Policyholder’s Age Low Cost Area Annual Subsidy Med. Cost Area Annual Subsidy High Cost Area Annual Subsidy 35$1,694$3,422$5,149 45$3,649$5,865$8,081 55$7,074$10,147$13,219 60$9,745$13,485$17,225 “For most families, the cost of health insurance will go down.” Consider: Family of 4, with family income of $60,000 Kaiser Family Foundation: Health Reform Subsidy Calculator

51 Making insurance affordable Policyholder’s Age Low Cost Area Annual Subsidy Med. Cost Area Annual Subsidy High Cost Area Annual Subsidy 35$4,731$6,458$8,186 45$6,686$8,902$11,118 55$10,111$13,183$16,256 60$12,782$16,522$20,262 “For most families, the cost of health insurance will go down.” Consider: Family of 4, with family income of $40,000 Kaiser Family Foundation: Health Reform Subsidy Calculator

52 New Federal Law: Entitlement Copyright 2010: DGRCommunications, Inc. Seven of every ten will be in the wagon

53 Recommendations  Kill it before we become used to it  #9: Require asset test for Medicaid  #10: We cannot afford the middle income subsidies – Eliminate them  #11: Delay, Defund, Defeat the Exchange  Avoid the idea that Republicans can support it  We really cannot do socialism better than others

54 ACA: protecting consumers? ACA-No rescissions was already the law ACA-No annual or lifetime limits Increases insurance premiums ACA-No pre-ex exclusion for children And no policies for healthy children

55 ACA emphasis is on preventive care Copyright 2010: DGRCommunications, Inc. 55 Healthy Human Being Weight Exercise Diet No Tobacco Sleep Stress Family Spiritual

56 Screenings: Choose from List A & B  May prevent disease from becoming worse  United States Preventive Services Task Force  Except for politically sensitive tests  Those reported on or about November 2009  Annual mammograms Copyright 2010: DGRCommunications, Inc. 56

57 Preventive Care Means Us…  Means lifestyle changes, the primary one of which is:  Become healthier 70% of health spending lifestyle related Copyright 2010: DGRCommunications, Inc. 57

58 Copyright 2010: DGRCommunications, Inc. 58

59 Real Preventive health care  What if there was a real way to reduce catastrophic and even routine illnesses?  To reduce new breast cancers by 83 %  To reduce colon cancer by 60%  To reduce childhood diabetes by 66%  To reduce Multiple Sclerosis by 50%  To reduce flu rate by 90%  For $3 per month Copyright 2010: DGRCommunications, Inc. 59 Grassroots Health - D3

60 The ACA does address the cost of care  Reducing Medicare payments to doctors and hospitals – Once again, Congress backed down  Comparative effectiveness research - $1.1 billion  Which things work and which do not  Concern: Cost versus effectiveness  Value of human life Copyright 2010: DGRCommunications, Inc. 60 * Emmanuel, Z. et al. “Principles for allocation of scarce medical interventions” Lancet, January 2009

61 Addressing cost of care  Value of human life – When is too much, too much? Copyright 2010: DGRCommunications, Inc. 61 * Emmanuel, Z. et al. “Principles for allocation of scarce medical interventions” Lancet, January 2009

62 Attitude and ideas drive actions  "I am romantic about the NHS (British National Health Service). I love it.“  "NICE is not just a national treasure; it is a global treasure“  NICE mandates that NHS cannot spend more than $22,000 to extend life 6 months. 62 Copyright 2010: DGRCommunications, Inc.

63  We fight for the lives of the most vulnerable among us. Copyright 2010: DGRCommunications, Inc. 63 Rumaisa Rahman oz.

64 Recommendations  #12: Get realistic about preventive care: consumers must have money at stake.  #13: Consider two major Medicare reforms:  Means testing  Balanced billing  # 14: Move effectiveness testing to medical schools and medical societies

65 Recommendations  #15: Get realistic about preventive care: consumers must have money at stake.  #13: Consider two major Medicare reforms:  Means testing  Balanced billing  # 14: Move effectiveness testing to medical schools and medical societies

66 Some popular conservative reforms  Suggestion  Eliminate employer- based coverage  Sell across state lines  Alternative  Individual health plans  Best plan offered by insurance company despite location  Consider:  Increase in uninsured rate-Employment instability/cost  Reco: Equalize tax status ($4,000/$8,000)  Lack of networks  Differences in mandates and potential for fed- imposed plan

67 Some popular conservative reforms  Suggestion  Evidence-based outcomes (Practice guidelines)  Tort reform-Loser pays, caps on damages  Alternative  Reward MDs that follow the guidelines: Hold down cost  Federal government establishes a national standard  Consider:  Who sets up the guidelines?  Limitations on MD’s ability to adapt to the unexpected  Proper federal role?  Trial lawyers’ political impact- safer federal or state level?

68 High risk health insurance pools  ACA high risk plan concept made some sense  Terribly underfunded  No reliable funding system  PAS – Pooled Affordable Stable  GAP – Guarantee Affordable Portable  APT – Affordable Price Transparent } Federal role? Eliminate barriers

69 Health Care Redesign Where the Affordable Care Act Leads

70 Health Care Redesign Where redesign should take us

71 Who really needs help? You decide Copyright 2010: DGRCommunications, Inc. 71 CategorySituation DisabledUnable to work: No financial assets Unable to work: With financial assets Able to work: With financial assets

72 Who really needs help? You decide CategorySituation Chronically IllUnable to work: No financial assets Unable to work: With financial assets Able to work: With financial assets Copyright 2010: DGRCommunications, Inc. 72

73 Who really needs help? You decide Copyright 2010: DGRCommunications, Inc. 73 CategorySituation Healthy, Able Bodied In-between jobs: No financial assets In-between jobs: With financial assets Employed: No financial assets Employed: With financial assets Choose unemployment: No financial assets Choose unemployment: With financial assets

74 “Radical” redesign? Two-tiered system?  Private health care  Anyone with private insurance or the ability to pay for their own care  Using private health care facilities and privately paid staff  Public health care  Anyone without private insurance or the ability to pay for their own care  Using Community Health Centers, public hospitals, and other public facilities

75 The COHR Principle Coalition for Healthcare Redesign  Bringing together stakeholders that actually work with people on a daily basis  Broad, market-based solutions  Reducing governments’ role  Increasing consumers’ role  More access to higher quality acre at a more affordable price  Coming soon to a town hear you

76 THE ACA OF 2010 & REAL HEALTH CARE REDESIGN Cong. Michelle Bachmann Staff Briefing – 12/13/2010 Dave Racer, MLitt


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