1. The American Problem: Health Insurance Jennifer Bernstein Michael Berry Tom Chiang Ryan Lubitz Leanne Lundby

2. History: The roots of American Health Care Problems beginning in the early 1900’s Problems beginning in the early 1900’s The Great Competition among firms The Great Competition among firms The System of Reimbursement and high Health care expenditures The System of Reimbursement and high Health care expenditures No Federal or State Law regulations No Federal or State Law regulations all leading to the biggest problem of all… all leading to the biggest problem of all…

3. History: The development of current Health Care practices Social Security Act, 1938 Social Security Act, 1938 Coverage of hospitalization and serious illness (1940’s- 1950’s) Coverage of hospitalization and serious illness (1940’s- 1950’s) 3 Major movements 3 Major movements Higher wages and better benefits offered by employers (1945- 1969) Higher wages and better benefits offered by employers (1945- 1969) Passage of government funded Health care programs (1960- 1970s) Passage of government funded Health care programs (1960- 1970s) Employee Retirement and Income Security Act (ERISA) Employee Retirement and Income Security Act (ERISA) Movement to control costs Movement to control costs Hospitals and State government administer funds Hospitals and State government administer funds Laws of 1980’s-1990’s Laws of 1980’s-1990’s

4. Types of Health Care Coverage Employer sponsored Employer sponsored Preferred Provider Organization (PPO) Preferred Provider Organization (PPO) Health Maintenance Organization (HMO) Health Maintenance Organization (HMO) Government sponsored Government sponsored Medicare Medicare Medicaid Medicaid

5. The Main Players The Employers The Employers The Health Care Providers and Professionals The Health Care Providers and Professionals The Government The Government

6. The Issues Increase in Premiums Increase in Premiums Federal Health Benefits Program Federal Health Benefits Program 10% increase 10% increase California Public Employees Retirement System California Public Employees Retirement System 25% increase 25% increase Approximately 6 in every 10 employees are currently covered by Health care benefits provided by their employer Approximately 6 in every 10 employees are currently covered by Health care benefits provided by their employer

7. Factors associated with coverage… Industry type Industry type Public v. Private Public v. Private 25% of workforce is in the Private sector 25% of workforce is in the Private sector 87% of the private sector employees are covered by their employer 87% of the private sector employees are covered by their employer Small business v. Large Business Small business v. Large Business Small (under 100 employees) Small (under 100 employees) 71% are covered by their employer 71% are covered by their employer Large (over 100 employees) Large (over 100 employees) 82% are covered by employer 82% are covered by employer

8. …more factors Union v. Non-Union Union v. Non-Union 92% of Union workers are covered by their employer 92% of Union workers are covered by their employer 75% of Non-union workers are covered by their employer 75% of Non-union workers are covered by their employer Contingent and Part time employees Contingent and Part time employees 17% of the workforce are part time 17% of the workforce are part time Only 16% of part time employees are covered by their employer Only 16% of part time employees are covered by their employer Dependents Dependents Includes spouse, children, parents and others Includes spouse, children, parents and others

9. Current Problems Rising Costs - wages decreasing, prices for good, services, & taxes increasing Rising Costs - wages decreasing, prices for good, services, & taxes increasing Quality – No accountability Quality – No accountability Logic - Reactive vs. Proactive Logic - Reactive vs. Proactive Complicated – hard to find appropriate policy for company & employees Complicated – hard to find appropriate policy for company & employees Lots of limitations and exclusions lead to abusive practices Lots of limitations and exclusions lead to abusive practices Security – 2 million Americans lose their health insurance every month Security – 2 million Americans lose their health insurance every month

10. Clinton Health Security Plan “guaranteed comprehensive health benefits for all American citizens and legal residents, regardless of health or employment status. Health coverage is seamless; it continues with no lifetime limits and without interruption if Americans lose or change jobs, move from one area of the country to another, become ill or confront a family crisis.”

11. Clinton’s Principles to Address Current Problems Clinton’s Principles to Address Current Problems Control rising costs Control rising costs Improve Quality Improve Quality More Choices for consumers More Choices for consumers Simplified system Simplified system Make everyone responsible Make everyone responsible

12. LOSER: Why it Failed Most everyone was in support of universal health reform BUT, Most everyone was in support of universal health reform BUT, Bipartisan Congress Bipartisan Congress Didn’t agree on the approach the plan was taking Didn’t agree on the approach the plan was taking Too many groups with different interests involved Too many groups with different interests involved Lobbyists Lobbyists

13. Possible solutions: What the Individual can do Be proactive! Be proactive! Take responsibility for your own Health, try to solve the problem before it occurs and becomes more serious Take responsibility for your own Health, try to solve the problem before it occurs and becomes more serious If your employer does not provide coverage, seek out Union coverage If your employer does not provide coverage, seek out Union coverage Support government and other officials who are proactive in helping to solve America’s Health care problems Support government and other officials who are proactive in helping to solve America’s Health care problems

14. Possible solutions: What the Employer can do Defined Contribution Plan Defined Contribution Plan Set allowance for employees health care benefits Set allowance for employees health care benefits Can choose amongst various plans with different levels of coverage and price Can choose amongst various plans with different levels of coverage and price Supporters – Forces employees to educate themselves to make smart decisions Supporters – Forces employees to educate themselves to make smart decisions Critics – employees lose the abilities and purchasing powers their employers do for them on their behalf Critics – employees lose the abilities and purchasing powers their employers do for them on their behalf Cooperative agreement to form a Unified coverage plan Cooperative agreement to form a Unified coverage plan

15. Possible solutions: What the Government can do Focus on the declining quality of Health care coverage Focus on the declining quality of Health care coverage Maybe focus on the your own country instead of Iraq for a second Maybe focus on the your own country instead of Iraq for a second Reform current laws to be more lenient on employers Reform current laws to be more lenient on employers Defined Contribution Plan Defined Contribution Plan Federal Patient’s Bill of Rights Federal Patient’s Bill of Rights Refund more money to individuals so the ability of people in lower income brackets to purchase insurance increases Refund more money to individuals so the ability of people in lower income brackets to purchase insurance increases

16. Case Study on Children and Health Insurance Case study created to see how to affect number of children without health insurance Case study created to see how to affect number of children without health insurance 4 states involved, California, New Mexico, Georgia, and Ohio 4 states involved, California, New Mexico, Georgia, and Ohio Gov’t money provided CHIP (Children’s Health Insurance Program) passed by Congress Gov’t money provided CHIP (Children’s Health Insurance Program) passed by Congress

17. Case study cont.’d Basis of case was built to see how many children in the four states could be provided insurance Basis of case was built to see how many children in the four states could be provided insurance Major difficulties due to: Major difficulties due to: Outreach programs Outreach programs Eligibility and Enrollment strategies Eligibility and Enrollment strategies Implementation Issues Implementation Issues Numerous problems within states Numerous problems within states

18. Conclusions to Case Study Difficult to build new infrastructure Difficult to build new infrastructure Each state must use own system to build in order to have statewide benefits, and local ones Each state must use own system to build in order to have statewide benefits, and local ones Health care coverage still a major issue for U.S., funding, eligibility, and implementation all problems Health care coverage still a major issue for U.S., funding, eligibility, and implementation all problems

19. In conclusion… No matter what choices are made and reforms occur, there is no way to satisfy all parties in the Health care battle, thus Health care coverage will remain an ongoing game between the employers, government and providers for many years to come…

20. Questions & Comments What do you think?? How many of you are actually covered under your own Health care plan? (not a dependent) How many of you are actually covered under your own Health care plan? (not a dependent) Do you think Health care coverage is an important part when considering taking a new job? (since we are all in this predicament right now) Do you think Health care coverage is an important part when considering taking a new job? (since we are all in this predicament right now) What role do you think the government should play regarding this issue? What role do you think the government should play regarding this issue?