Meeting our health care needs…together

Quality, affordable health care for everyone will help Alabama move forward ► Lower costs – push prevention, early treatment ► Lower worker absenteeism – boost productivity ► Lower school absenteeism – improve learning ► Decrease racial disparities in health care

► If you’re happy with your health care plan, you shouldn’t have to change it. ► If you’re unhappy with your current care, you should have other options. ► If coverage choices include a public plan, competition will benefit consumers. A key to reform: Freedom of choice

What we have heard Insurance coverage  Preventive care (vaccines, prenatal, check-ups, etc.)  Dental & optical  Mental health parity  Pre-existing conditions  Chronic care & long-term care  Coverage for everyone  No limits on benefits

What we have heard Access to health care  Need more health care professionals  More clinics & doctors’ offices with flexible hours  Decisions left to patient, doctors, patient advocates Barriers to health care  Income disparity  Lack of transportation Funding suggestions  Shared: consumer, insurance, government  Single-payer: government only

Guidelines for reform Affordable health care for everyone Protect consumers from unaffordable costs and medical debt Exclude no one Share costs fairly among individuals, employers and government Appropriate coverage for basic health needs Cover primary, emergency and preventive care Let people choose their health insurance and care providers Leave medical decisions to patients and their doctors, not insurance providers Accessible, high-quality health care Address health care provider shortage in rural and low-income areas Promote health equity in regard to race, age, gender and income Use incentives to improve quality of care

Historic window of opportunity ■ We need to pass health reform this year. ■ The costs of inaction are too great. ■ We may not get a perfect bill, but if we work together, we will take a giant step forward.

Key issues to watch Affordability Medicaid Public health insurance option Quality of care Financing Insurance reform

Affordability Naming the problem Family budgets are tight.  Many employers dropping their health plans.  In Alabama, 590 people lose coverage every week. Even insured families struggle with co-pays and deductibles.  28% say they delay care they need because of costs.

Affordability Crafting a solution No money to spare? No premium.  Alabama parents now get Medicaid if they make less than 11.5% of poverty line.  After reform, at least up to poverty line. Middle-income: Pay on a sliding scale. Subsidies help pay premiums for a plan in the Health Insurance Exchange if income under % of poverty line. Insurance reforms: Limit out-of- pocket costs. Subsidies on a sliding scale here, too.

Medicaid: Who pays – State or Federal? Every year Alabama faces Medicaid budget crises. $300 million shortfalls are common …despite federal-state match! House bill: Feds pay all costs of Medicaid expansion for 2 years, then 90% from then on. Senate draft: Feds pay all costs for first few years, then phase in larger state match. The House bill is good for Alabama’s budget! An American health plan with national funding.

Public Health Insurance Option A quality public plan to compete with private insurance plans – like offering Medicare to other age groups.  “Keep the insurance companies honest.” Driven by profit motive, private companies maximize profits and often deny care.  Public option would be one choice among many in the Health Insurance Exchange.

Quality of care Expand access to “medical home.”  Primary doctor who connects us to other care. Define standard benefit package similar to what federal employees get.  Health Insurance Exchange will offer list of plans with similar benefits. Promote best practices.  “Comparative Effectiveness Research”  Revise payment system.

Financing in perspective Total cost of plan: $1 trillion over 10 years Total health care spending in USA: $2.4 trillion this year alone Paying for plan:  Half from cuts  Half from taxes We can afford a reasonable increase in health spending!

Financing: Trim costs, add revenue Financial incentives for appropriate care, not the most expensive care. Discourage unnecessary procedures. Lower Medicare and Medicaid spending New revenue  House: Income tax surcharge for millionaires.  Senate: Watch debate in Finance Committee

Insurance reform Can’t deny coverage for pre- existing conditions or honest mistakes in paperwork Consumer choice of plans Individual mandate: Buy plan or pay (e.g., 2.5% fee); subsidies make plans affordable Employer mandate: “Pay or play” (e.g., $750/worker) Health Insurance Exchange  sets standards for quality benefit packages  offers consumers a list of health plans so they can make informed choices

Where we are in the process DC Happenings…

Ways & Means Education & Labor Energy & Commerce Health, Education, Labor, & Pensions Finance Full House of Representatives Vote Full Senate Vote House BillSenate Bill

19 Full House of Representatives Vote Conference Committee President Full Senate Vote Full House of Representatives Vote Full Senate Vote Compromise Bill

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