COLORADO’S HEALTH CARE SYSTEM Understanding the Basics Boomer’s Leading Change in Health Advocacy Course ©

Tonight’s Agenda I. Introduction – The Big Picture II. Coverage options III. A look at Colorado’s Uninsured IV. Healthcare Reform and Implementation

Why do we need to know about how our health care system works?  Consider: Is there a connection between a healthy population and a Nation’s strength? We all need access to health care at some point in our lives.

What influences our health? Our Actions (exercise, diet, smoking) Income Preventive Services (immunizations, screenings) Public Infrastructure (hospital certification, insurance commission, regulations) Access to Quality Health Care Public Health (clean air, clean water, sanitation) Social Factors

Some illnesses or injuries are unavoidable How do we manage the risk?

Health Coverage!  What’s the role of Health Insurance?  What is the role of the safety net?  What to expect with reforms?

A unique system Source: Kaiser Family Foundation

A growing gap

Health care costs have changed  Health insurance costs are rising rapidly for businesses and families  Average premium for employee coverage in Colorado doubled during the decade between 1996 and 2006  Colorado families spend 19% of their income on health insurance Source: Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Image source: Healthcare.gov

Why is it so darn expensive now?  Technology  Drug Pricing  Imbalance in market power between patient and provider; insurer and purchaser  Administrative Overhead  Profit-driven system (For-profit insurers & hospitals)  Defensive Medicine  Misaligned provider incentives  Demographics (e.g. aging population)

Suggested Solutions to Reduce Cost  Better Information about systems (payment reform)  Better Use of Technology --Reduce Medical Errors  Evidence-Based Medicine  Enabling Healthier Lifestyles  Greater Emphasis on Public Health and Environmental Conditions  Explicit Assessment of Costs and Benefits of Expensive New Treatments and Technologies  Encourage Written Instructions for End of Life Care

Cost shifting - a big problem

That Brings Us to the Safety Net “ Those providers that organize and deliver a significant level of health care and other health- related services to uninsured, Medicaid, and other vulnerable patients ”- Institute of Medicine

Why do we need a Safety Net?  Rate of employer sponsored health insurance  State Medicaid eligibility rules  Number of undocumented immigrants  Participation rate of private providers in charity care  Legal requirements (EMTALA, State and local laws)

Types of Safety Net Providers  Public Hospitals  Local Health Departments  Community Health Clinics  Variety of sponsors  FQHCs qualify for federal grants and enhanced Medicaid reimbursement  Physicians  Majority have some Medicaid patients in practice  Many provide reduced cost or free care  Combined charity exceeds that provided in clinics  Physician participation in Medicaid and charity care decreasing over time

Who Really Pays for the Safety Net?  Federal  Enhanced hospital payments: Disproportionate Share Hospital (DSH) / Indirect Medical Education (IME)  Veterans Administration (VA)  Community Programs: Indian Health Service (IHS), HIV/AIDS, Maternal/Child, clinic grants, National Health Service Corps  State/local  Tobacco settlement, general and/or designated tax funds  Cost shifting from paying patients  Charity  Private contributions  Volunteer health care providers

Sources of Uncompensated Funding, 2008 Source: Hadley et al, Health Affairs, 2008 ) Return to KaiserEDU.org Total = $57.4 billion Medicaid/ Medicare (DSH/IME funds) Community Programs (IHS, HIV/AIDS, Maternal/Child, Clinic, NHSC) VA Charity 11% Private Physicians State/Local 32% 16% 9% 18% 14%

Impacts of Health Reforms on Safety Net  How Does Availability of Safety Net Care Compare to Insurance?  Both contribute to improving access  Health insurance has a bigger impact on access than availability of a safety net  Health insurance is a more expensive strategy  Is the Safety Net Necessary with Universal Health Insurance?  Segregating the poor in the safety net may contribute to lower quality care  However: Safety net is an innovator in care of vulnerable populations Safety net likely to remain an important source of providers Immigrants, homeless and others may not be eligible for universal programs

Colorado’s Uninsured Today Who are they?  About 829,000 Coloradans are uninsured  And this number is growing according the Colorado Health Access Survey by Colorado Health Institute  150,000 Uninsured children (19% of our uninsured)  70% of uninsured families have at least 1 full-time job  An additional 15% have a part-time job  Challenges for employees who work for small business, are seasonal, in service sector, etc.  88% of uninsured cite cost as a major barrier to accessing health care

Underinsurance is also a big problem Examples:  High annual deductible  Inadequate coverage levels  Exclusions 1.5 million Coloradans are either uninsured, or underinsured That’s 1 in 3 Coloradans

BUT The Winds are A-Changin’  Colorado has enacted several major state-level health reform efforts in the last few years  HB – Hospital Provider fee  HB – All Payer Claims Database  HB – Prohibiting Gender Rating  SB11-08 – Medicaid Alignment for Children  SB – Child only health plans  SB – Health Benefit Exchange

The Federal Changes  In March 2010, the Patient Protection and Affordable Care Act was signed into law

How will the Affordable Care Act change our health care system?  Responsibility for individuals and employers  More people in the pool  Health Care Exchange  More competitive plans  Guaranteed Issue and elimination of caps  Don’t have to be afraid to get sick  Insurance reforms  Insurers will have to spend more on health care services  Improvements to Health Care Delivery – Both Public and Private These are only a few things, for more information go to or

Other Resources to Check Out  Federal Government Sites:  State Sites:  Kaiser Family Foundation –  Colorado Health Access Survey  Colorado Health Institute  America ’ s Healthcare Safety Net: Intact but Endangered. Institute of Medicine  Bureau of Primary Health Care  National Association of Community Health Centers  National Association of Public Hospitals  National Association of County and City Health Officials

YOU ROCK! You made it to the end! Thanks! Ashley Wheeland Policy Associate Colorado Consumer Health Initiative 1536 Wynkoop St, Ste 102 (see what I did here!!!! )