Healthcare Reform J Rush Pierce Jr, MD, MPH Dept of Internal Medicine, Univ of New Mexico Medical Economics and Leadership Elective October, 2010

Agenda Disclosures, general comments Why Healthcare Reform? Major Provisions for the Patient Protection and Affordable Care Act (PPACA) of 2010 Implications of Healthcare Reform for various groups 10/04/2010Healthcare Reform2

Disclosures I am on the full-time faculty at University of New Mexico School of Medicine University of New Mexico Hospital pays part of my salary I am on Governing Council of the New Mexico Chapter of the American College of Physicians 10/04/2010Healthcare Reform3

Healthcare Reform – general observations A very emotional issue for many Americans Not easy or fun for Congress Complicated Misconceptions and misinformation commonplace 10/04/2010Healthcare Reform4

Why Healthcare Reform? 1.Large number of uninsured 2.America’s sub-par performance on population health measures 3.Predicted future costs are unsustainable 10/04/2010Healthcare Reform5

America’s Uninsured Who is currently covered? – Medicaid – covers all poor kids – Medicare – covers all citizens > 64 years old – Employer-based insurance (large employers) – subsidized coverage for employees +/- dependents – Special groups: poor Veterans, permanently disabled, poor pregnant women So who is not covered? 10/04/2010Healthcare Reform6

America’s Healthcare Report Card 10/04/2010Healthcare Reform7 Mortality amenable to healthcare, deaths/100,000 Source: WHO

US Healthcare Expenditures 10/04/2010Healthcare Reform8

Projected Solvency of Medicare 10/04/2010Healthcare Reform9 Source: CBO

Major Provisions of the PPACA Insurance reform Coverage for the uninsured Expansion of workforce Payment reform and cost containment Liability reform 10/04/2010Healthcare Reform10

Insurance reform Limitations on exclusions – Can’t cancel (2010) – No pre-existing conditions (phase-in) – Children to age 26 on parent's policies (2010) – No annual or life-time limitations (phase-in) Limit administrative costs (2011) Required coverage for preventive svcs (phase-in) Restriction of premium differentials (2014) 10/04/2010Healthcare Reform11

Coverage for the uninsured Expand community health centers (2010) Expand small business tax credits (2010) Tax credits to individuals (2014) Health insurance exchanges (2014) Fine if do not purchase (2014) Expanded Medicaid (2014) Will result in coverage of all but 12M - 95% of citizens 10/04/2010Healthcare Reform12

Expansion of Workforce More funding for primary care residencies (2010) More loan forgiveness programs (2010) Reallocation of unfilled residency positions to primary care (2011) 10/04/2010Healthcare Reform13

Payment Reform Closure of “donut hole” (phase out) More payment to community clinics (2010) 10% bonus to primary care doctors (2011) Increase Medicaid rates (2013) Pilot programs to look at new payment models (begins 2011) Mandatory quality reporting (2011) Independent Payment Advisory Board (2014) 10/04/2010Healthcare Reform14

Liability Reform Pilot programs (2011) Liability protection for workers in free clinics (2010) 10/04/2010Healthcare Reform15

What does this mean for me? Implications for patients – Will access to my doctor change? – Will my insurance premiums go up? – Will my benefits be limited? – Will my taxes go up? Implications for doctors Implications for hospitals Implications for young people 10/04/2010Healthcare Reform16

Questions and Comments 10/04/2010Healthcare Reform17