1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.9: Unit 9: The evolution and reform of healthcare in the US 1.9e: Healthcare Reform In The US

2. Healthcare Reform In The US Long history of healthcare reform in the US The Social Security Amendments of 1965 –President Lyndon B Johnson signed the bill –2 amendments to the Social Security Act of 1935 Title XVIII – later known as Medicare –Part A: hospital insurance for elders –Part B: supplementary medical insurance Title XIX – later known as Medicaid –Health care for economically disadvantaged individuals 2Component 1/Unit 9e Health IT Workforce Curriculum Version 1.0/Fall 2010

3. The EMTALA Act The Emergency Medical Treatment and Active Labor Act (EMTALA) –Passed by Congress in 1986 Part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) –EMTALA mandates hospitals and ambulance services to provide care to all, without discrimination –Applies to hospitals that participate in Medicare program Health IT Workforce Curriculum Version 1.0/Fall 2010 3Component 1/Unit 9e

4. The CHIP Program State Children's Health Insurance Program (SCHIP), also known as the Children's Health Insurance Program (CHIP) –Legislated in 1997 under title XXI of the Social Security Act –Administered by the Department of Heath and Human Services –Provides matching funds to states to insure children Health IT Workforce Curriculum Version 1.0/Fall 2010 4Component 1/Unit 9e

5. The HIPAA Act Health Insurance Portability and Accountability Act (HIPAA) in 1996 Workers could keep health insurance coverage with a change in their job status Standards for protecting privacy and confidentiality of health information Health IT Workforce Curriculum Version 1.0/Fall 2010 5Component 1/Unit 9e

6. Attempting Comprehensive Healthcare Reform Unsuccessful attempts: –1933: President Franklin D Roosevelt attempted to include public funding for healthcare programs in the Social Security Act –1949: President Harry Truman considered universal healthcare as part of the Fair Deal plan –1974: President Richard Nixon introduced the Comprehensive Health Insurance Act Health IT Workforce Curriculum Version 1.0/Fall 2010 6Component 1/Unit 9e

7. Attempting Comprehensive Healthcare Reform (continued) Unsuccessful attempts: –1993: Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton Aim: to provide universal healthcare –2001: Patient Bill of Rights - allowed fundamental rights for patients as consumer Health IT Workforce Curriculum Version 1.0/Fall 2010 7Component 1/Unit 9e

8. Two New Acts: New Healthcare Reform Measures Patient Protection and Affordable Care Act (PPACA) –Signed by President Barack Obama on March 23, 2010 Health Care & Education Reconciliation Act –Signed on March 30, 2010 Health IT Workforce Curriculum Version 1.0/Fall 2010 8Component 1/Unit 9e

9. Insurance Reform Affordable Care Act, 2010 –The Pre-Existing Condition Insurance Plan (PCIP) administered by states or the U.S. Department of Health and Human Services Is a new health coverage option for patients currently cannot get health insurance because of various issues Plan functions until 2014 In 2014: start of health insurance exchanges –Competitive marketplace where individuals and small businesses can buy health benefit plans from a menu of choices Health IT Workforce Curriculum Version 1.0/Fall 2010 9Component 1/Unit 9e

10. Insurance Reform (continued) Individual and group health plans cannot have lifetime dollar value limits Insurers cannot rescind coverage in most cases No pre-existing condition exclusions for children As of September 2010, young adults under age 26 can usually be insured under a parent’s insurance Improved insurance options for early retirees Insurers must justify increases in health plan premiums Health IT Workforce Curriculum Version 1.0/Fall 2010 10Component 1/Unit 9e

11. Preventive Care Reform Health plans will be required to offer many preventive services without charging a co- payment or deductible Preventive services that are rated A or B by the US Preventive Services Task Force will be included in this reform Health IT Workforce Curriculum Version 1.0/Fall 2010 11Component 1/Unit 9e

12. Preventive Care Reform (continued) Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nation’s health Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item Health IT Workforce Curriculum Version 1.0/Fall 2010 12Component 1/Unit 9e

13. Medicare Reform The life of the Medicare Trust fund will be extended to at least 2029 Commitment to reduce Medicare fraud by 50 percent by 2012 In 2011 -- 50% discount on brand-name drugs when patients reach the Medicare Part D coverage gap (prescription ‘donut hole’ ) Patients will pay less every subsequent year until 2020, when the Medicare Part D coverage gap will disappear Health IT Workforce Curriculum Version 1.0/Fall 2010 13Component 1/Unit 9e

14. Medicare Reform (continued) Efforts to improve care coordination between clinicians to reduce unnecessary hospital re-admissions Hospitals will receive incentives to improve quality of care measures After 2014, the Affordable Care Act limits the amount that Medicare Advantage plans can spend on administrative costs and profits Health IT Workforce Curriculum Version 1.0/Fall 2010 14Component 1/Unit 9e

15. Medicaid Reform Increase the Medicaid drug rebate percentage Establish the Community First Choice Option in Medicaid Create a new plan option to permit Medicaid enrollees to designate a provider as a health home Health IT Workforce Curriculum Version 1.0/Fall 2010 15Component 1/Unit 9e

16. Quality Improvement Develop a national quality improvement strategy Establish a non-profit Patient-Centered Outcomes Research Institute to support comparative effectiveness research Improve coordination and integration of healthcare services for low-income, uninsured and underinsured populations by setting up a Community-based Collaborative Care Network Program Health IT Workforce Curriculum Version 1.0/Fall 2010 16Component 1/Unit 9e

17. Workforce Reform Establish a Workforce Advisory Committee to develop a national workforce strategy Establish Teaching Health Centers to assist primary care residency programs Provide scholarships and loans for health professionals Health IT Workforce Curriculum Version 1.0/Fall 2010 17Component 1/Unit 9e

18. Malpractice Reform Grants to states to develop, implement, and evaluate alternatives to current tort litigations Health IT Workforce Curriculum Version 1.0/Fall 2010 18Component 1/Unit 9e

19. Prescription Drug Reform Authorize the Food and Drug Administration (FDA) to approve generic versions of biologic drugs FDA can grant biologics manufacturers 12 years of exclusive use before generics can be developed Health IT Workforce Curriculum Version 1.0/Fall 2010 19Component 1/Unit 9e

20. Other Changes In 2014 By 2014: –U.S. citizens and legal residents will be required to have qualifying health coverage –Limits on deductibles for health plans in the small group market –American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges will be created Health IT Workforce Curriculum Version 1.0/Fall 2010 20Component 1/Unit 9e

21. What Is The Best Way To Reform US Healthcare? One opinion: “To Reform U.S. Health Care, Start with Systematic Reviews” –Kay Dickersin, Director Center for Clinical Trials, Director U.S. Cochrane Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD The United States has lagged behind other countries in making a national commitment to creating and utilizing research on “what works” Evidence-based health care: “the integration of best research evidence with clinical expertise and patient values” Health IT Workforce Curriculum Version 1.0/Fall 2010 21Component 1/Unit 9e