Health Care on the Precipice. New Jersey, has good reason to be proud...

Health Care on the Precipice

Health Care on the Precipice

New Jersey, has good reason to be proud . . .

New Jersey, has good reason to be proud . . .

We have one of our nation’s highest per capita incomes. We have one of our nation’s highest per capita incomes.

We are home to more high

technology, pharmaceutical and

biotechnology companies per

square mile than any place in the

world.

We are home to more high

technology, pharmaceutical and

biotechnology companies per

square mile than any place in the

world.

We are home to the University of Medicine and Dentistry ‑‑ the

largest free‑standing public health university in the country.

We are home to the University of Medicine and Dentistry ‑‑ the

largest free‑standing public health university in the country.

Our college and professional sports teams, particularly

our women’s basketball team and

varsity football team at Rutgers

University, compete at a championship

level.

Our college and professional sports teams, particularly

our women’s basketball team and

varsity football team at Rutgers

University, compete at a championship

level.

Unfortunately, we also rank near the top statistically in

some categories where we are not particularly proud. . .

Unfortunately, we also rank near the top statistically in

some categories where we are not particularly proud. . .

Total Uninsured = 1,300,000Total Uninsured = 1,300,000

New Jersey Total Population = 8,500,000New Jersey Total Population = 8,500,000

We are home to more than 1.3 million uninsured, 240,000 of them children

We are home to more than 1.3 million uninsured, 240,000 of them children

One out of every seven children in our state received

NO medical care last year as a result of being uninsured.

One out of every seven children in our state received

NO medical care last year as a result of being uninsured.

The cost of providing coverage has increased 80% in our state in the

last five years.

The cost of providing coverage has increased 80% in our state in the

last five years.

As a result, businesses providing coverage for

their workers has dropped so dramatically that now, one in every five New Jersey small

business owners simply cannot afford health

insurance.

As a result, businesses providing coverage for

their workers has dropped so dramatically that now, one in every five New Jersey small

business owners simply cannot afford health

insurance.

A recent study demonstrated that

New Jersey paid the highest premiums for single plans and the

third highest for family plans.

A recent study demonstrated that

New Jersey paid the highest premiums for single plans and the

third highest for family plans.

High health costs make it

harder for people to afford

coverage.

High health costs make it

harder for people to afford

coverage.

High costs also mean higher taxes to support

state‑financed health programs, including

Medicaid, NJFamilyCare and the state employee

health benefits program.

High costs also mean higher taxes to support

state‑financed health programs, including

Medicaid, NJFamilyCare and the state employee

health benefits program.

For most uninsured New Jerseyans, there

is no health care “system,” but rather a

blotchy and frayed patchwork of

unreliable and inconsistent

programs, providers, and facilities.

For most uninsured New Jerseyans, there

is no health care “system,” but rather a

blotchy and frayed patchwork of

unreliable and inconsistent

programs, providers, and facilities.

Most of the uninsured routinely experience delays in getting care for a variety of medical problems.

Most of the uninsured routinely experience delays in getting care for a variety of medical problems.

The uninsured receive less

preventive care and poorer

treatment for both minor and serious chronic

and acute illnesses.

The uninsured receive less

preventive care and poorer

treatment for both minor and serious chronic

and acute illnesses.

Sources: Commonwealth Fund

Nolte and McKee: Health Affairs, Jan-Feb 2008Nolte and McKee: Health Affairs, Jan-Feb 2008

7474Top 5 statesTop 5 states

110110U.S.U.S.142142Bottom 5 statesBottom 5 states

6565

71717171

74747474777780808282828284848484

909093939696101101103103103103104104

FranceFrance

JapanJapanAustraliaAustralia

SpainSpainItalyItaly

CanadaCanadaNorwayNorwaySwedenSweden

NetherlandsNetherlandsGreeceGreeceAustriaAustria

GermanyGermanyFinlandFinland

New ZealandNew ZealandDenmarkDenmark

IrelandIrelandU.K.U.K.

PortugalPortugal

DeathsDeaths per 100,000 population

International International Scorecard on Scorecard on Health System Health System PerformancePerformance

The bottom line: In many cases, the uninsured live

shorter lives than comparable insured

populations.

The bottom line: In many cases, the uninsured live

shorter lives than comparable insured

populations.

INSTITUTEQUALITYHEALTHCARENEW JERSEY

Quality powered.

We knew where to start.We knew where to start.

1.1. Enroll all who are eligible for state Enroll all who are eligible for state sponsored coverage and manage sponsored coverage and manage the Federal dollars available to us the Federal dollars available to us for this purpose.for this purpose.

2.2. Make sure that those who have Make sure that those who have health care coverage are able to health care coverage are able to keep it. keep it.

3.3. Provide an affordable and adequate Provide an affordable and adequate coverage alternative for every man, coverage alternative for every man, woman and child in our state.woman and child in our state.

Total Uninsured = 1,300,000Total Uninsured = 1,300,000

New Jersey Total Population = 8,500,000New Jersey Total Population = 8,500,000

New Jersey’s UninsuredNew Jersey’s Uninsured

600,000 remaining uninsured

600,000 remaining uninsured

300,000 Eligible but not enrolled

300,000 Eligible but not enrolled

400,000 undocumented400,000 undocumented

Comprehensive & TransformationalComprehensive & TransformationalComprehensive & TransformationalComprehensive & Transformational

Successful Successful Health Care ReformHealth Care Reform

Successful Successful Health Care ReformHealth Care Reform

CommercialCommercialGradeGrade

CommercialCommercialGradeGrade

Universal &Universal &PortablePortable

Universal &Universal &PortablePortable

Affordable & Affordable & SustainableSustainable

Affordable & Affordable & SustainableSustainable MandatedMandatedMandatedMandated

Reform ElementsReform

Elements

Individuals will be Individuals will be responsible to responsible to

provide proof of provide proof of health insurance health insurance

when they file their when they file their state income tax state income tax

return.return.

If they do not provide proof of health insurance, they will

be placed by the state into the new state health

insurance plan.

If they do not provide proof of health insurance, they will

be placed by the state into the new state health

insurance plan.

We must enroll all New Jerseyans

who are currently eligible for

Medicaid and FamilyCare but who are not yet

enrolled.

We must enroll all New Jerseyans

who are currently eligible for

Medicaid and FamilyCare but who are not yet

enrolled.

We must expand

FamilyCare to the extent

permitted so we might effectively apply the

federal dollars available to us

We must expand

FamilyCare to the extent

permitted so we might effectively apply the

federal dollars available to us

If, for whatever reason, a New Jersey resident seeks care without

insurance, they will be placed into a new, state-

sponsored plan and billed an appropriate premium.

If, for whatever reason, a New Jersey resident seeks care without

insurance, they will be placed into a new, state-

sponsored plan and billed an appropriate premium.

Our plan combines all individuals

together in one, self‑funded plan to take advantage of the “law of large numbers,” so the healthy and the

sick balance each other out with the result of a more

affordable health insurance product.

Our plan combines all individuals

together in one, self‑funded plan to take advantage of the “law of large numbers,” so the healthy and the

sick balance each other out with the result of a more

affordable health insurance product.

This new health insurance plan will. . . This new health insurance plan will. . .

Include a statewide network of providers, Include a statewide network of providers, Be available in an HMO and a PPO Be available in an HMO and a PPO

format. format. Be a commercial grade product, with Be a commercial grade product, with

commercial reimbursements commercial reimbursements Offer benefits modeled after the current Offer benefits modeled after the current

standard plan in New Jersey’s small standard plan in New Jersey’s small employer market.employer market.

Be state-sponsored and state controlledBe state-sponsored and state controlled

Where an employee does not have employer‑based coverage

his or her employer must provide them access

to a flexible‑spending account under Section 125 of the IRS Code so the employee can

purchase their coverage with before tax dollars.

Where an employee does not have employer‑based coverage

his or her employer must provide them access

to a flexible‑spending account under Section 125 of the IRS Code so the employee can

purchase their coverage with before tax dollars.

Final ElementsFinal Elements

• Our plan will be offered to all New Our plan will be offered to all New Jersey residents, Jersey residents,

• A state subsidy will be provided on a A state subsidy will be provided on a sliding scale based on what is sliding scale based on what is affordable to the individual or their affordable to the individual or their family family

• Our current charity care and related Our current charity care and related hospital subsidies will be redirected hospital subsidies will be redirected over time to provide premium over time to provide premium assistance in the new plan.assistance in the new plan.

Comparison to the Massachusetts PlanComparison to the

Massachusetts Plan

• Individual MandateIndividual Mandate

• Expand Medicaid & Expand Medicaid & SCHIPSCHIP

• Section 125 RequiredSection 125 Required

• Connector to Private Connector to Private marketmarket

• Multiple Insured PlansMultiple Insured Plans

• Employer MandateEmployer Mandate

MassachusettsMassachusetts New JerseyNew Jersey

• Individual MandateIndividual Mandate• Expand Medicaid & Expand Medicaid &

SCHIPSCHIP• Section 125 RequiredSection 125 Required

• State-Run Public PlanState-Run Public Plan

• Single, Self-Insured Single, Self-Insured PlanPlan

• No Employer MandateNo Employer Mandate

Phases of ReformPhases of Reform

FamilyCare Buy-inFamilyCare Buy-in [Passed Into Law – 12/1/8][Passed Into Law – 12/1/8]

““Kids First” MandateKids First” Mandate Familycare ExpansionFamilycare Expansion Market ReformMarket Reform Results: Results:

Announced 3/17/8Announced 3/17/8 First Reading 4/7/8First Reading 4/7/8 PASSED 6/23/8PASSED 6/23/8 Signed by Governor 7/8/8Signed by Governor 7/8/8 Implementation 9/1/08 Implementation 9/1/08

Creation of Garden Creation of Garden State AllCareState AllCare

Individual MandateIndividual Mandate Section 125 MandateSection 125 Mandate Collaborative Care Collaborative Care

System CreationSystem Creation

II IIII

ProcessProcess

Sensing Interviews

MeMy Chief of Staff, Sarah

McLallen

Commissioner of Health. Heather

Howard

DHSS Rep Noreen Bodman

Medicaid Director

John Guhl

Keri Logosso, Director ofChildren’s

Health Services

Sen. Vitale’s Chief of Staff,

Laurie Cancialosi

John Jacoby,

Governor’s Counsel

Senator Joe Vitale

Politics

Legislation CreationLegislation CreationLegislation CreationLegislation Creation

• Delayed until the last minuteDelayed until the last minute• ““Sensing Interviews” responding to Sensing Interviews” responding to

concepts presented – no documentconcepts presented – no document• Introduced with major press conference Introduced with major press conference

– “White Paper” (both phases) & Bill – “White Paper” (both phases) & Bill Statement (phase I) only Statement (phase I) only

• Negotiations begin in earnestNegotiations begin in earnest• Printed bill distributed at first committee Printed bill distributed at first committee

hearinghearing

Areas of ConflictAreas of Conflict

• DelayDelay• Mandate (affordability)Mandate (affordability)• Individual/small group market reformsIndividual/small group market reforms

– Age rating vs. community ratingAge rating vs. community rating– Increase Minimum Loss RatioIncrease Minimum Loss Ratio

• Not far enoughNot far enough– Subsidize to higher FPLSubsidize to higher FPL– Single PayerSingle Payer

• No “Play or Pay” Employer MandateNo “Play or Pay” Employer Mandate

The 2 Year OddeseyThe 2 Year OddeseyVitale

Request – Formation

of Working Group

Working Group

meets – Consensus

Retreat

Stakeholder “Sensing” Meetings

Feedback Assimilation

White Paper, Phase 1 bill

prepared and introduced

Bill passes both houses

and Governor signs it

• Primary CarePrimary Care

• Chronic DiseasesChronic Diseases

• UndocumentedUndocumented

• POS AlgorithimPOS Algorithim

• Cost ContainmentCost Containment

• ReinsuranceReinsurance

• TransitionTransition

• Hospital SolvencyHospital Solvency

• ““Hold HarmlessHold Harmless

• Assessment & Assessment & EvaluationEvaluation

Remaining IssuesRemaining Issues

Lessons LearnedLessons LearnedKeep FocusKeep Focus

No Bill = FlexibilityNo Bill = Flexibility

Drive ConsensusDrive Consensus

Hold Friends Close, Enemies CloserHold Friends Close, Enemies Closer

Garner Relationship With Press EarlyGarner Relationship With Press Early

Don’t Forget The FearDon’t Forget The Fear

Fat & Happy Vs. Famished & ScaredFat & Happy Vs. Famished & Scared

Skill Set = CampaignSkill Set = Campaign

Get Executive Branch ChampionGet Executive Branch Champion

Just Keep Walkin’Just Keep Walkin’

““It must be considered that there is nothing more It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm who profit by the old order, and only lukewarm defenders in all those who would profit by the new defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of order, this lukewarmness arising partly from fear of their adversaries, who have the laws in their favour; their adversaries, who have the laws in their favour; and partly from the incredulity of mankind, who do not and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual truly believe in anything new until they have had actual experience of it. Thus it arises that on every opportunity experience of it. Thus it arises that on every opportunity for attacking the reformer, his opponents do so with for attacking the reformer, his opponents do so with the zeal of partisans, the others only defend him the zeal of partisans, the others only defend him half-heartedly, so that between them he runs great half-heartedly, so that between them he runs great danger."danger."

The Prince, 1531

So Why Must New Jersey Enact Health Reform Now?

“Somebody has to do something . . .

Jerry GarciaJerry GarciaGrateful DeadGrateful DeadJerry GarciaJerry GarciaGrateful DeadGrateful Dead

. . . it’s just incredibly pathetic

it has to be us”

INSTITUTEQUALITYHEALTHCARENEW JERSEY

Quality powered.

WWW.NJHCQI.ORWWW.NJHCQI.ORGG

Ten Years of AdvocacyTen Years of Advocacy