“Improved Medicare For All” for Beginners (Part A)
“Improved Medicare For All” for Beginners (Part A)
Dec 26, 2015
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“Improved Medicare For All”for Beginners (Part A)
How is Health Care Currently Financed?
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI)
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI) Individual Market
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI) Individual Market VA Health
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare Medi-Cal (Medicaid)
How is Health Care Currently Financed?
Employer Sponsored Insurance (ESI) Individual Market VA Health Medicare Medi-Cal (Medicaid) Out-of-pocket
What Are the Results?
What Are the Results?
What Are the Results?
What Are the Results?
What Are the Results?
What Are the Results?
What Are the Results?
How Do We Compare?
Maternal Mortality
Life Expectancy Infant Mortality
Source: OECD 2011
How Do We Compare?
How Do We Compare?
The Secret Life of theHealth Care Dollar
$
Private Insurance Takes Its Cut
$
20% Overhead(5% Profit)
Delivery Side Takes Its Hit
$
10% Overhead
Clinical Waste Weighs In
$
20% Lost
The End Result?
$
50% Left for Actual Health Care
The Single-PayerHealth Care Dollar
$
5% Overhead(or less)
The Patient Protection and Affordable Care Act (ACA)
Impact of ACA on:The Uninsured
# of uninsured reduced from 46 million today to ~26 million in 2019 (most likely even higher due to SCOTUS decision).
Safety net hospital funding through Medicare cut by $36 billion through 2019.
Community health centers receive extra $1 billion annually
Impact of ACA on:The Underinsured
If you like your current coverage you can keep it.
If you don’t like your current job-based coverage, you HAVE to keep it.
Policies required to cover at least 60% of expected health costs – e.g. $2,000 deductible + 20% co-insurance for next $15,000 of care.
Impact of ACA on:Medical Bankruptcy
No change for 75% of medical bankruptcy filers who have insurance.
Up to 50% reduction among the 25% of the medically bankruptcy who were uninsured in 2007 but will gain coverage under reform.
Maximum expected reduction in medical bankruptcies = 12.5%.
Impact of ACA on:Health Care Costs - 1
Expanded Medicaid - $434 billion (maybe)
Subsidies for private coverage - $358 billion
Small employer tax credits - $37 billion
Temporary high risk pools, subsidy for retirees <65, etc – ~$10 billion
All figures reflect spending through 2019
Impact of ACA on:Health Care Costs – 2 (savings)
Decreased Medicare Advantage/HMO overpayment - $136 billion
Decreased Medicare (DSH) payment to safety net hospitals - $36 billion
Decreased Medicare fee-for-service payments to doctors/hospitals - $196 billion
Other Medicare/Medicaid cuts - $87 billion
All figures reflect spending through 2019
Impact of ACA on:Cost Control Provisions
Insurance exchanges Health information technology Comparative effectiveness research Fraud and abuse prosecution/recovery Alternatives to F-F-S (experiments) Coverage of preventive services Tax on “Cadillac” coverage Malpractice reform (experiments) Medicare advisory board
Health Reform Bill:Proven Cost Control Provisions
Impact of ACA on:Administrative Costs
IRS cost to enforce mandate - $5-10 bil Running insurance exchanges - ~4% of
premiums (based on Massachusetts) Insurance overhead - ~13% of new
premium revenues = $42 billion Cap on insurance overhead - ???? Standardized claim forms - ????
break
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