Winston F. Wong, MD, MS has no relevant financial Health Care disclosures or relationships to disclose Reform in Early October 2017 Winston F. Wong, MD, MS, FAAFP UCSF Asian Health Chair, National Council Symposium of Asian Pacific October 7, 2017 Islander Physicians 2 Health Status, literally, is the reason we have View from the White House the ACA as the rule of the land 3 4 1
ACCESS: After years without improvement, the rate of uninsurance A Funny thing Happened On the among adults ages 18- 64 decreased substantially during the first Way to the Hospital half of 2014 Adults ages 18-64 who were uninsured at the time of interview, 2000-2014 1st Affordable Care Enrollment Begins Marketplace 50 40 30 Percent 20 10 0 Source: National Center for Health Statistics, National Health Interview Survey, 2000-June 2014. 5 ACA: what it is APINH have seen a significant increase in coverage under ACA Distribution of Uninsured APIs, 2011 Expansion of Medicaid coverage for those states that Since ACA “opt in”: income status and citizenship only criteria for the Uninsured eligibility rate among Asian Establishes a marketplace for any individual to Americans has purchase health care coverage, with subsidies for dropped from individuals 138% - 400% of FPL 15.1% to 7.5% Establishes the minimum standard for adequate insurance coverage, i.e., basket of services, pre- Among NHPIs, existing conditions the Uninsured Establishes mandates: “individual”, “coverage for rate has dropped dependents”, “premium bands” from 14.5% to 7.8% 7 8 2
Individual purchasers now rely on the Marketplaces 17% of AAs and 34% of NHPIs are enrolled in Medicaid coverage NHPIs match American Indians as the racial community with highest % of Medicaid enrollees 9 10 Ideologic and Political Divisions across the health It is much easier to give than take away care coverage debate Pro-ACA Anti ACA Healthcare is a right Purchasing healthcare is a right National responsibility States’ autonomy Social contract to citizens Individual determinism Leverage federal $$ to establish a social safety Big government is net expensive, unsustainable and out of touch Business and Industry for the common good Business is competition and competition is good Care for the most vulnerable Middle class preservation 11 12 3
AHCA, BCRA, ACA: the playing fields Medicaid (MediCal) Insurance Marketplaces and Coverage 13 14 Covered California is popular among API – Californians California: 23.1% of Covered California purchasers were API descent; 13.7% of Californians are of API descent 15 16 4
Market place Reform Managing an entitlement (how to shift burden to the poor): Medicaid “Stabilize the Market”: Subsidies are critical in Expansion against States’ rights (their willingness or mitigating premium increases: “Insurers need to be unwillingness to cover poor folks) insured” (or they abandon the market, resulting in a Does Medicaid have its own set of rules to “control single plan that bears the cost and raises premiums) the costs of care”? Vis: eligibility, benefits • Release appropriations to provide premium subsidies Block grants: the Trojan Horse? Or vehicle to • Retain or expand strategies to maintain an adequate risk catalyze reform and efficiency? pool: “individual mandate”, “premium penalty if declined”, “automatic enrollment into catastrophic plan” • High risk insurance pools • Individual purchasers over 400% of FPL should be insulated from dramatic increases in premiums year to year 17 18 Graham Cassidy Has Clear Winners and Losers Red States on Map gain more $$ because they DIDN’T expand Medicaid 19 20 5
As Single Payer Gains Popularity, What to Look for in the future No One really Knows what it is Pressure to solidify market places because insurance industry facing tremendous pressures Medicaid “reform” will happen sooner or later: wholesale vs waivers Core popular elements of ACA seem culturally implanted: no prior condition exclusion, no set limits, essential benefits, coverage for family members up to age 26 Single payer gaining traction, but probably not viable for another “generation” AANHPIs are in the center of the storm; diversity of income, immigration, and socio-economic status 21 22 6
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