Health Policy And The 2020 Election Disclosure I have no relevant financial relationships with any companies related to the content of this course. Andrew B. Bindman MD Professor of Medicine Philip R. Lee Institute for Health Policy Studies University of California San Francisco Health Care Policy: How The ACA Works Lots of Drama No exclusions for pre-existing conditions Individual mandate Financial support for low- income individuals • Medicaid expansion • Marketplace subsidies 1 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Impact of the ACA Trump Sabotage of the ACA >20 million gained Not promoting Marketplace coverage nationally open enrollment Shortening open enrollment Decrease in coverage period disparities by race/ethnicity Withholding federal contributions to protect low- Protections for those with income from cost sharing pre-existing conditions Eliminating tax penalty for individual mandate in 2019 Average Job-Based Insurance Premiums 8 2 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Job-Based Premiums Have Grown While Health Care Availability and Affordability Is Wages Have Been Stagnant Americans Number 1 Concern 10 9 Gallup Poll Source: https://www.chcf.org/wp- content/uploads/2019/02/HealthCarePrioritiesExperiencesCaliforniaResidents.p df Proportion of Population Unable to See a Medicare for All Physician Because of Cost Hawks et al. JAMA IM Trends in Unmet Need January 27, 2020 3 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Medicare For All Creating a Single Insurance Pool Medicare for All Single payer has been rebranded as “Medicare for All” ↓ Administrative costs • Envisioned public plan is not Medicare ↑ Ability to control total cost All US residents would receive an insurance card entitling them to a broad range of services Savings could • Expand coverage • Eliminate cost-sharing Distinctions among Medicare, Medicaid, employer sponsored insurance, and non-group coverage would be eliminated Administrative Costs Why Are Health Care Costs Higher in US California Hospitals Higher administrative costs ~ 35% Total administrative costs as % of revenue : 20.9% Billing and insurance-related costs as % of revenue: 6.6-10.8% Greater quantity of procedures/imaging ~ 15% California Physicians Total administrative costs as % of revenue: 26.7% Higher prices ~ 50% Billing and insurance-related costs as % of revenue: 13.9% Neither estimate includes profits 15 Kahn et al Health Affairs, 2005 4 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Relative Cost Differences For Common Democratic Candidates National Debate Procedures By Country 17 Similarities and Differences Between Public Plan Option Medicare for All and Public Option • Creates a government-administered public option Similarities • Retains Medicare, Medicaid, employer and marketplace • Elimination of health plan profit insurance • Potential to reduce prices • Enhances premium and cost sharing subsidies in ACA marketplaces and the public option Differences • Proposals vary by who is eligible: • Age • Mandatory or optional disruption for those with coverage • Individual market +/- employer market • Elimination or continuation of administrative complexity • Availability of competition in region 5 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Broader Pubic Support For Public Option Democrats Prefer To Build On ACA Than To Than Medicare For All Replace it with Medicare For All Thinking about the Democratic candidates’ approach to health care. Would you prefer to vote for a candidate who wants to…? Percent who favor or oppose: Favor Oppose 100% 90% Replacing 24% 18% 18% 80% 29% the ACA 43% 70% Build on the with 60% existing Medicare- 50% ACA for-all 40% 77% 74% 75% 66% 55% 40% 30% 53% 20% 10% 0% Medicare-for-all Public option Optional Medicaid buy-in Medicare buy-in Medicare-for-all for ages 50-64 Other 5% NOTE: Among Democrats and Democratic-leaning independents. SOURCE: KFF Health Tracking Polls. See toplines for full question wording and response options. SOURCE: KFF Health Tracking Poll (September 3-8, 2019). See topline for full question wording and response options. Differences Between Democratic Candidates Prospects for Democrat Proposals Narrower than Differences with Trump Major change requires alignment of White House and Congress Democratic Congress did not • Repeal ACA agree to public option as a part of ACA • Texas v. US: Administration supports striking down most ACA provisions • Block grant Medicaid and reduce federal Doesn’t mean there isn’t a Medicaid spending major choice on health care • Reduce access to health coverage for legal between Democrats and immigrants Republicans • Reduce access to abortion 6 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
State Options To Expand Coverage California Actions Have Protected ACA Gains Medicaid expansion Consumer-oriented Number of uninsured (in millions) health exchange and uninsured rate among Californians age 0-64 7 Individual mandate If no action had 6 been taken 6.5m 4.27m 17.6% State funds for 5 12.9% 4 undocumented 770,000 3 3.47m Under CA policy 10.4 % Public option 2 3.52m 10.5 % 1 Single payer 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Source: CalSIM version 2.7 Healthy California For All CA Health Care Expenditures By Payer: 2017-2018 • California Commission charged with advising state on how to make progress towards unified financing/single payer • Governor, State Legislature made appointments • Held first public meeting January 2020 • Recommendations in early 2021 • University of California supporting the process 7 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Overcoming Legal Barriers Developing Options To Replace Employer Contribution: $120 Billion Income Tax Federal • 120% increase • Law to direct Medicare $ to state • Medicaid waiver Sales Tax • 18 percentage point increase • Marketplace waiver New Payroll Tax State • 9% • Constitutional amendment to over-ride Gann limit and Prop 98 New Gross Receipts Tax • 3% What Will Happen Resources Large changes in the financing https://www.kff.org/slideshow/public-opinion-on- of health care at either federal single-payer-national-health-plans-and-expanding- or state level will depend on access-to-medicare-coverage/ how effectively political leaders can galvanize general public https://www.kff.org/slideshow/where-do-the- and stakeholders around a democratic-candidates-stand-on-health-reform/ shared plan https://www.chhs.ca.gov/healthycaforall/ 8 2/10/2020 [ADD PRESENTATION TITLE: INSERT TAB > HEADER & FOOTER > NOTES AND HANDOUTS]
Recommend
More recommend