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Healthcare Reform and the ACA

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by Matthew Molloy on 28 October 2013

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Transcript of Healthcare Reform and the ACA

The Roosevelts and the New Deal
T. Roosevelt - failed with WWI
F.D. Roosevelt - Social Security Act - dropped to be bill passed
State-based proposals - AMA strongly opposes
Health Insurance becomes employer-based during WWII
Healthcare Reform in America
Previous Reform Attempts
2010
2011
2012-2013
2014
2010 Elements
Established PCORI
Prevention and Public Health Fund Appropriations
Tax Credits to Small Businesses that provide insurance
Pre-existing condition insurance plans (eg. MHIP)
Created healthcare.gov
Tax on indoor tanning services
Adult dependent coverage to age 26
Removed lifetime limits
on health insurance
Permanently authorized
Federally Qualified Health Centers
and
National Health Service Corps
2011 Elements
Rebates
if Insurance Companies spend less than 85% of premiums on healthcare costs
Closing the "Donut Hole" of Medicare Part D
10% Medicare bonus payment for primary care services
No cost-sharing for Medicare preventive services
Created Center for Medicare and Medicaid Innovation
Created
Medicaid "Medical Homes"
Expanded residency programs to community-based ambulatory patient care centers
Granted funding to study tort reform
Funded states to begin developing Exchanges
Nutritional Labeling
No payments for hospital-acquired infections
Created
Medicare Independent Payment Advisory Board
Expanded GME
2012-2013 Elements
Established
Accountable Care Organizations
Expanded home services available under Medicare
Increased fraud and abuse prevention in Medicare, Medicaid, and CHIP
Funded
"bundled payment" initiatives
in Medicaid and Medicare
Reduced Medicare payments for readmissions
Increased Medicaid reimbursement for primary care to 100% Medicare
Tax on medical devices
Created Co-Op Health Insurance Plans
2014 Elements
Expand Medicaid coverage
to all individuals below 138% FPL (State-dependent)
Individual Mandate
Health Insurance Exchanges
Premium Tax Credit and Cost-sharing Subsidies
Cannot be denied for
pre-existing condition
No annual limits
Essential Health Benefits
Employer Requirements if >50 employees (delayed to 2015)
Wellness Programs
Coming in 2018: Tax on "Cadillac plans"
Healthcare in America
Even with implementation of the ACA, many Americans will be left uninsured and costs will continue to rise.

Where do we go from here?
Public Option
Provide a government-run option for uninsured to purchase. Promote competition with the private market to lower costs.
Universal Coverage
Expand Medicare to all US citizens. Most other Western governments offer universal coverage.

This would necessitate significant tax increases, but many families now pay nearly 10% of their annual income on health insurance.
Focus on Costs
Focus on chronic care coordination
Reduce medical errors
Incentivize healthy behavior
Technology (EMR, e-doctors)
Quality-based measures
Change reimbursement strategy
Focus on preventive care
Focus on public health
Save primary care
Reform: What are the Options?
ACA Implementation
Truman's "Fair Deal" - universal healthcare
Opposed by AMA, unions
Kennedy supports health insurance for elderly
Johnson - signed Medicare and Medicaid into law 1965
The Fair Deal and the Great Society
The 1970s
The Health Security Act
Nixon, Kennedy (Senate), and Mills (House) agree on reform - competing proposals
Scandals impact Mills and Nixon
Carter - shift to cost containment
1983 - Medicare Prospective Payment System
First Lady Hillary Clinton chairs Healthcare Task Force
Single payer system, complex bill
Opposed by AMA and business
Never came to vote in Congress
1997 - Children's Health Insurance Program
The Patient Protection and Affordable Care Act
History of the Bill
1. Expanding Access
2. Controlling Cost
3. Improving Quality
Major component of Obama's campaign
Democratic control of House and Senate
More "liberal" universal approaches dropped for bipartisan support
Addition of individual mandate led to Republican opposition
House and Senate versions of bill
Dropped "public option" to pass Senate filibuster 60-39
House passed Senate bill 219-212
Signed into law March 23, 2010
June 2012 - Individual mandate upheld by Supreme Court. Mandated Medicaid expansion not upheld.
Insurance Market Reform
Medicaid Expansion
Individual Mandate
Subsidies
Insurance Exchanges
Essential Health Benefits
Free Preventive Services
Patient Safety
Targeting readmissions
Nutritional Info on Menus
Delivery System
Tax Reforms
Accountable Care Organizations (ACOs)
Bundled Payments
Ind. Payment Advisory Board (IPAB)
Patient-Centered Outcomes Research Institute
Innovation Center
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