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Health Insurance for the Uninsured: Past, Present and Future

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on 29 January 2014

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Transcript of Health Insurance for the Uninsured: Past, Present and Future

World leader in abdominal/intestional failure and transplant
Michael Chaney
Jill Clymer

Health Insurance for the Uninsured:
Past, Present & Future...

1912: Theodore Roosevelt and his party champion national health insurance- ultimately defeated.
1929: The Original Group Health Insurance at Baylor Hospital introduces a pre-paid hospital insurance plan available for teachers.
1935: Social Security Act passed by Congress
Roosevelt again favors creating National Health Insurance. Great Depression pushes it back for Social Security.

1942-1945: Due to the 2nd World War, Businesses compete for employees by adding benefits (i.e. health insurance) and increasing pay
President Truman requests Congress to create a National Insurance program.
Denounced as "socialized medicine" by AMA
1956: Military "Medicare" programs enacted

1965: In response to President Johnson's arm twisting alongside a Democratic Congress Medicare and Medicaid were created.
1974: President Nixon wants to require employers to provide health insurance coverage for employees
1972: Medicare adds long term disability and End Stage Renal Disease to the list of qualifying factors for Medicare Coverage.
1993: Health Security Act is introduced to Congress but fails to gain support
1996: Medical Expenditure Panel Survey is created
1997: State Children's Health Insurance Program is enacted
2003: Prescription Drug Benefit created under Medicare and managed by private plans
2003: Health Savings Accounts created
2006: Massachusetts creates its own version of social insurance coverage for almost every resident
2009: CHIP is expanded allowing states additional funding
Family Affair
Women were primary caretakers
Home remedies
Few scientifically practiced procedures
Doctors lacked modern type of credentials
"Bone-setters" and Surgeons
Life Threatening/Serious illness common
...No health insurance
In the mid 1800's hospitals were for the first
time being built by cities.
- Physician held the power and authority
-Everyone was treated under one roof without
the convenience of a private room

1846- American Medical Association (AMA) established...health insurance still undeveloped
Dorothea Dix
Land-Grant Bill for indigent and insane people passes in 1854
Bill was advocated and assisted by Dix through Congress
President Franklin Pierce vetoes bill
Believes responsibility lies with state
-Dallas Teacher's pay of 50 cents/month provides 21 days of hospital care per year.
...still no health insurance for those who do not qualify
And then this happened...
1988: Medicare Catastrophic Coverage Act expands coverage for medication and other out of pocket expenses.
2008: Hillary Clinton campaigns major Health Plan but lost Democratic nomination to Barack Obama
2010: Affordable Health Care Act was signed by President Obama into law.
2012: Supreme Court upholds law with a final vote of 5-4
So, what will happen?
PCIP plans disappear to make way for Affordable Care Act

Marketplace at Home

Four Major Divisions:
Medicare/ Medicaid expansion
Market place (Exchange)
Employee Sponsored Insurance
Not Moving Forward at this Time (21 States)
























Current Status of the Medicaid Expansion Decision, as of August 28, 2013

* These states are exploring an approach to the Medicaid expansion that is likely to require waiver approval.

Debate Ongoing (5 States)

Moving Forward at this Time (25 States including DC)

Current Medicaid Eligibility Limit for Parents
Median of 21 States Not Expanding:
48% FPL

Eligibility for Medicaid and Subsidies as of 2014 in 21 States Not Expanding Medicaid at this Time:

In States That Do Not Expand Medicaid, There Will Be Large Gaps in Coverage for Low-Income Adults

KFF Subsidy Calculator, http://www.kff.org/interactive/subsidy-calculator/

Kaiser Family Foundation- http://kff.org/health-reform/event/what-do-consumers-need-to-know-about-health-reforms-changes/
Kaiser Family Foundation- http://kff.org/health-reform/event/what-do-consumers-need-to-know-about-health-reforms-changes/
Future for the Uninsured.
51 million (18.9%)
23 million (8.7%)
19 million- nonelderly adults
37% eligible for Medicaid but not enrolled
25% undocumented immigrants
16% exempt from individual mandate due to inability to afford
8% eligible for affordable subsidized coverage in market place
14% subject to mandate but have too high of income to qualify for subsidy
What should the uninsured expect?
Difficulty in finding affordable sources of healthcare
Two to Four times as much in charges as insured individuals
50%-250% more in physician charges
New England Journal of Medicine- http://www.nejm.org/doi/full/10.1056/NEJMp1011502
...still have no health insurance
1986: President Reagan signs COBRA into effect
In 1960, JFK campaigned for elderly health care
Did not make it through Congress
As we know through history, the Kennedy family has always been strong advocates for healthcare reform
A large scale set of surveys that served as a source of data on the cost and use of healthcare and health insurance coverage
As transplant financial coordinators we will be responsible for informing each uninsured patient about multiple options available for health care coverage.
Same theme of issues for over 165 years may be coming to an end.
Most Consumers in Marketplaces Will Be Eligible for Subsidies to Lower the Cost of Coverage

KFF Subsidy Calculator, http://www.kff.org/interactive/subsidy-calculator/

Plans Sold through Marketplaces Will Be Easier to Compare

Michael Chaney is currently the Lead TFC from Memorial Hermann – Texas Medical Center
He has been working with the Advanced Heart Failure Team, and has assisted with upfront finances for 32 heart tx in less than 11 months.
Pictured are the AHF team physician leaders.

Jill is a currently pharmacy financial counselor at The Nebraska Medical Center. She works primarily with the Liver/Small Bowel Transplant Team. Jill has Master's Degree in Public Administration with a Health Care Concentration from the University of Nebraska Omaha. She also has a Bachelor's Degree in Health Administration and Policy from Creighton University.
Full transcript