Download Health Care Reform 2009 – implications for you and your patients

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Health Care Reform 2009 –
implications for you and your
December 1, 2009
The punch line:
• Probably will expand access to most medical services
• But does not address other system flaws
• Therefore, either a bow to “reality”, or an historic
missed opportunity
• A mish-mash of “demonstration” projects and pilots to
improve quality
• Costs (to you, as taxpayer and as purchaser) will rise
faster than they otherwise would have
• So surely no “bending of the cost curve”
• Revenues (for the public part) are uncertain
• Physician payments will decline in real terms – maybe
specialists more than generalists
• Hospital payments will too
• Possible silver lining – doctors and hospitals may
innovate just to preserve something close to what they
Access – but to what?
• “Insurance” to cover basic medical services
• Paid for via same fee-for-service mechanism
• Without much regard for “value”
Is it “insurance”? Does it matter?
• Insurance protects vs. uncommon or
catastrophic events
• Health plans also cover routine and nonemergency expenses
• Result – “moral hazard”, over-utilization,
consumer not engaged in care decisions
• Some coverage of common expenses is a
good thing – e.g. effective prevention;
medications for chronic conditions that delay
or prevent complications
Any efforts to control cost?
• New Medicare Advisory Board
» “independent”
» Charge: reduce “excess cost growth”
» But. . . Can’t raise premiums, cut benefits, or
reduce eligibility
• “Patient centered outcomes research”
» See current screening mammography debate
• What does “cost control” mean, exactly?
» One time savings vs. changing the slope of
the curve
HR 3590 – key provisions
2074 pages
Individual mandate to purchase insurance
Guaranteed coverage
Insurance Exchanges
Community Insurance (“Public”) Option with state optout
No federal funds (via public option, or via premium
subsidies) for abortion
Continuation of some quality initiatives – Core
Measures, reducing so-called “hospital-acquired
conditions”, reducing readmissions
Pilots for Accountable Care Organizations, bundled
payments, home-based primary care
“Someone should do something about malpractice
Some wellness stuff
Basic long-term care coverage for home services
HR 3590: The numbers
Estimated cost $848B through 2019
Coverage for 31 million citizens
Most provisions start in 2014
Reduces deficit by $130B
New taxes
» Medicare payroll tax increase for those with income
> $200/250K
» Cosmetic surgery
» Tax on high cost insurance policies
• Medicare payment cuts
» Hospitals -- $192B
» Medicare Advantage -- $118B
» Disproportionate Share payments -- $42B
• ***NO permanent fix to SGR formula