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How Americans Pay for Health Care: A Brief Overview

How Americans Pay for Health Care: A Brief Overview. October 12, 2010 Merton D. Finkler , Ph.D. John R. Kimberly Distinguished Professor in the American Economic System Lawrence University. Agenda. Spending Patterns Overall Payment Patterns Overall Payment Structure

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How Americans Pay for Health Care: A Brief Overview

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  1. How Americans Pay for Health Care: A Brief Overview October 12, 2010 Merton D. Finkler, Ph.D. John R. Kimberly Distinguished Professor in the American Economic System Lawrence University

  2. Agenda • Spending Patterns Overall • Payment Patterns Overall • Payment Structure • Patient Protection and Affordable Care Act – 2010 • Primary Sources • California HealthCare Foundation – Health Care Costs 101 • Kaiser/ HRET Surveys of Employer-Sponsored Benefits • 2010 Milliman Medical Index

  3. National HC Spending/ GDP

  4. Cumulative Impact

  5. Spending Distribution by Sector

  6. Spending Distribution by Payor

  7. Health Plan Enrollment Distribution History

  8. Spending Distribution, Private Insurance vs. Out-of-Pocket

  9. Worker Identified Premium Payment Trend

  10. The 80- 20 Rule Provides Guidance

  11. Health Reform Effects on Payment • Near Term – New coverage requirements • Expanded dependent coverage up to age 26 • Remove of lifetime and annual limits • Elimination of cost-sharing for preventive care • Prohibition of pre-existing conditions clauses • Since new requirements for coverage neither require healthy young adults to enroll nor extra Federal support, premiums are likely to rise

  12. Health Reforms continued • Medium Term (2013 – 2014) • Creation of exchanges with a variety of provisions • Tax changes include increase in Part A payroll tax rate for high income taxpayers • Required coverage for individuals and firms with 50 or more employees • Longer Term (2015 or later) • Multistate compacts for sale of insurance • Excise tax on employer plans with individual premium of $10,200 or family premium of $27,500 (2018)

  13. Comments • Three Legs of Health Care Policy (Cost, Quality, and Access) Require Coherent Attention • Health Care Reform Addresses the Insurance Leg (and partly the access leg) • Despite the assigned burden, the cost of employer organized health care mostly falls on the employee • Demographics and intensive practice styles make our policy choices increasingly severe • There are no free lunches.

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