Health Care Reform: Challenges and Opportunities

1. Health Care Reform: Challenges and Opportunities Marian Mulkey, MPP, MPH California HealthCare Foundation www.chcf.org State Association of County Retirement Systems Spring Conference May 15, 2009

2. The Problems • Rising health care costs • Growing population of uninsured • Declining rate of employer-sponsored insurance • Ongoing concerns with health care quality

3. Health spending represents a growing share of the US economy. Slide #3 of HC Costs 101, 2008

4. In the US, health care spending is split between private and public sector.

5. Most non-elderly Californians receive health coverage through employment… Subsitute Slide 4, Unins snapshot 2008 Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008.

6. Yet employer-based coverage is steadily declining, and more are uninsured. Source: California HealthCare Foundation, Snapshot: California’s Uninsured, 2008. www.chcf.org/documents/insurance/CAUninsured08.pdf

7. The uninsured are less likely to get the care they need. Source: Kaiser Family Foundation, The Uninsured: A Primer, October 2006

8. Nationwide, on average adults receive recommended care less than half the time. Percentage of Adults Receiving Recommended Care, by Type 54.9% = Overall care 54.9% = Preventive care 53.5% = Acute care 56.1% = Chronic care Source: McGlynn EA, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine, Vol. 348, No. 26, June 26, 2003, pp. 2635-2645

9. Higher spending doesn’t necessarily mean higher quality California

10. Premium and out-of-pocket expenses add up for consumers

11. Health care expenses represent a substantial share of income

12. Some policy approaches and ideas • Broad coverage expansion • Employers required to provide coverage (“pay or play”) • Individuals mandated to buy, insurers required to sell • Single payer (all participate, broad tax-based financing) • Other proposals • Reduce insurance and/or employer regulation • Make consumers more aware of prices • Reduce health care provider administrative burden • Use health information technology to better manage care • Change provider payments to reward “performance” rather than volume • Directly regulate new technology, and/or prices • And on, and on…

13. Many groups have a stake in the health reform debate • Hospitals, doctors, and other health care providers • Employers • Labor unions • Insurance companies • Government agencies: federal, state, local • Consumer advocates • Citizens It’s much easier to agree that current system needs reform, than to agree on who should pay more or be obligated to behave differently to change it.

14. Health Reform: Key Issues and Challenges • Coverage expansion addresses one aspect of larger set of problems • Who should pay? Who should be subject to mandates or other new requirements? • How should “affordability” be defined for: • Employers • Employees/ Individuals • Government • How should “quality” be defined and monitored? • How can costs be contained and quality improved, now and in future?

15. What’s next?