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Health Care on the Precipice

Health Care on the Precipice. Is now the time for reform?. New Jersey, has good reason to be proud. We have one of our nation’s highest per capita incomes. We are home to more high technology, pharmaceutical and biotechnology companies per square mile than any place in the world.

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Health Care on the Precipice

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  1. Health Care on the Precipice Is now the time for reform?

  2. New Jersey, has good reason to be proud . . .

  3. We have one of our nation’s highest per capita incomes.

  4. We are home to more high technology, pharmaceutical and biotechnology companies per square mile than any place in the world.

  5. We are home to the University of Medicine and Dentistry ‑‑ the largest free‑standing public health university in the country.

  6. Our college and professional sports teams, particularly our women’s basketball team and varsity football team at Rutgers University, compete at a championship level.

  7. Unfortunately, we also rank near the top statistically in some categories where we are not particularly proud. . .

  8. Total Uninsured = 1,300,000 New Jersey Total Population = 8,500,000 We are home to more than 1.3 million uninsured, 240,000 of them children

  9. One out of every seven children in our state receivedNO medical care last year as a result of being uninsured.

  10. The cost of providing coverage has increased 80% in our state in the last five years.

  11. As a result, businesses providing coverage for their workers has dropped so dramatically that now, one in every five New Jersey small business owners simply cannot afford health insurance.

  12. A recent study demonstrated that New Jersey paid the highest premiums for single plans and the third highest for family plans.

  13. High health costs make it harder for people to afford coverage.

  14. High costs also mean higher taxes to support state‑financed health programs, including Medicaid, NJFamilyCare and the state employee health benefits program.

  15. For most uninsured New Jerseyans, there is no health care “system,” but rather a blotchy and frayed patchwork of unreliable and inconsistent programs, providers, and facilities.

  16. Most of the uninsured routinely experience delays in getting care for a variety of medical problems.

  17. The uninsured receive less preventive care and poorer treatment for both minor and serious chronic and acute illnesses.

  18. Deathsper 100,000 population France 65 Minnesota 70 Japan 71 Australia 71 Top 5 states 74 Spain 74 Italy 74 Canada 77 Norway 80 Sweden 82 Netherlands 82 Greece 84 Austria 84 Germany 90 Finland 93 New Zealand 96 Denmark 101 Ireland 103 U.K. 103 Portugal 104 U.S. 110 Bottom 5 states 142 Wash D.C. 160 Sources: Commonwealth Fund International Scorecard on Health System Performance Nolte and McKee: Health Affairs, Jan-Feb 2008

  19. The bottom line: In many cases, the uninsured live shorter lives than comparable insured populations.

  20. NEW JERSEY HEALTHCARE QUALITY INSTITUTE Quality powered.

  21. We knew where to start. Enroll all who are eligible for state sponsored coverage and manage the Federal dollars available to us for this purpose. Make sure that those who have health care coverage are able to keep it. Provide an affordable and adequate coverage alternative for every man, woman and child in our state.

  22. Total Uninsured = 1,300,000 New Jersey Total Population = 8,500,000

  23. New Jersey’s Uninsured 300,000 Eligible but not enrolled 600,000 remaining uninsured 400,000 undocumented

  24. Successful Health Care Reform Commercial Grade Universal & Portable Affordable & Sustainable Mandated Comprehensive & Transformational

  25. Reform Elements

  26. Individuals will be responsible to provide proof of health insurance when they file their state income tax return.

  27. If they do not provide proof of health insurance, they will be placed by the state into the new state health insurance plan.

  28. We must enroll all New Jerseyans who are currently eligible for Medicaid and FamilyCare but who are not yet enrolled.

  29. We must expand FamilyCare to the extent permitted so we might effectively apply the federal dollars available to us

  30. If, for whatever reason, a New Jersey resident seeks care without insurance, they will be placed into a new, state-sponsored plan and billed an appropriate premium.

  31. Our plan combines all individuals together in one, self‑funded plan to take advantage of the “law of large numbers,” so the healthy and the sick balance each other out with the result of a more affordable health insurance product.

  32. This new health insurance plan will. . . Include a statewide network of providers, Be available in an HMO and a PPO format. Be a commercial grade product, with commercial reimbursements Offer benefits modeled after the current standard plan in New Jersey’s small employer market. Be state-sponsored and state controlled

  33. Where an employee does not have employer‑based coverage his or her employer must provide them access to a flexible‑spending account under Section 125 of the IRS Code so the employee can purchase their coverage with before tax dollars.

  34. Final Elements Our plan will be offered to all New Jersey residents, A state subsidy will be provided on a sliding scale based on what is affordable to the individual or their family Our current charity care and related hospital subsidies will be redirected over time to provide premium assistance in the new plan.

  35. Comparison to the Massachusetts Plan Individual Mandate Expand Medicaid & SCHIP Section 125 Required Connector to Private market Multiple Insured Plans Employer Mandate Massachusetts New Jersey • Individual Mandate • Expand Medicaid & SCHIP • Section 125 Required • State-Run Public Plan • Single, Self-Insured Plan • No Employer Mandate

  36. Phases of Reform I II • FamilyCare Buy-in [Passed Into Law – 12/1/8] • “Kids First” Mandate • Familycare Expansion • Market Reform • Results: • Announced 3/17/8 • First Reading 4/7/8 • PASSED 6/23/8 • Signed by Governor 7/8/8 • Implementation 9/1/08 • Creation of Garden State AllCare • Individual Mandate • Section 125 Mandate • Collaborative Care System Creation

  37. Process

  38. Sensing Interviews

  39. Keri Logosso, Director of Children’s Health Services Sen. Vitale’s Chief of Staff, Laurie Cancialosi Commissioner of Health. Heather Howard Medicaid Director John Guhl Senator Joe Vitale John Jacoby, Governor’s Counsel Me DHSS Rep Noreen Bodman My Chief of Staff, Sarah McLallen

  40. Politics

  41. Legislation Creation Delayed until the last minute “Sensing Interviews” responding to concepts presented – no document Introduced with major press conference – “White Paper” (both phases) & Bill Statement (phase I) only Negotiations begin in earnest Printed bill distributed at first committee hearing

  42. Areas of Conflict • Delay • Mandate (affordability) • Individual/small group market reforms • Age rating vs. community rating • Increase Minimum Loss Ratio • Not far enough • Subsidize to higher FPL • Single Payer • No “Play or Pay” Employer Mandate

  43. The 2 Year Oddesey Working Group meets – Consensus Retreat Feedback Assimilation White Paper, Phase 1 bill prepared and introduced Vitale Request – Formation of Working Group Bill passes both houses and Governor signs it Stakeholder “Sensing” Meetings

  44. Remaining Issues • Primary Care • Chronic Diseases • Undocumented • POS Algorithim • Cost Containment • Reinsurance • Transition • Hospital Solvency • “Hold Harmless • Assessment & Evaluation

  45. Lessons Learned Keep Focus No Bill = Flexibility Drive Consensus Hold Friends Close, Enemies Closer Garner Relationship With Press Early Don’t Forget The Fear Fat & Happy Vs. Famished & Scared Skill Set = Campaign Get Executive Branch Champion Just Keep Walkin’

  46. “It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries, who have the laws in their favour; and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it. Thus it arises that on every opportunity for attacking the reformer, his opponents do so with the zeal of partisans, the others only defend him half-heartedly, so that between them he runs great danger." The Prince, 1531

  47. So Why Must New Jersey Enact Health Reform Now? “Somebody has to do something . . . . . . it’s just incredibly pathetic it has to be us” Jerry Garcia Grateful Dead

  48. NEW JERSEY HEALTHCARE QUALITY INSTITUTE Quality powered. Ten Years of Advocacy WWW.NJHCQI.ORG

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