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Major Health Issues

Major Health Issues. The Affordable Healthcare Act. Introduction. Costs- US per capita is 2x costs in other industrialized nations Recent years increasing 6-9% per year Approximately 20% of US economy. Can the average Mississippi family afford healthcare?.

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Major Health Issues

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  1. Major Health Issues The Affordable Healthcare Act

  2. Introduction • Costs- US per capita is 2x costs in other industrialized nations • Recent years increasing 6-9% per year • Approximately 20% of US economy

  3. Can the average Mississippi family afford healthcare? • Family of four in Mississippi estimated cost is $15,000 • What drives the cost? • Technology - excessive use • Aging population • Overutilization – duplication of services • Excess Administrative costs

  4. Can the average Mississippi family afford healthcare? • Driving Cost cont’d • Waste and Fraud – Overuse of Emergency Rooms • Defensive Medicine • Fee for Service System –Over utilization • Insurance Coverage

  5. Access • The UNinsured • 40-50 Million in the US • 500,000+ in Mississippi • The UNDERinsured

  6. Access • Other Factors • Knowledge • Culture • Poverty • Disparity – Racial – Economic

  7. Quality • Significant variability • Process Issues • Many preventable and avoidable errors • 80-100,000 Excessive deaths per year • Evidence Based Medicine • Centers of Excellence • Mayo’s • Cleveland Clinic

  8. The Affordable Healthcare Act • Battle over Single Payer vs. Multiple Payer System • Builds on Existing System • Government Plans – Healthcare Insurance Plan • Strengthens Health Insurance • Regulation – Consumer Protection- Placed on States

  9. The Affordable Healthcare Act • Emphasis on Prevention – Wellness • Goal of Universal Coverage • Improve Access • Lower overall costs • Reduce Misuse of Emergency Rooms • Promote the “Medical” Home

  10. Major Provisions • Phased in over Several Years

  11. Access • Medicaid Expansion • Covers all under 133% of the Federal Poverty Line • Estimates for Mississippi are an additional 200-300,000 • Who are largely adults without children • Why not covered now • State and Federal Funding

  12. Access • Medicaid Expansion cont’d • Funding • No Match for 3 years • 5% to 10% for years 2017-2020 • 10% Capped after 2020 • Very Attractive to Mississippi • Economically Important

  13. Premium Support • Tax Credits for individuals to purchase health insurance • Above 133% of the poverty line for individual health insurance • Estimates 200,000+ in Mississippi

  14. Premium Support • Will enable uninsured individuals 133% to 400% above the poverty income level to afford insurance – no premium > 10% annual income • Economic Impact – No state match the average subsidy will be < $5,000

  15. Regulatory Reform • Accept all applications • No rejections for preexisting conditions • Increase payment for primary care • Under the age of 26 may continue on parents plan if no other access to a group plan • Remove Annual Caps -Rescissions

  16. Mandates Coverage For All • Individual or group plans • Penalty if not offered or purchased • Mandates all large employer groups must provide coverage or pay penalty • Small employers are provided tax credits for employee coverage • Employers of early retirees age 55-64 may reduce premium costs through reinsurance

  17. Costs • Medical Effectiveness Studies • Support for Health Information Systems • Computerized health records • Standardized health insurance claim forms • Standardized definitions for procedures • Systems for providers to exchange information • Health Insurance Exchanges • A marketplace in each state for the uninsured and small employers to compare health insurance plans and prices as well as purchase coverage • Also determines eligibility for Medicaid and Premium Support programs

  18. Costs • Sets minimum medical loss ratios for health insurance plans • Expansion of Community Health Centers • Expansion of preventative services • Includes governmental plans and private health insurance • Sets limits on amount insurance companies can deduct as expense items for executive salaries • Independent Payment and Advisory Board (IPAB) • Sets limits on fees and payments to keep Medicare growth in control • Congress cannot change, if it rejects must substitute to equal cost reductions of (IPAB) • Accountable Care Organizations • Supports projects to change Medicare payments for primary care services somewhat like DRG’s for hospitals

  19. Funding HCR • Individuals with earned income greater than $200,000 per year ($250,000 joint filers) will have a .9% increase in Medicare tax • Same individuals or joint filers as above an additional 3.8% Medicare tax on investment income, dividends, capital gains, rents, and passive income • Excise tax on high cost employer sponsored plans • Premiums > $10,200 for individuals and $27,500 for families • Increased taxes on drug companies, health insurance companies and other health related companies • Estimated cost through 2020 $800 Billion

  20. Questions?

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