Health Care disclosures or relationships to disclose Reform in - - PDF document

▶

Aug 26, 2022 362 likes •436 views

Winston F. Wong, MD, MS has no relevant financial Health Care disclosures or relationships to disclose Reform in Early October 2017 Winston F. Wong, MD, MS, FAAFP UCSF Asian Health Chair, National Council Symposium of Asian Pacific

SLIDE 1

1

Health Care Reform in Early October 2017

Winston F. Wong, MD, MS, FAAFP Chair, National Council

f Asian Pacific

Islander Physicians

UCSF Asian Health Symposium October 7, 2017

 Winston F. Wong, MD, MS has no relevant financial

disclosures or relationships to disclose

Health Status, literally, is the reason we have the ACA as the rule of the land

View from the White House

SLIDE 2

2

A Funny thing Happened On the Way to the Hospital

Source: National Center for Health Statistics, National Health Interview Survey, 2000-June 2014.

ACCESS: After years without improvement, the rate of uninsurance among adults ages 18- 64 decreased substantially during the first half of 2014

Adults ages 18-64 who were uninsured at the time of interview, 2000-2014 10 20 30 40 50 Percent Marketplace Enrollment Begins 1st Affordable Care

ACA: what it is

 Expansion of Medicaid coverage for those states that

“opt in”: income status and citizenship only criteria for eligibility

 Establishes a marketplace for any individual to

purchase health care coverage, with subsidies for individuals 138% - 400% of FPL

 Establishes the minimum standard for adequate

insurance coverage, i.e., basket of services, pre- existing conditions

 Establishes mandates: “individual”, “coverage for

dependents”, “premium bands”

7 8

Distribution of Uninsured APIs, 2011 APINH have seen a significant increase in coverage under ACA Since ACA the Uninsured rate among Asian Americans has dropped from 15.1% to 7.5% Among NHPIs, the Uninsured rate has dropped from 14.5% to 7.8%

SLIDE 3

3

Individual purchasers now rely on the Marketplaces

9 10

17% of AAs and 34% of NHPIs are enrolled in Medicaid coverage NHPIs match American Indians as the racial community with highest

% of Medicaid enrollees

It is much easier to give than take away

Ideologic and Political Divisions across the health care coverage debate

Pro-ACA

 Healthcare is a right  National responsibility  Social contract to citizens  Leverage federal $$ to

establish a social safety net

 Business and Industry for

the common good

 Care for the most

vulnerable Anti ACA

 Purchasing healthcare is

a right

 States’ autonomy  Individual determinism  Big government is

expensive, unsustainable and out of touch

 Business is competition

and competition is good

 Middle class preservation

SLIDE 4

4

AHCA, BCRA, ACA: the playing fields

 Medicaid (MediCal) Insurance Marketplaces and

Coverage

13 14

Covered California is popular among API – Californians

California: 23.1% of Covered California purchasers were API descent; 13.7% of Californians are of API descent

SLIDE 5

5

Market place Reform

 “Stabilize the Market”: Subsidies are critical in

mitigating premium increases: “Insurers need to be insured” (or they abandon the market, resulting in a single plan that bears the cost and raises premiums)

Release appropriations to provide premium subsidies
Retain or expand strategies to maintain an adequate risk

pool: “individual mandate”, “premium penalty if declined”, “automatic enrollment into catastrophic plan”

High risk insurance pools
Individual purchasers over 400% of FPL should be insulated

from dramatic increases in premiums year to year

Managing an entitlement (how to shift burden to the poor): Medicaid

 Expansion against States’ rights (their willingness or

unwillingness to cover poor folks)

 Does Medicaid have its own set of rules to “control

the costs of care”? Vis: eligibility, benefits

 Block grants: the Trojan Horse? Or vehicle to

catalyze reform and efficiency?

18 19

Graham Cassidy Has Clear Winners and Losers

Red States on Map gain more $$ because they DIDN’T expand Medicaid

SLIDE 6

6

As Single Payer Gains Popularity, No One really Knows what it is

What to Look for in the future

 Pressure to solidify market places because insurance

industry facing tremendous pressures

 Medicaid “reform” will happen sooner or later:

wholesale vs waivers

 Core popular elements of ACA seem culturally

implanted: no prior condition exclusion, no set limits, essential benefits, coverage for family members up to age 26

 Single payer gaining traction, but probably not viable

for another “generation”

 AANHPIs are in the center of the storm; diversity of

income, immigration, and socio-economic status