Health Policy And The 2020 Election Disclosure I have no relevant - - PDF document

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Health Policy And The 2020 Election Disclosure I have no relevant - - PDF document

Health Policy And The 2020 Election Disclosure I have no relevant financial relationships with any companies related to the content of this course. Andrew B. Bindman MD Professor of Medicine Philip R. Lee Institute for Health Policy Studies


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Health Policy And The 2020 Election

Andrew B. Bindman MD Professor of Medicine Philip R. Lee Institute for Health Policy Studies University of California San Francisco

Disclosure

I have no relevant financial relationships with any companies related to the content of this course.

Health Care Policy: Lots of Drama

  • No exclusions for pre-existing

conditions

  • Individual mandate
  • Financial support for low-

income individuals

  • Medicaid expansion
  • Marketplace subsidies

How The ACA Works

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Impact of the ACA

  • >20 million gained

coverage nationally

  • Decrease in coverage

disparities by race/ethnicity

  • Protections for those with

pre-existing conditions

Trump Sabotage of the ACA

  • Not promoting Marketplace
  • pen enrollment
  • Shortening open enrollment

period

  • Withholding federal

contributions to protect low- income from cost sharing

  • Eliminating tax penalty for

individual mandate in 2019

8

Average Job-Based Insurance Premiums

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Job-Based Premiums Have Grown While Wages Have Been Stagnant

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Source: https://www.chcf.org/wp- content/uploads/2019/02/HealthCarePrioritiesExperiencesCaliforniaResidents.p df

Health Care Availability and Affordability Is Americans Number 1 Concern

Gallup Poll

Medicare for All Proportion of Population Unable to See a Physician Because of Cost

Hawks et al. JAMA IM Trends in Unmet Need January 27, 2020

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Medicare for All

  • Single payer has been rebranded as “Medicare

for All”

  • Envisioned public plan is not Medicare
  • All US residents would receive an insurance

card entitling them to a broad range of services

  • Distinctions among Medicare, Medicaid,

employer sponsored insurance, and non-group coverage would be eliminated

Medicare For All Creating a Single Insurance Pool

  • ↓ Administrative costs
  • ↑ Ability to control total cost
  • Savings could
  • Expand coverage
  • Eliminate cost-sharing

California Hospitals Total administrative costs as % of revenue : 20.9% Billing and insurance-related costs as % of revenue: 6.6-10.8% California Physicians Total administrative costs as % of revenue: 26.7% Billing and insurance-related costs as % of revenue: 13.9% Neither estimate includes profits

Kahn et al Health Affairs, 2005 15

Administrative Costs

  • Higher administrative costs ~ 35%
  • Greater quantity of procedures/imaging ~ 15%
  • Higher prices ~ 50%

Why Are Health Care Costs Higher in US

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Relative Cost Differences For Common Procedures By Country Democratic Candidates National Debate

  • Creates a government-administered public option
  • Retains Medicare, Medicaid, employer and marketplace

insurance

  • Enhances premium and cost sharing subsidies in ACA

marketplaces and the public option

  • Proposals vary by who is eligible:
  • Age
  • Individual market +/- employer market
  • Availability of competition in region

Public Plan Option

  • Similarities
  • Elimination of health plan profit
  • Potential to reduce prices
  • Differences
  • Mandatory or optional disruption for those with coverage
  • Elimination or continuation of administrative complexity

Similarities and Differences Between Medicare for All and Public Option

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SOURCE: KFF Health Tracking Polls. See toplines for full question wording and response options.

Percent who favor or oppose:

53% 66% 74% 75% 77% 43% 29% 24% 18% 18%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Medicare-for-all Public option Optional Medicare-for-all Medicaid buy-in Medicare buy-in for ages 50-64

Favor Oppose

Broader Pubic Support For Public Option Than Medicare For All

Thinking about the Democratic candidates’ approach to health care. Would you prefer to vote for a candidate who wants to…?

NOTE: Among Democrats and Democratic-leaning independents. SOURCE: KFF Health Tracking Poll (September 3-8, 2019). See topline for full question wording and response options.

Replacing the ACA with Medicare- for-all 40% Other 5% Build on the existing ACA 55%

Democrats Prefer To Build On ACA Than To Replace it with Medicare For All Prospects for Democrat Proposals

  • Major change requires

alignment of White House and Congress

  • Democratic Congress did not

agree to public option as a part of ACA

  • Doesn’t mean there isn’t a

major choice on health care between Democrats and Republicans

  • Repeal ACA
  • Texas v. US: Administration supports striking

down most ACA provisions

  • Block grant Medicaid and reduce federal

Medicaid spending

  • Reduce access to health coverage for legal

immigrants

  • Reduce access to abortion

Differences Between Democratic Candidates Narrower than Differences with Trump

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State Options To Expand Coverage

  • Medicaid expansion
  • Consumer-oriented

health exchange

  • Individual mandate
  • State funds for

undocumented

  • Public option
  • Single payer

1 2 3 4 5 6 7 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Number of uninsured (in millions) and uninsured rate among Californians age 0-64 Under CA policy If no action had been taken 770,000 10.5% 12.9% 10.4% 17.6% 6.5m 3.47m 3.52m 4.27m

Source: CalSIM version 2.7

California Actions Have Protected ACA Gains

  • California Commission charged with advising state on how

to make progress towards unified financing/single payer

  • Governor, State Legislature made appointments
  • Held first public meeting January 2020
  • Recommendations in early 2021
  • University of California supporting the process

Healthy California For All

CA Health Care Expenditures By Payer: 2017-2018

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Overcoming Legal Barriers

  • Federal
  • Law to direct Medicare $ to state
  • Medicaid waiver
  • Marketplace waiver
  • State
  • Constitutional amendment to
  • ver-ride Gann limit and Prop 98

Developing Options To Replace Employer Contribution: $120 Billion

  • Income Tax
  • 120% increase
  • Sales Tax
  • 18 percentage point increase
  • New Payroll Tax
  • 9%
  • New Gross Receipts Tax
  • 3%

What Will Happen

Large changes in the financing

  • f health care at either federal
  • r state level will depend on

how effectively political leaders can galvanize general public and stakeholders around a shared plan

Resources

https://www.kff.org/slideshow/public-opinion-on- single-payer-national-health-plans-and-expanding- access-to-medicare-coverage/ https://www.kff.org/slideshow/where-do-the- democratic-candidates-stand-on-health-reform/ https://www.chhs.ca.gov/healthycaforall/