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Outline
Why?:
The
current
state
of
health
and
health
care
in
USA
What?:
Intro
to
Health
Insurance
How?:
IntroducFon
to
the
Aordable
Care
Act
(ACA)
18 16 14 12 10
4,000
8
3,000 2,000 1,000 0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
6 4 2 0
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998
2000
2002
2004
2006
* PPP=Purchasing Power Parity. Data: OECD Health Data 2011 (database), version 6/2011. 4 Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
2008
12
10.3
7.2
7.0
6.9
6.8
7.0
6.8
6.8
6.9
6.7
6.8
6.8 5.1
5.3
5.1
5.0
4.9
4.8
4.7
4.7
5.0
5.0
5.0
0
n d de lan we ce I S
20 20
Ja
02
19
19
20
20
20
04
20
20
^ Denotes years in 2006 and 2008 NaFonal Scorecards. Data: NaFonal and stateNaFonal Vital StaFsFcs System, Linked Birth and Infant Death Data (AHRQ 20032008; Mathews and MacDorman, 2011); internaFonal comparisonOECD Health Data 2011 (database), Version 06/2011. Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
20
pa
98
99
00
01
03
05
06
07
The
Uninsured
Uninsured
adults
have
a
25
percent
greater
mortality
risk
than
adults
with
coverage
Lack
of
health
insurance
is
associated
with
as
many
as
44
789
deaths
per
year
more
than
those
caused
by
kidney
disease
Wilper et al 2009
20092010
AZ
NM
OK
HI
HI
No Workers, 24%
75
50
52
42 35
9 14
44
102
16
25 26 0
2003 2007 2010
29
28 28
* Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income; medical expenses equaled 5% or more of income if low-income (<200% of poverty); or deductibles equaled 5% or more of income. ** Subgroups may not sum to total because of rounding. Data: 2003, 2007, and 2010 Commonwealth Fund Biennial Health Insurance Surveys. 11 Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
Underinsured
62.1%
of
all
bankruptcies
have
a
medical
cause.
Most
medical
debtors
were
well
educated
and
middle
class;
three
quarters
had
health
insurance.
The
share
of
bankruptcies
ahributable
to
medical
problems
rose
by
50%
between
2001
and
2007
You
loose
coverage
when
you
loose
job,
you
loose
the
health
insurance
when
is
most
needed!
Himmelstein et al 2009
Iatrogenic
events
US
esFmates
12
000
deaths/year
from
unnecessary
surgery
7000
deaths/year
from
medicaFon
errors
in
hospitals
20
000
deaths/year
from
other
errors
in
hospitals
80
000
deaths/year
from
nosocomial
infecFons
in
hospitals
106
000
deaths/year
from
non-error,
adverse
eects
of
medicaFons
The
average
number
esFmated
is
225
000
deaths
per
year
Admission
to
a
hospital
is
the
third
leading
cause
of
death
in
the
United
States,
ater
deaths
from
heart
disease
and
cancer.
EXECUTIVE SUMMARY
Exhibit 1
Overall Performance Top Quartile Second Quartile Third Quartile Bottom Quartile Not Populated
Skinner et al 2006 HA
By Insurance, 20052008
Percent of nonelderly adults ages 1864
100
19992000 88 79 86
20032004
20072008
85
Private
Public
Uninsured
76
75
72
50
31
50 41
55 49
29
25
0
Diabetes under control* High blood pressure under control**
*Refers to diabetic adults whose hemoglobin A1c is <9.0% **Refers to hypertensive adults whose blood pressure is <140/90 mmHg. Data: J. M. McWilliams, Harvard Medical School analysis of National Health and Nutrition Examination Survey. Source: Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
75
72
68
50 28 25 17
46 37
2000
2006
2009
NETH
NZ
NOR
UK
AUS
ITA
SWE
GER
FRA
CAN
United States
AUS=Australia; CAN=Canada; FRA=France; GER=Germany; ITA=Italy; NETH=Netherlands; NZ=New Zealand; NOR=Norway; SWE=Sweden; UK=United Kingdom. Data: Commonwealth Fund International Health Policy Survey of Physicians. Source: Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
* NHE = naFonal health expenditures; ** PPP = purchasing power parity. a 2008. b Includes claims administraFon, underwriFng, markeFng, prots, and other administraFve costs; based on premiums minus claims expenses for private insurance. Data: OECD Health Data 2011 (database), Version 06/2011. Source: Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
h)p://,nyurl.com/3ohmvjd
Percent of adults who could get an appointment on the same or next day when sick or needed medical attention
100 80 75 71 62 50 61 59 53
Waiting Time to See Doctor When Sick or Need Medical Attention, Among Sicker Adults, 2008
43 36
25
NETH
NZ
FRA
UK
GER
AUS
US
CAN
Sicker adults met at least one of the following criteria: health is fair or poor; serious illness in past two years; or was hospitalized or had major surgery in past two years. AUS=Australia; CAN=Canada; FRA=France; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom; US=United States. Data: 2008 Commonwealth Fund International Health Policy Survey. Source: Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
33 25 22 13 14 15
25
10 5 0 6
10
11
UK
NETH
SWE
SWIZ
NOR
FRA
NZ
CAN
AUS
GER
US
* Did not get medical care because of cost of doctors visit; skipped medical test, treatment, or follow-up because of cost; or did not fill Rx or skipped doses because of cost. AUS=Australia; CAN=Canada; FRA=France; GER=Germany; NETH=Netherlands; NZ=New Zealand; NOR=Norway; SWE=Sweden; SWIZ=Switzerland; UK=United Kingdom; US=United States. Data: 2010 Commonwealth Fund International Health Policy Survey. Source: Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
h)p://,nyurl.com/7832fc3
h)p://,nyurl.com/7832fc3
How?
Individual mandate
ACA
Guaranteed
issue
Insurance
subsidies
Individual mandate
Insurance
subsidies
Expand
Medicaid
up
to
133%
of
the
poverty
level
Create new Health Insurance Exchanges where individuals and small employers can purchase coverage
2019 (estimated)
AZ
NM
OK
HI
HI
Data: U.S. Census Bureau, 201011 Current Population Survey ASEC Supplement; estimates for 2019 by Jonathan Gruber and Ian Perry of MIT using the Gruber Microsimulation Model for The Commonwealth Fund. Commonwealth Fund NaFonal Scorecard on U.S. Health System Performance, 2011.
Congressional Budget Oce (CBO) esFmates 23 million uninsured in 2019 Who are they? Immigrants who are not legal residents Eligible for Medicaid but un-enrolled Exempt from the mandate (most because cant nd aordable coverage) Choose to pay penalty in lieu of ge|ng coverage Many remaining uninsured will be low-income
2010
2011-2013
2014
Medicaid
expansion
Health
Insurance
Exchanges
Premium
subsidies
Insurance
market
rules prohibiFon
on
denying
coverage
or
charging
more
to
those
who
are
sick,
standardized
benets
Individual
mandate
Employer
requirements
Some insurance market No cost-sharing for changesno cost-sharing prevenFve services in for prevenFve services, Medicare and Medicaid dependent coverage to age Increased payments for 26, no lifeFme caps primary care Pre-exisFng condiFon Reduced payments for insurance plan Medicare providers and Small business tax credits Premium review health plans New delivery system models in Medicare and Medicaid Tax changes and new health industry fees
ACA
in
acFon
2.5
million
young
adults
are
now
enrolled
in
their
parents'
health
insurance
105
million
Americans
no
longer
face
lifeFme
benet
caps
on
their
insurance
plans
86
million
Americans,
including
those
in
Medicare
and
private
coverage,
have
received
free
prevenFve
services
such
as
check-ups
and
cancer
screenings
17
million
children
can
no
longer
be
denied
coverage
because
of
pre- exisFng
condiFons
3.6
million
Medicare
seniors
have
received
savings
on
prescripFon
drugs
because
of
the
closing
of
the
so-called
"donut
hole;"
in
2011
360,000
small
employers
used
the
small
employer
tax
credit
to
make
insurance
more
aordable
for
their
two
million
employees.
John
McDonough
2011
h)p://,nyurl.com/ 856wj8s
Nearly
Half
Say
They
Feel
Confused
About
ACA;
Three
In
Ten
Angry;
Quarter
EnthusiasFc
Percent
who
say
that
each
of
the
following
describes
their
feelings
about
the
health
reform
law:
80%
Confused
Enthusiastic
Angry
60%
55 44 45
53 47 42 31 43
52 43
50
53 46 47%
40%
30
30
28
31 30
32 30
35 30 32 28
33 30
34 31
34
34
31%
20%
27
28
25%
0%
2010
2011
2012
Apr
May
Jun
Jul
Aug Sep
Oct
Nov Dec
Jan
Feb Mar
Apr
May
Jun
Jul
Aug Sep
Oct
Nov
Dec
Jan
Feb Mar
END