Health Reform Primer (NMA 2010)

A Primer on Health Reform : 

A Primer on Health Reform for the National Medical Association Note: Images are Copyright their respective owners. Appropriate attribution provided where available.

health reform : 

health reform Health Care is #3 election issue after Economy (#1) and Gas Prices (#2) Photo by Chris Gallevo N Engl J Med. 2008 Nov 6;359(19):2050-61. Epub 2008 Oct 30.

health reform : 

health reform Summer of Discontent Franken video still: DustyTrice.com/Town hall photos: Reuters

health reform : 

health reform 7 November 2009 - House version of health reform bill passed

health reform : 

health reform 24 December 2009 - Senate version of health reform bill passed

Scott Brown : 

Scott Brown 20 January 2010 - Democrats lose the 60th Senate vote Image: Yana Paskova for The New York Times

Health Reform : 

Health Reform 21 March 2010 - House Passes Senate Version

Health reform : 

Health reform 23 March 2010 - A Reality

What should the MD know? : 

What should the MD know? Health reform: the big picture Impact on patients Immediate deliverables What’s coming in the future? What was left out of reform?

Health Reform: The Big Picture : 

Health Reform: The Big Picture Consumer Protections: guaranteed issue, guaranteed renewal, modified community rating (age, tobacco) Individual responsibility (mandate) Medicaid expansion to 133% FPL Insurance exchanges Investments in workforce, public health NO “PUBLIC OPTION”

Impact on Patients : 

Impact on Patients Patients cannot lose or be refused coverage because they get sick Patients must have insurance (just like car insurance) No co-pays for most preventive care

2010: Immediate Deliverables : 

2010: Immediate Deliverables Established temporary high risk pools Dependent coverage up to age 26 Prohibit lifetime limits on coverage Require FREE preventive services (USPSTF rated A and B) Tax credits for small employers (<25) purchasing health insurance $250 rebate for Medicare Part D (donut hole) Reauthorized the Indian Health Services Act Established Patient-Centered Outcomes Research Institute for Comparative Effectiveness Research 10% tanning tax

The Future : 

The Future Nutritional content disclosure for chain restaurants and vending machines within one year Definition of essential health benefit package by 2014 Implementation of insurance market regulations in 2014 Individual mandate with associated penalties, increasing each year until 2016 Creation of health insurance exchanges by 2017 Decreasing federal funding of state Medicaid programs through 2020

What was left out of reform? : 

What was left out of reform? Physician payment Malpractice

How NMA can help... : 

How NMA can help... Medicare payment (“The Doc Fix”) Medicaid payment Minimal creditable coverage (what should be considered basic?)

Medicare Payment : 

Medicare Payment A National level policy decision SGR formula consistently called for reductions in physician payments for Medicare Temporary fix will expire November 30, 2010

Medicaid Payments : 

Medicaid Payments A State level policy decision Average is 72% of Medicare payment Nearly 17 million more Medicaid enrollees as a result of health reform; who will care for them?

Slide 19: 

Health Affairs, 28, no. 3 (2009): w510-w519

Minimal Creditable Coverage : 

Minimal Creditable Coverage What should be included as part of the “basic benefit package” to be defined by the Secretary of DHHS? Will there be a battle between the specialties? What should NOT be covered?

Policy Prescriptions : 

Policy Prescriptions Website: www.policyprescriptions.org Mission: To empower communities through timely, insightful, evidence-based analysis designed to shape the political landscape and policy governing health care Photo by Tyeese Gaines Reid

Policy Prescriptions : 

Policy Prescriptions Cedric K. Dark, MD, MPH - Founder and Executive Editor Stanley Frencher, Jr., MD, MPH - Co-Founder Kameron Leigh Matthews, MD, Esq. Lisa J. Maurer, MD Renee Volny, DO, MBA

QUESTIONS? : 

QUESTIONS?

Medicine is a social science, and politics nothing but medicine at a larger scale. : 

Medicine is a social science, and politics nothing but medicine at a larger scale. Rudolf Virchow