1. Public
Policy and
the Primary
Care
Physician
Senator Irene Aguilar, MD

2. Case Report

3. Lewin Analysis of Health Proposals for Colorado
September 2007
CHS/ Single
Payer
Author
Remaining
Uninsured
Health
Spending
Medicaid/CHP
Subsidies
Benefit Floor
Benefit Cap
Mandates
Solutions for
a Health CO
CO Assn of
State Health
Underwriters
Better Health
Care for CO
0
138,000
487,000
108,600
106,600
($1,400 M)
Obsolete
Progressive
Premium
$271 M
Expand
$595 M
Expand
$1,289 M
Expand
$861 M
Expand
250% FPL
Less than
current law
$35,000
Individual
300% FPL
Basic
400% FPL
Comprehensi
ve
None
Individual
Employer
400% FPL
Basic
HCAC
Comprehensive
None
Individual
Employer
SEIU
$35,000
None
A Plan for
Commission’s
Covering CO 5th Proposal
Committee for
208
CO Health
Commission
Solutions
$50,000
Individual

5. US v. Other G7 Countries
Updated
Canada
France
Germ.
Italy
Japan
UK
Avg
USA
MD visits (2009)
per capita
6.5
6.9
8.2
NA
13.2*
5.0
6.3
3.9
Hosp discharges
per 100 pop
8.4
17.0
26.3
NA
NA
13.3
16.0
13.1
Avg hospital
LOS (2009)
7.7
5.2
7.5
NA
NA
6.8
5.9
5.4
144.0
83.2
(2009)
Hospital days per
100 population
$4,445
$3,974
$4,338
$2,964
NA
$3,433
$ 3,831 $8,232
HC spending
as % of GDP
11.4
11.6
11.6
9.3
NA
9.6
10.6
15.8
LE at birth (2010)
80.8 (08)
80.2
80.5
82 (09)
83
80
81.1
78.7
Infant deaths per
1000 live births
NA
3.6
3.4
3.4
2.3
4.2
3.4
6.1
HC spending
(2010)
per capita (PPP)
(2010)
OECD website : http://stats.oecd.org/index.aspx
The spending per capita numbers were converted from the currency of the country to US dollars by a PPP index.
(2010)
ORIGINAL BY: John A. Nyman, PhD
University of Minnesota
5

6. IOM: Best Care at Lower Cost
7.2%
9.8%
27.5%
INSTITUTE OF
MEDICINE 2012:
US Health Care
Annual Waste
$ 765
Billion
24.8%
17%
13.7%

8. Determinants of Health
2011
U.S.
Healthcare
Spending:
$2.7
Trillion

9. Health Reform in Colorado
 2011 Bipartisan legislation to establish a
health care exchange: Connect for Health
 2013 Medicaid Expansion endorsed by
Legislature and signed by Governor
 Moving forward: focus on Payment Reform

10. Brings together buyers and sellers of insurance
Compare health insurance options and shop for
coverage that will take effect as early as January 1,
2014
Choice of up to 150 different private health
insurance plans from ten carriers
Financial assistance based on income available to
close to 500,000 Coloradans

11. As of October 28th
316,326 visitors
44,945 accounts
created
30,862 calls to
Service Center
3164 purchases

12. Table 2: Estimate of ACA Effect, 2016
With ACA
ACA Impact
2,630,000
2,600,000
-30,000
Small Firm ESI (1-50 employees)
560,000
540,000
-20,000
Other ESI
2,070,000
2,060,000
-10,000
Unreformed Non-group
340,000
60,000
-280,000
Reformed Non-group
0
620,000
620,000
Tax Credit Recipients
0
470,000
470,000
Non-Recipients
0
150,000
150,000
Public Insurance
550,000
710,000
160,000
Uninsured
860,000
400,000
-460,000
Total
4,390,000
4,390,000
ESI
→
→
Source: Dr. Jonathan Gruber’s analysis for the Colorado Health Benefit Exchange, 2011
→
No Reform

13. Research shows significant variation in
health care spending.
Medicare Payments per Enrollee, by Hospital Referral Region, 2009
Source: The Dartmouth Atlas of Health Care.
DENOMINATOR DEFINITION:
A 20% random sample of the enrollment file for beneficiaries age 65-99 enrolled in both Medicare Parts A and B, selected on the basis of the terminal digits in the
Social Security number. Patients enrolled in risk-bearing health maintenance organizations (HMOs) are excluded.
ADJUSTMENTS:
Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population as the standard. Gender-specific rates are age and race
adjusted; race-specific rates are age and sex adjusted.

14. Massachusetts: Private, Medicare & Medicaid
Payment for Professional Procedures
Private Payer
Payment Variation
Min
Price
Max
Price
Office
Visit
$45
$330
MRI
Brain
$104
$646
Colonoscopy
$203
$1,045
Source: Massachusetts Division of Health Care Finance and Policy, Massachusetts Health Care Cost
Trends: Price Variation in Massachusetts Health Care Services, May 2011.

16. Percent of Total Health Care Spending
Concentration of Health Care Spending in the U.S.
Population, 2009
(≥$51,951)
(≥$17,402)
(≥$9,570)
(≥$6,343)
(≥$4,586)
(≥$851)
(<$851)
Note: Dollar amounts in parentheses are the annual expenses per person in each percentile. Population is the civilian noninstitutionalized population, including
those without any health care spending. Health care spending is total payments from all sources (including direct payments from individuals and families,
private insurance, Medicare, Medicaid, and miscellaneous other sources) to hospitals, physicians, other providers (including dental care), and pharmacies;
health insurance premiums are not included.
Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality,
Medical Expenditure Panel Survey (MEPS), Household Component, 2009.

19. Cooperative would put Colorado on
sustainable path: Spending growing no
faster than the GSP
Savings grow by “bending the
cost curve” by reducing
administrative share and
restraining drug price inflation

20. Figure 4. Share of Colorado population without
health insurance coverage, alternative funding
programs, 2015-24.

21. 21

22. If you’re not at the table,
you’re on the menu