sbar analysis

1. Do you believe the remaining uninsured will impact the extent to which the ACA will result in
cost savings? Support your argument with current data.
SBAR
http://www.nytimes.com/2013/09/24/us/immigrant-population-shows-signs-of-growth-estimates-
show.html
http://www.americanprogress.org/issues/healthcare/report/2013/10/23/77537/the-affordable-
care-acts-lower-than-projected-premiums-will-save-190-billion/
Situation
In projections for 2023, “the ACA reduces the number of people without health insurance by 25
million, leaving 31 million uninsured.” Over a third of the uninsured (about 11.7 million in
2013) are illegal immigrants, and this number is likely to rise. Will this impact the extent to
which the ACA will result in savings?
Background
When it was enacted, the Affordable Care Act was already fully paid for and projected to lower
the federal budget deficit. In a recent estimate, the CBO projected that the law would lower the
deficit by $109 billion over the next 10 years.
Despite these significant savings, hospitals continue to be at risk because of the amount of
charity care they provide to the uninsured. Further, increased enrollment via Medicaid means
that hospitals (and other healthcare facilities) will be treating an increasing number of patients
that are not paid for by the generally more lucrative ‘commercial’ payers. (Government does
not reimburse at the same rates as other payers.)
The question then becomes whether the savings are significant in light of the escalating costs of
healthcare that are set to approach 20% of GDP this decade (more than twice the percentage of
many other OECD countries). Illegal immigrants, with little access/options to preventive and
primary care often avail themselves of Emergency Care which is far more costly.
Note that while dollar savings are important, increasing the numbers of insured can have other
less tangible savings. For example, studies have demonstrated the link between overall
wellbeing and health coverage. Having a sizable segment of the population left out, negatively
affects their sense of wellbeing.

2. Assessment
The ACA is a health care policy that is a major legislative step towards universal coverage – for
Americans. It also results in cost savings and our overall economic health would stand to
benefit further if the pool of insured rose. However any attempts to expand coverage to the
undocumented is politically fraught.
Recommendation
1st Do No Harm. Sometimes, a President can do too much too soon and this can do more harm
to a cause than good. History teaches that the chance of passing new radical legislation towards
the end of an incumbent President’s tenure (and especially after a major legislative
achievement such as the ACA) is strongly diminished. (See Governing Health for more
discussion of ‘timing is everything.’)
I would therefore recommend that those organizations and policy makers that are currently
exploring immigration reform be mindful of the health care implications and bide their time
before proposing reforms to Congress.
References:
Undocumented Immigrants, Left Out Of Health Reform, Likely To Continue To Grow As Share
Of The Uninsured; Stephen Zuckerman, Timothy A. Waidmann and Emily Lawton, Health
Affairs; October 2011 30:101997-2004;
http://www.cbo.gov/publication/44176
http://kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-affordable/
Changes in Health Insurance Enrollment Since 2013, The Rand Corporation:
http://www.rand.org/content/dam/rand/pubs/research_reports/RR600/RR656/RAND_RR656.pdf
http://economix.blogs.nytimes.com/2013/08/07/the-economics-of-the-affordable-care-
act/?_php=true&_type=blogs&_r=0

3. Analysis
Politically , especially after a major piece of legislation
Recommendation
Studies that link to mental health…
It’s important to understand how the ACA proposed to save the nation money before we can
understand the impact of the uninsured – specifically the largest segment: illegal immigrants.
s a law enacted to ensure that all Americans have access to affordable health insurance. It
does this by offering consumers discounts (known as tax credits) on government-sponsored
health insurance plans, and by expanding the Medicaid assistance program to include more
people who don't have it in their budgets to pay for health care.
Will limit
$190 billion in context
When it was enacted, the Affordable Care Act was already fully paid for and projected to lower
the federal budget deficit. In its most recent estimate, CBO projected that the law would lower
the deficit by $109 billion over the next 10 years. Our estimated $190 billion in savings will
increase that deficit reduction by 174 percent to almost $300 billion.
Recent long-term debt-reduction plans have proposed substantial health care savings in
combination with additional tax revenue. The Simpson-Bowles commission, for example,
proposed $487 billion in health care savings. And in the last “grand bargain” offer that
President Barack Obama made to House Speaker John Boehner (R-OH) in December 2012, he
proposed about $400 billion in health care savings.

4. Our estimated $190 billion in savings represents a sizable share of these proposals’ health care
savings—about 40 percent of the Simpson-Bowles plan’s savings and almost half of the
president’s proposed savings.
are living in the United States illegally