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Arielle Kane Health Care Update

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Join Business Forward to welcome Arielle Kane, Director of Health Care at the Progressive Policy Institute, for a discussion on the current state of health care access in America. Kane will discuss how improvements to the ACA are more beneficial than repealing the law and moving to a single-payer system.

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Arielle Kane Health Care Update

  1. 1. 1 Health care update Arielle Kane, Director of Health Care at Progressive Policy Institute
  2. 2. 2 Health care to be a top issue in the 2018 midterms Forces on the current health care market Health care system in America • Democrats poll better on health care −Drawing attention to candidates who voted against protections for preexisting conditions −Some calling for “Medicare-for- all” as a solution −Disagreement over how best to solve ongoing woes • Costs −Still high out of pocket costs for many in the individual market −Medicare/Medicaid costs remain a concern to lawmakers −Employers bear large portion of health care costs • Businesses are concerned about health care turmoil −Don’t want “Medicare-for-all” −Health care industry is worried about government price setting • Trump administration −Repeal of the individual mandate −Stops cost sharing reduction payments −Allowing the sale of short term health plans for up to one year −Lawsuit challenging the legality of the ACA in the absence of the individual mandate
  3. 3. 3 After years of turmoil, premiums are stabilizing, but some still slip through the cracks The ACA is working Average premiums fell 1.5 percent for 2019 Insurance companies increased prices year after year and finally have priced them accurate for the individual market population But premiums are still high The average monthly premium for a mid-level “silver” plan under the ACA will be $406 in 2019—69 percent higher than the average premium just three years ago Those ineligible for subsidies may not be able to afford coverage Those above 400 percent of the federal poverty level are ineligible for subsidies, about 6.7 million people. A married couple in their 50s can easily pay $25,000 per year in premiums alone. Source: 1. https://www.cms.gov/sites/drupal/files/2018-10/10-11-18%20Average%20Monthly%20Premiums%20for%20SLCSP%20and%20LCP%202016-2019_0.pdf 2. https://finance.yahoo.com/news/obamacare-finally-working-republicans-still-want-kill-125728257.html?ncid=twitter_yfsocialtw_l1gbd0noiom 3. https://finance.yahoo.com/news/health-care-costs-still-crushing- problem-170955821.html
  4. 4. 4 A short history of the Affordable Care Act (ACA) History 2010 Uninsured rate: 18.8 percent Uninsured rate 12.5 percent of non-elderly ACAissigned intolaw SCupholdsmajor provisionsofACA Healthcare.gov goeslive SCrulesfederal governmentcanprovide subsidiesforstates withoutexchanges PresidentTrumpis elected Thegovernment ceasesCSRpayments Theindividual mandateis repealed 2012 2013 2015 2016 2017 2018 Reasons for remaining uninsured: • The cost of health care is still too high • Immigration Status – undocumented immigrants are ineligible for Medicaid and for legal immigrants are only eligible for Medicaid 5 years after receiving qualified immigration status Sources: 1. https://www.census.gov/prod/2010pubs/p60-238.pdf 2. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201808.pdf 3. http://affordablehealthca.com/timeline-obamacare/ 4. https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
  5. 5. 5 Efforts to undo the ACA Timeline of recent health care policy decisions January 2018 Repeal of the individual mandate goes into effect August 2018 Administration approves sale of “junk” insurance November 2018 Administration shortens enrollment period and education and outreach October 2017 Ceasing cost sharing reduction payments February 2018 Lawsuit challenges constitutionality of ACA without the individual mandate November 2018 Midterm elections July 2017 Sen. John McCain joins Sens. Susan Collins and Lisa Murcowski to reject ACA repeal August 2018 Administration joins lawsuit
  6. 6. 6 Medicaid expansion states – a two tiered system FL NM DE MD TX OK KS NE SD NDMT WY CO UT ID AZ NV WA CA OR KY ME NY PA MI VT NH MA RI CT VA WV OH INIL NC TN SC ALMS AR LA MO IA MN WI NJ GA DC AK HI Expanded Considering expansion Not yet expanded Source: https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ There will continue to be debate around Medicaid expansion – work requirements, etc. – for the next several years
  7. 7. 7 In 2018, the annual Kaiser Family Foundation Employer Health Benefits Survey found the average annual premium for coverage rose 3 percent to $6,896 for an individual and the average annual premium for family rose 5 percent to $19,616 Employer market: Modest premium growth in 2018 but higher worker contributions Wages increases are absorbed into health care: Workers’ wages increased 2.6 percent and inflation increased 2.5 percent over the past year Costs are going up: The average premium for family coverage has increased 20 percent since 2013 and 55 percent since 2008 More expensive at small firms: Workers in small firms contribute a higher percentage of premiums for family coverage (38 vs. 26 percent in large firms). 27 percent of workers in small firms are in a plan where the employer pays the entire premium for single coverage, compared to 6 percent of covered workers in large firms. Source: https://www.kff.org/report-section/2018-employer-health-benefits-survey-summary-of-findings/
  8. 8. 8 Health care costs continue to consume a large portion of wages and taxes Costs $10,348 $3.3t https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
  9. 9. 9 Improving and building upon the ACA will reduce the demand for a government solution What can be improved? Individual market Greater premium subsidies, reinsurance, individual mandate, etc. 02 01 Reinsurance A permanent reinsurance program would help bring down costs and encourage insurer participation in the individual market 04 03 05 06 Drug pricing Better align incentives in the system to encourage value and increase transparency in the PBM sector Innovation Health care is a very labor intensive industry; increasing and encouraging innovation to make it easier to deliver and access care can help bring down overall costs Health care costs Out of pocket costs are still too high for many Helping those on the margins The reality is, while the health care system works well for a majority of people, some slip through the cracks