2. History of National Reform
1965
President Lyndon
Johnson enacted
legislation which
introduced
Medicare
1985
President Ronald
Reagan signs
COBRA into law
1997
President Bill Clinton
passes SCHIP into
law
2010
President Barack
Obama enacts The
Patient Protection
and Affordable
Care Act
3. What is Medicare?
Federally administered, not a private
organization
For the aged; 65 years + or disabled persons
Pays a substantial amount or the total for
health services, depending on the service
Everyone pays into this program in working
years, it comes out of your paycheck like
social security
5. What is Medicaid?
Medicaid
Federally and state funded program
Provides health insurance for the needy
(low income and lacking resources)
State administered program
States set their own guidelines but must
comply with the federal government to
receive funding
6. COBRA and SCHIP
COBRA
Consolidated Omnibus Reconciliation Act of 1985
Passed by President Reagan
Mandated an insurance program for people who left their jobs
/ laid-off
SCHIP
State Children’s Health Insurance Program
U.S. Department of Heath and Human services provide
matching funds to families with children
Intended to cover families with children with modest incomes
but too high for Medicaid
Bush Jr. denied expanding coverage because it would be a
step towards federalized healthcare
Barack Obama passed the Children’s Health and
Reauthorization Act of 2009 which extended coverage to 4
million children and pregnant women as well as legal
immigrants without a wait period
7. Before Universal Healthcare
1997
•Analysis estimate the number of people in the United States who
die due to lack of medical care was nearly 100,000.
2007
•15.3% of the population, or 45.7 million people have no health
insurance.
•62% of all bankruptcies in the United States were due to inability
to pay medical cost.
2009
•Harvard study published in the American Journal of Public
Health found more then 44,800 excess deaths annually were
associated with lack of insurance
*According to the Institute of Medicine of the United States National
Academies, the United States is the “only wealthy industrialized nation
that does not ensure that all citizens have cover.”
9. 2010 Key Reforms
Extend Health
Insurance
Address
Insurance
Company
Abuse
Make Health
Insurance More
Effective
Reduce The
Deficit
Eliminate
Overpayment
in Medicare
Advantage
10. Extend Health Insurance
The health-care legislation signed into law in
March 2010 is estimated to result in 32 million
additional citizens
being insured by 2019,
but would still leave
an estimated 23
million without
coverage.
11. Address Insurance Company Abuse
Since the 1970s health insurance had began to
compete not on service and price but by
becoming good risk differentiators seeking to
insure only those with
good or normal
health profiles and
excluding those
considered to be or
to become
unhealthy resulting in
less profit.
12. Make Health Insurance More
Effective
By forcing insurers to cover more of a
person's health care costs by excluding
lifetime and annual caps, cover first dollar
costs for screenings
and immunizations
and preventing
exclusions for
necessary care.
13. Reduce the Deficit
The reform legislation
that passed was
estimated by
the Congressional
Budget Office to reduce
the deficit by $138 billion
over 10 years
In the second 10 years it
would reduce the
federal debt by 1.2
trillion dollars.
14. Eliminate Overpayment in
Medicare Advantage
Medicare Advantage plans are offered by private insurers and
provide benefits coverage in Medicare Parts A and B. However,
under a revised contract during the previous Bush presidency,
Medicare was overpaying the
private insurers.
MedPAC estimated the
overpayment as being
approximately $12 billion a
year. This meant that the
average person in traditional
Medicare was paying $90 a
year as a subsidy to private
insurers for which they
received zero benefit and eliminating this overpayment would save
$177 billion over ten years.
15. Legal Challenges
March 17, 2010
Virginia Attorney General
send house Speaker Nancy
Pelosi a letter threatening
constitutional challenge
March 23, 2010
Attorney General of
Florida, South Carolina,
Nebraska, Texas, Utah,
Louisiana, Alabama,
Michigan, Colorado,
Pennsylvania, Washington,
Idaho, and South Dakota
filed a joint law suit
challenging the new law
March 24, 2010
Gov. Bob McDonnell signs the
Virginia Healthcare Freedom
Act which claims the new
federal law is unconstitutional
and Virginians cannot be
forced to buy health insurance
or pay a penalty if they refuse
August 2, 2010
District Court Judge Henry
Hudson denied the Justice
Department attempt to have
the lawsuit dismissed, stating
the Virginians case raises
constitutional issues
17. Within one year of enactment
(2010–2011)
Insurance companies cannot drop people from
coverage when they get sick.
Young adult able to stay on their parents health
plans until age 26 since many current plans drop
coverage once turning 19.
Un-insured adult with pre-existing conditions will be
able to obtain health coverage
Health insurers cannot deny group coverage to
children under 19 due to a pre-existing condition
Tax credit to small business to help provide
coverage for workers
10% tax on indoor tanning
18. Effective during 2011
10% bonus payments to primary care physicians
and general surgeons
Medicare will cover the full cost of annual wellness
visits and personalized prevention plan services for
beneficiaries.
Payments to insurers offering Medicare
Advantage services are frozen at 2010 levels
Employers are required to disclose the value of
health benefits on employees' W-2 tax forms
An annual fee is imposed on pharmaceutical
companies according to market share
19. Effective as of 2012
An incentive program is established in Medicare
for acute care hospitals to improve quality
outcomes.
The Centers for Medicare and Medicaid Services,
which oversees the government programs, begin
tracking hospital readmission rates and puts in
place financial incentives to reduce preventable
readmissions
Physician payment reforms are implemented in
Medicare to enhance primary care services and
encourage doctors to form "accountable care
organizations" to improve quality and efficiency of
care
20. In 2013
A national pilot program is established for
Medicare on payment bundling to encourage
doctors, hospitals and other care providers to
better coordinate patient care.
The Federal Insurance Contributions Act tax (FICA)
is raised to 2.35% from 1.45% for individuals earning
more than $200,000 and married couples with
incomes over $250,000. The tax is imposed on
some investment income for that income group.
A 2.9% excise tax is imposed on the sale of
medical devices. Anything generally purchased at
the retail level by the public is excluded from the
tax.
21. Effective as of 2014
State health insurance exchanges for small businesses and
individuals open
Individuals with income up to 133% of the federal poverty
level qualify for Medicaid coverage
Healthcare tax credits become available to help people with
incomes up to 400 percent of poverty purchase coverage on
the exchange
Most people required to obtain health insurance coverage or
pay a tax if they don't.
Health plans no longer can exclude people from coverage
due to pre-existing conditions.
Employers with 50 or more workers who do not offer coverage
face a fine of $2,000 for each employee if any worker receives
subsidized insurance on the exchange. The first 30 employees
aren't counted for the fine.
Health insurance companies begin paying a fee based on
their market share.
22. The Cost of Care
The Cost of
Universal
healthcare
would be
940 billion
dollars over
the next 10
years.
23. Healthcare and Immigrants
Illegal immigrants
will not be allowed
to purchase
healthcare in the
exchange, even if
they completely
pay with their own
money.
The coverage for
legal immigrants is
up for debate in
congress. It seems
like Republicans
favor a 5 year wait
for coverage while
Democrats want
initial coverage like
any other legal
citizen.
24. Pro Choice or Pro Life?
Individuals seeking an abortion would have to
make two payments to receive an abortion.
Private funds would have to be kept in a
separate bank account from Federal or taxpayer
funds.
No healthcare plan would be required to offer
abortion coverage; in the future states could
pass legislation to deny abortion coverage as
well.
An exceptions was made for rape, incest,
and/or the mother’s physical or mental
Health by Democrats, allowing federal
funds to be used.
25. Works Cited
Gratzer, David. "Why Isn't Government Healthcare the Answer?." Free Market Cure
(2002): n. pag. Web. 25 Oct 2010.
<http://www.freemarketcure.com/whynotgovhc.php>.
"Health Care Statistics." Health Care Problems. Web. 29 Sept. 2010.
<http://www.healthcareproblems.org/health-care-statistics.htm>.
Jackson, Jill, and John Nolen. "Health Care Reform Bill Summary: A Look At What's
in the Bill - Political Hotsheet - CBS News." Breaking News Headlines:
Business, Entertainment & World News - CBS News. 21 Mar. 2010. Web.
29 Sept.2010.<http://www.cbsnews.com/8301-503544_162-20000846-
503544.html>.
Kavilanz, Parija. "Underinsured Americans: Cost To You." CNN Money (2009): n. pag.
Web. 25 Oct 2010.
<http://money.cnn.com/2009/03/05/news/economy/healthcare_underi
nsured/>.
"YouTube - France: 'Best' Health Care?" CBS News. CBS. YouTube - Broadcast
Yourself. 26 Oct. 2008. Web. 29 Sept. 2010.
<http://www.youtube.com/watch?v=uNR_6UuVl4s>.
