Martin Trussell presented on upcoming healthcare reform and how it may affect different groups. He discussed that reform is now a priority due to the economic crisis, unsustainable growth of Medicare and Medicaid, and consensus among stakeholders. The proposed reforms include expanding coverage to all Americans, eliminating pre-existing condition restrictions, implementing an individual mandate, emphasizing prevention, and finding $2 trillion in savings over 10 years. The reforms would impact employers, carriers, brokers, individuals, providers, and other healthcare industry roles in various ways. The speaker noted many specifics are still unknown as legislation is still being drafted.
1. Healthcare Reform and You.
Presented by:
Martin Trussell,
SVP First Horizon Msaver, Inc.
HealthCampNash, May 30, 2009
2. Healthcare Reform
Why now?
What will it look like?
How will it affect me?
Carriers & TPAs
Brokers & Agents
Employers
Individuals
Providers
Others…
Healthcare Reform and You.
3. Why Now?
Economic crisis.
Medicare and Medicaid.
Stakeholder consensus.
Needs to happen in 1st Term.
Healthcare Reform and You.
4. Why Now?
National healthcare spending reached
$2.2 trillion, or $7,421 per person, in
2007 representing more than 16% of
the gross domestic product.
Continuing at the same pace, it will
reach 20.3% of the country's gross
domestic product by 2018.
Healthcare Reform and You.
5. Why Now?
32% of state budgets now go to
paying for Medicaid.
Growth rates for Medicare is
unsustainable.
Healthcare Reform and You.
6. What will it look like?
We don’t know, for sure.
Legislation to be revealed in June.
Passed by July 31.
Healthcare Reform and You.
7. What will it look like?
The promise:
All Americans guaranteed affordable,
high-quality healthcare
the freedom to choose whatever doctor
or health plan they want,
all at a savings of some $2,500 per
family.
Healthcare Reform and You.
8. What will it look like?
The cost: $1.5 trillion.
Healthcare Reform and You.
9. What will it look like?
Individual mandate.
Sufficient coverage.
Elimination of underwriting.
Tax equity, subsidy (indiv. vs. group).
Public Plan to complete.
Emphasis on prevention & wellness.
Elimination of waste.
Electronic data keeping.
Comparative effectiveness.
Healthcare Reform and You.
10. Employer
Elimination or reduction the favored
tax status of healthcare expenses.
Revenue “lost” to current policy at
$194.2 billion a year.
Less control over plan designs offered
to employees.
Loss of members to individual plans.
Healthcare Reform and You.
11. Carriers
Competition from “Public Plan.”
Inability to underwrite.
Increased regulation.
Shift to individual policies.
Looking for $2T in savings.
Healthcare Reform and You.
12. TPAs
Potential loss of FSA/HRA admin.
Potential gain of HSA substantiation.
Shift from groups to individuals.
Healthcare Reform and You.
13. Brokers and Agents
Competition from “Connectors.”
Shift to individual market.
Relief from underwriting.
Healthcare Reform and You.
14. Individuals
Requirement to purchase insurance.
Tax credits or subsidy.
Reduced the tax advantages of HSAs,
FSAs and itemized deductions of
medical expenses.
New “sin taxes” on products such as
alcohol and sugary soft drinks.
Healthcare Reform and You.
15. Providers
Reduced Medicare spending on home
healthcare, durable medical equipment,
medical imaging and prescription drugs.
Increased demand for services, especially
primary care.
5% bonus payment for office visits and
other “primary care services.”
Input on “best practices.”
Looking for $2T in savings.
Healthcare Reform and You.
16. Providers (Medicare)
Increase payments to doctors who regularly exceed
“national benchmarks” for the quality of care.
Bonuses to hospitals that provide superior care for
heart attacks, heart failure, pneumonia and selected
other conditions.
Doctors could receive extra payments if they hire
nurses to manage follow-up care for chronic cases.
Government to set national standards for the
appropriate use of CAT scans, magnetic resonance
and other diagnostic imaging techniques.
Healthcare Reform and You.
17. Providers (Medicare)
Medicare would make a single
“bundled payment” for all the
services provided to a hospital
patient.
Bad for nursing homes, home care,
hospice, etc.
Healthcare Reform and You.
18. Pharmaceuticals
Reduce government spending on
prescription drugs.
Re-importation of drugs from other
countries to lower costs.
Shifting insurance coverage toward
prevention, could increase sales for heart,
diabetes and other drugs that patients take
long term.
Increased Rx spend by $15 to $18 billion.
Looking for the $2T in savings.
Healthcare Reform and You.
19. Wellness
Tax credits or other subsidies to
employers who offer wellness
programs that meet federal criteria.
Make it easier for employers to use
financial rewards or penalties to
promote healthy behavior among
employees.
Healthcare Reform and You.
20. Health IT Providers
$20 billion in Stimulus Money.
Electronic Health Records.
Healthcare Reform and You.
