Embed Size (px)
Citation preview
Health Care Costs and the Long-Term Fiscal Imbalance
Colorado Human Services Directors Association
June 6, 2012
Overview
The Federal Budget and Healthcare Costs
The Affordable Care Act Reform Proposals What’s Coming Up
2
Growth of Government
Federal Spending & the Political Party in Power
19
45
19
47
19
49
19
51
19
53
19
55
19
57
19
59
19
61
19
63
19
65
19
67
19
69
19
71
19
73
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
20
05
20
07
20
09
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500Democratic Controlled Congress Republican Controlled Congress
Split Congress Republican President
Democratic President
Fiscal Years
Bill
ions
of
Con
stan
t 20
05 D
olla
rs
Source: OMB, Budget, Historical Tables, Table 1.3—Summary of Receipts, Outlays, and Surpluses or Deficits (−) in Current Dollars, Constant (FY 2005) Dollars, and as Percentages of GDP: 1940–2016
Social Security Act of 1965(Medicare)
Medicare Prescription Drug, Improvement, and Modernization Actof 2003and the Invasion of Iraq
America Recovery and Reinvestment Act of 2009
Patient Protection and Affordable Care Act of 2010
Gramm-Rudman-Hollings Balanced Budget and Emergency Deficit Control Act of 1985
Budget EnforcementAct of 1990
Deficit Reduction Act of 1993
2001 Invasion of Afghanistan
Vietnam Conflict1960-75
Korean Conflict1950-53
End of WWII
End of Statutory Budget Controls 2002
20%
19%
23%
20%
12%
6%
42%
20%
4%
15%
12%
7%
Defense Other Discretionary Medicare and Medicaid Social Security Other MandatoryNet Interest
2010Source: CBO, Budget and Economic Outlook: Fiscal Years 2011 Through 2021, Historical Tables
Composition of Federal Spending(% of Total Outlays)
1970
Our Fiscal Future
Source: The Dartmouth Atlas of Health Care. (2009). The Policy Implications of Variations in Medicare Spending Growth. Link: http://www.dartmouthatlas.org/atlases/Policy_Implications_Brief_022709.pdf. Note: Data adjusted for age, race, and sex but not price. Category definitions as in source document.
Chart 1: Medicare Spending per Beneficiary, by Hospital Referral Region, 2006
National Average = $8,304
$7,500 – $8,000
$8,000 – $9,000
> $9,000
$7,000 – $7,500
< $7,000
Not populated
Variations in Healthcare Spending
The ACA Dominos …
GI and Community
Rating
Mandates
SubsidiesExchanges
Cost cuts, Prevention,
Workforce, etc.
8
Impact of ACA on Insurance Coverage
Pre-ACA 2016 2022
Pre-ACA Medicaid/CHIP 34 32 32
Employer 153 159 162
Non-group 24 28 30
Uninsured 53 56 54
Total 267 273 282
Post-ACA (+/-) Medicaid/CHIP 17 17
Employer -4 -3
Non-group -2 -3
Exchanges 20 22
Uninsured -30 -33
# of Uninsured 55m 26m 27m
% of Eligible 81% 93% 93%
Comparison of Pre and Post ACA Premium Contributions*
$10,
000
$15,
000
$20,
000
$25,
000
$30,
000
$35,
000
$40,
000
$45,
000
$50,
000
$55,
000
$60,
000
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Pre-ACAPost-ACA
10*As % of Income for Single Adult
Status of ACA Implementation
Immediate Benefits
2010
Delivery Reforms
2011-2014
Coverage Expansions
2014-2017
11
Simpson-Bowles Plan
Discretionary Spending Caps
Tax Reform to Reduce Rates & Raise Revenue
Long-term Medicare “Doc
Fix” & IPAB
Additional Mandatory
Savings
Social Security Solvency
12
The Ryan Budget
• Medicare Premium Support
• Medicaid Block Grants
• Individual Tax Credits
Healthcare
• Eliminate Corporate Tax
• Eliminate Deductions• Lower Rates
Taxes • Social Security Reforms
• Discretionary Spending Caps
Other
13
Key Medicaid Reform Proposals
Proposal Simpson-Bowles
WhiteHouse
Rep. Ryan
CBO Options
Global cap on Medicaid spending growth/Block Grants
√ √
Reform/reduce FMAP formula √ √
Reduce cap on State Medicaid provider fees
√ √
Increase reliance on managed care in Medicaid
√ √
Permit reductions in Medicaid eligibility thresholds
√
Expedite Medicaid waiver process √
The “Fiscal Cliff”
$221
$95$65
$65$26$11
$123
-$607 Billion in 2013
Bush Tax Cuts & AMT
Payroll Tax
Other Tax Ex-tenders
Sequester
Unemployment Benefits
Medicare Payments
Other
15
The Next Six Months
25 Day Lame Duck Session
Debt Limit Vote
Expiring Tax Cuts, etc.
Sequester
16
THANK YOU
Billy Wynne
Senior Vice President & Principal
Health Policy Source, Inc.
