1. HEALTHCARE, ACCESS TO HEALTHCARE, AND HEALTH REFORM MAY 4, 2012 Albert J. Farias, MPH, PhD 14’

2. Outline  Current State of Healthcare  Costs and outcomes  Access to Health Care  Financial and non-financial barriers  Insurance (Public and Private)  Definitions and Types of Insurance  Patient Protection and Affordable Care Act (PPACA)  Overview from Kaiser Foundation  How does PPACA affect you?  Updates and challenges to PPACA  Highlight opportunities to improve health disparities  Class discussion

3. Learning Objectives  Explain the costs in healthcare expenditure in the US  Apply how different types of barriers affect healthcare access  Define the different types of insurance  Define kinds of insurance  Highlight demographics of underinsured/uninsured in different groups (age, work status, etc)  Explain the changes occurring due to healthcare reform (mentioned in Kaiser Foundation video)

4. Current State of Healthcare

5. Current State of Healthcare Healthcare Costs as a percent of GDP: 2012

6. Current State of Healthcare Healthcare Costs

8. Current State of Healthcare Healthcare quality

9. Current State of Healthcare Spending Costs vs. Other Countries

10. Current State of Healthcare Relative Health Outcomes Source: Frontline “Sick Around the World”

11. Access to Healthcare DEFINITION: Access to healthcare is the ability to obtain necessary and preventive medical care. Scenario: After a long night of drinking with friends Jenna went home with a guy that she barely knew and they ended up having sex. She is unsure if he was wearing a condom and as a precaution she realizes that she should seek some type of care.

12. Access to Healthcare  Discuss with your neighbor: What factors affect whether or Jenna will seek care? What are some types of environmental and individual level factors that affect her access to healthcare?

13. Access to Healthcare Barriers to access has two major components: 1) Non-financial barriers to access 2) Financial barriers: ability to pay

14. Access to Healthcare Barriers to Access  Geography  Individual/Social factors  System factors  Underinsured/ Uninsured

15. Access to Healthcare/ Barriers Individual/Social Factors  low education  client beliefs  substance misuse  depression, apathy  low acculturation  fear of medical care  denial of illness  language difficulties  lack of knowledge of services  low social support  mistrust in institution, providers  competing life demands/stress

16. Access to Healthcare/ Barriers System Factors  system capacity/provider supply  poor coordination of services  lack of usual source/lack of continuity of care  inadequate tracking and outreach  provider communication/attitude  lack of childcare  lack of transportation  discrimination  cultural competency  convenience: hours, sites, waiting times  bureaucratic complexity and unfriendliness  managed care/provider reimbursement & incentives  Medicaid not accepted*

17. Access to Healthcare/ Barriers Underinsured Underinsured: People who have health insurance but who face out-of-pocket health care costs or limits on benefits that may affect their ability to access or pay for health care services.

18. Access to Healthcare/ Barriers What does Underinsured look like? Age breakdown  Under 18 years  18-24 years  25-34 years  45-64 years  over 65 years

19. Access to Healthcare/ Barriers What does Underinsured look like? Age breakdown  11.4% under 18  30.2% 18-24 years  26.4% 25-34 years  13.9% 45-64 years  0.8% over 65 years

20. Access to Healthcare/ Barriers Uninsured In 2009, there were 50.7 million individuals without health insurance (16.7% of the population)

21. Uninsured: by age group

22. Access to Healthcare/ Barriers What Does Uninsured Look Like?

23. Access to Healthcare/ Barriers What does Uninsured look like? Work breakdown 1 or More Full-Time Workers No Workers Part-Time Workers SOURCE: KCMU/Urban Institute analysis of 2008 ASEC Supplement to the CPS

24. Access to Healthcare/ Barriers What does Uninsured look like? Work* breakdown 1 or More Full-Time Workers No Workers Part-Time Workers 19% 69% 19% SOURCE: KCMU/Urban Institute analysis of 2008 ASEC Supplement to the CPS

25. Access to Healthcare/ Barriers Consequences for Uninsured/Underinsured

26. Primer Insurance Terms  Premium: The amount paid, often on a monthly basis, for health insurance.  Co-pay: A fixed dollar amount paid by an individual at the time of receiving a covered health care service from a participating provider.  Deductible: A feature of health plans in which consumers are responsible for health care costs up to a specified dollar amount. After the deductible has been paid, the health insurance plan begins to pay for health care services.  Co-insurance: A method of cost-sharing in health insurance plans in which the plan member is required to pay a defined % of their medical costs after the deductible has been met.  Lifetime benefit: A cap on the amount of money insurers will pay toward the cost of health care services over the lifetime of the insurance policy.  Pre-existing conditions: An illness or medical condition for which a person received a diagnosis or treatment within a specified period of time prior to becoming insured.

27. Primer Types of Health Insurance  Public  Medicaid  Medicare  VA  Private  Employer based Self insured Group market  Individual

28. 2007 NHIS

29. Primer Medicare  Federal government financed health insurance  Covers over 95% of elderly (age 65 +)  On July 1, 2004, 12% of all Americans were 65 and over. By 2050, people 65 and over will comprise an impressive 21 % of the U.S. population

30. Primer Medicaid  State and federal government financed health insurance  State-run program  For low-income population  Pregnant women  Children  Elderly  Low-income adults in families with children

31. Healthcare Reform Patient Protection and Affordable Care Act (PPACA) Addressing costs, quality, and access to care

32. Overview of Reform in a few minutes!  Kaiser Foundation Overview of Health Reform http://healthreform.kff.org/the-animation.aspx http://www.youtube.com/watch?v=3- Ilc5xK2_E&feature=player_embedded

33. Overview of Reform  How does it affect me? College students (18-24)  Covers an additional 32 million people through premium subsidies and expansion of Medicaid (300% FPL)  Allows children to remain on employer-based health coverage until age of 26  $938 billion over 10 years, with decrease in overall deficit of $143 billion

34. Reform Prevention and Wellness  Establishes Council and new mandatory spending in the form of a Prevention and Public Health Fund  $500 million in FY 10  $750 million in FY 11  $1 billion each in FY 12, 13, 14  $2 billion in FY 15 and each year thereafter Some highlights:  Mandates the Secretary of HHS collect data on health disparities  Funds a childhood obesity program  Expands oral health programs  Establishes labeling requirements for restaurants, retail food establishments, and vending machines

35. Challenges to Reform  26 State Attorney’s filed suit in the Supreme Court on the constitutionality of PPACA: 1) mandating health insurance or minimum coverage provision 2) penalizing individuals who do not satisfy the requirement 3) expanding medicaid and coercing states to cover larger percentage of individuals  What happens: Is the reform severable?

36. Health Reform Class Discussion Discuss with your partner what attributes of a healthcare reform you would support

37. Reform Class Discussion

38. Learning Objectives  Explain the costs in healthcare expenditure in the US  Define the different types of insurance  Define kinds of insurance  Apply how different types of barriers affect healthcare access  Highlight demographics of underinsured/uninsured in different groups (age, work status, etc)  Explain the changes occurring due to healthcare reform (mentioned in Kaiser Foundation video)

39. Thank you! Questions?