1. Utah Health Policy Project [UHPP]: Health Care Solutions - 2016
What’s Next ?
Access to health care in Utah

2. Uncertainty abounds, but we can count on significant change…

3. Context
Political earthquake – landscape has changed, but ground has not yet settled so prognostications are speculative at this time.
Budget imperative to address costs of health care (see next slide)
Utah well positioned to be able to help influence federal policy.
Utah legislature not likely to “take up” Medicaid expansion in the session.

5. “Repeal and Replace Obamacare” ?
Inevitable – appointment of physician politician Dr. Tom Price (R-Ga), characterized by President elect Donald Trump as “exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible health care to every American.”
At least 7 proposals have been offered by Republicans, so there is a menu of options to consider.
However, will not be easy – “Could be More Complicated that it Looks” [Kaiser Health News, Nov. 9th].
Governor’s want a “very, very active” role in Obama Care rewrite.[The Hill, Nov. 26].

6. Some common elements of proposals for alternatives to the ACA [Affordable Care Act]
Block grant Medicaid - a long-time proposal of conservative Republicans, based on “federalist” view of role of governments, and reducing federal expenditures, i.e. debt.
Require “able-bodied applicants” to meet work requirements to receive benefits (example – Indiana version of Medicaid expansion).
Move to from a “defined benefit” to a “defined contribution” for Medicare and Medicaid beneficiaries, allowing them to buy health insurance in the private sector.
Allow health insurance companies to sell their products across state lines, promoting more competition.
Address the high costs of drugs.
Create “high risk pools” to cover those with complex and costly health problems.
Promote health savings accounts [HAS’s] as an alternative to traditional health insurance.

7. Concerns about “block grants”
Uneven access to care across states.
Economic burden for those states already “strapped for cash”, i.e. those whose budgets are already in the red.
Uneven administrative capacity among states to administer their own version of Medicaid for their citizens.
Public health consequences resulting from diminished timely access to needed care.
Others?

8. APHA Roundtable – “Public Health in the Presidential Campaign” Oct
Relative dearth of discussion, or “precious little attention paid” to current public health challenges [Dr. John E McDonough, Harvard School of Public Health]. NOTE: nothing new here, has not been part of any presidential campaign in recent memory.
All polices need to be based on science, political feasibility, and budgetary reality. [ASTHO Annual Meeting, Sept. 2016, Minneapolis].
“No matter who wins the White House, we have important and essential work to do and will continue to do it, to the extent we can with the budget provided, and as directed by our elected officials”. Dr. Jewel Mullen, Dep. Assistant Secretary for Health, HHS, formerly Senior Health Official for Connecticut.

9. Utah’s coverage gap……
The most recent data indicates, 164,415 persons have obtained health insurance through the federal exchange, reducing our rate of the uninsured to 10.5%, a 16% drop. Of those Utahans who enrolled on the federal exchange , 85% received a premium subsidy.[ However, there are significant differences among various population groups, e.g. Utah ranks lowest in the nation of the number of insured Hispanic children, with 16.8% being uninsured].* UHPP data
The most recent data indicates 8.8% of Utah residents do not have health insurance, the lowest number in the past 10 years. [ ceAnalysis.pdf]
We have made significant progress in reducing the number of uninsured, but much remains to be done to fill in the “gap”.

10. What would you do if you were president to achieve a more fair and affordable health care system?
I would:
Federalize “acute care” Medicaid for adults (keep CHIP) —repeal the federal–state collaboration and enroll those now entitled to Medicaid in Medicare(while a bold proposal, it is likely more feasible than “Medicare for All” which is a proposal favored by many to achieve a more fair and affordable health care system).
Block grant Long Term Services and Support [LTSS] – not a new idea, and given the demographics on aging in our country, this proposal should be revisited. There is great variation among states in the proportion of elderly, and their care should be culturally appropriate and tailored to different needs, which can likely be best achieved at the local level.
Establish a national bipartisan initiative to reduce infant mortality. We rank 26th among the nations of the world – a national embarrassment and shameful. Take coverage for maternity care out of Medicaid, Title XI of the Social Security Act, and merge it with Title V, the Maternal and Child Health Services Block Grant. This would couple insurance coverage with proven public health practices that improve birth outcomes and maternal health.

11. President-elect Donald Trump’s promise
“I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."
CNN interview with Scott Pelley on 60 Minutes, Oct. 2016
Let’s hold him to it.