1. Health Care Costs and the Long-Term Fiscal Imbalance Colorado Human Services Directors Association June 6, 2012

2. Overview The Federal Budget and Healthcare Costs The Affordable Care Act Reform Proposals What’s Coming Up 2

3. Growth of Government

4. Federal Spending & the Political Party in Power

5. Composition of Federal Spending (% of Total Outlays) 1970

6. Our Fiscal Future

7. 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

8. The ACA Dominos … GI and Community Rating Mandates SubsidiesExchanges Cost cuts, Prevention, Workforce, etc. 8

9. Impact of ACA on Insurance Coverage Pre-ACA20162022 Pre-ACAMedicaid/CHIP3432 Employer153159162 Non-group242830 Uninsured535654 Total267273282 Post-ACA (+/-)Medicaid/CHIP17 Employer-4-3 Non-group-2-3 Exchanges2022 Uninsured-30-33 # of Uninsured55m26m27m % of Eligible81%93%

10. Comparison of Pre and Post ACA Premium Contributions* 10 *As % of Income for Single Adult

11. Status of ACA Implementation Immediate Benefits 2010 Delivery Reforms 2011-2014 Coverage Expansions 2014-2017 11

12. 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

13. 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

14. Key Medicaid Reform Proposals Proposal Simpson- Bowles White House 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√

15. The “Fiscal Cliff” 15

16. The Next Six Months 25 Day Lame Duck Session Debt Limit Vote Expiring Tax Cuts, etc. Sequester 16

17. THANK YOU Billy Wynne Senior Vice President & Principal Health Policy Source, Inc. bwynne@healthpolicysource.com