1. A Roadmap for Achievable Health Care Reform Karen Ignagni President and CEO America’s Health Insurance Plans November 13, 2007

2. Access Challenges Uninsured Trends Source: Income, Poverty, and Health Insurance Coverage in the United States: 2005, Census Bureau.

3. Bumps in the Road: Quality Gaps  Evidence Based Medicine: Immediate Improvements Necessary  Results of Studies on the Adoption of Evidence Based Medicine 24% Diabetics who received recommended blood-sugar tests over a 2-year period 65%Hypertensive patients who received recommended care 68% Patients with coronary artery disease who received recommended care 45% Patients with myocardial infarction who received beta- blockers 64%Elderly patients who received or were offered a Pneumococcal vaccine Source: America’s Health Insurance Plans Issue Brief: Making Evidence-Based Medicine The Cornerstone of the U.S. Health Care System

4. Source: Congressional Budget Office Analysis of Medicare Spending Based Upon the Dartmouth Atlas Quality Challenges Variation in Medical Practice

5. Trends How Rising Costs Affect Coverage Source for Premiums and Expenditures: Centers for Medicare and Medicaid Services, National Health Expenditures by Type of Service and Source of Funds. Source for uninsured: U.S. Census Bureau. Uninsured Rate National Health Expenditures Private Health Insurance Premiums

6. Sources: NIH Data Book; Research!America, Investment in U.S. Health Research 2001, 2002, 2004 and 2005 Cost Challenges Technology Spending

7. Source: The Factors Fueling Rising Healthcare Costs 2006; PricewaterhouseCoopers; 2006 Cost Challenges Cost and Utilization of Care Drive Premium Growth

8. Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October 2007 Why is U.S. Health Care Spending So High Compared to Other Nations?

9. Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October 2007 Why is U.S. Health Care Spending So High Compared to Other Nations?

10. What We Have Proposed Addressing Access SCHIP up to 200% FPL Medicaid up to 100% FPL Child Health Credit up to 300% FPL Universal Health Account with subsidies up to 400% FPL State Performance Grant

11. What Voters Think of These Proposals Question: Now I am going to read some different ideas that some people have proposed for providing health care coverage for people who are currently uninsured. Would you please tell me if you support or oppose each idea. Question: Now I am going to read some different ideas that some people have proposed for providing health care coverage for people who are currently uninsured. Would you please tell me if you support or oppose each idea. Giving a federal tax credit to low and moderate income parents Increasing funding for health insurance program for children Providing grants from the federal government Having the federal government match contributions Giving federal tax deduction for purchase of private insurance Expanding the federal government’s Medicaid program Establishing a tax-free Health Account for all Americans Ranked by Percent “Support” 83% 65% 63% 75% 54% 66% 59% 88% 89% 77% 68% 82% 65% 82% 83% 75% 67% 69% 67% 64% 69% RepIndDem

12.  Create a new entity for comparative effectiveness  Set a national research agenda to address gaps in evidence  Accelerate efforts to give patients and their physicians the necessary information to make value-based decisions  Emphasize the adoption of best practices  Develop innovative tools to help physicians and patients manage chronic conditions  Create a new medical dispute resolution system to resolve disputes fast, fairly, and effectively What We Have Proposed Addressing Quality

13.  Disease management, care coordination and prevention programs  Pay for performance  Investments in health information technology  More information regarding the cost and quality of care  Consideration of a reinsurance program to help pay for experimental therapies to make emerging therapies more accessible  Medical liability reform What We Have Proposed Addressing Costs

14.  The challenges are palpable to the public  Health care is number one domestic policy issue among voters  Solutions must appeal to red, blue and purple electorate  Must address costs, quality and access together to enact effective reform Conclusion