1. Health Reform: Why, What, How … Liz Baxter May 18, 2013 liz@wecandobetter.org

6. Total Expenditure of Health as Share of U.S. GDP Current Projected Source: Organization for Economic Co-Operation and Development, OECD Health Data, Feb 2011; U.S. Congressional Budget Office, The Long-Term Budget Outlook, June 2010, p. 42 %

7. Medicare & Medicaid Spending U.S. Nondefense Discretionary Spending Billions

12. What Influences Overall Lifetime Health Status? Source: McGinnis J.M., Williams-Russo, P., Knickman, J.R. (2002). Health Affairs, 21(2), 83 Lifestyle & Behavior 40% Human Biology 30% Medical Care 10% Environmental Factors 5% Environmental Factors 5% Social Factors 15%

16. IJFALTIJ CABF RFFQPM

19. The Triple Aim ①Improved Health ②Lower Cost ③Better Experience of Care

20. Traditional Approach to Balancing Budgets Cut reimbursement Cut services Cut people

21. Major Elements of Reform Expansion of Medicaid eligibility Delivery System Reform Health Insurance Exchange

22. Medicaid Expansion Traditional Medicaid State and federal partnership Oregon Health Plan Raising Income Eligibility

23. Oregon Health Plan 50% of babies born in Oregon 16% of Oregonians 85% of Oregon providers 11% percent of total state budget 40% are people of color 23

24. OR: Changing How Care is Delivered Coordinated Care Organizations (CCOs) Reduce waste Accountable for health outcomes Local decision-making Align financial incentives Create fiscal sustainability Reduce disparities Better coordination of care

25. Health Insurance Exchange Created by OR Legislature in 2011 Public Corporation 9 member board of directors State option under Affordable Care Act Cover Oregon (coveroregon.com)

26. Mission of Cover Oregon Improving the health of all Oregonians by providing health coverage options, increasing access to information, and fostering quality and value in the health care system

27. ONE HOUSE ONE DOOR Individuals and Families Small Employers

28. INFORMED DECISIONS ABOUT PREMIUMS VS. COPAYS

29. No one can be denied, no lifetime limits Carriers must spend 80% of premiums on care Health plans held accountable for quality Essential health benefits:  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Mental health and substance use disorder services, including behavioral health treatment NEW HEALTH COVERAGE RULES  Prescription drugs  Rehabilitative and habilitative services and devices  Laboratory services  Preventive and wellness services, and chronic disease management  Pediatric services, including oral and vision care

30. HOW WILL COVER OREGON AFFECT ME?

31. ELIGIBILITY FOR FINANCIAL ASSISTANCE

32. Carrier A Carrier B Carrier C Carrier D Platinum$400$395$450$420 Gold$375 $400$380 Silver$350$330$380$340 Bronze$325$300$340$320 Carrier A Carrier B Carrier C Carrier D Platinum$400$395$450$420 Gold$375 $400$380 Silver$350$330$380$340 Bronze$325$300$340$320 Carrier A Carrier B Carrier C Carrier D Platinum$400$395$450$420 Gold$375 $400$380 Silver$350$330$380$340 Bronze$325$300$340$320 Carrier A Carrier B Carrier C Carrier D Platinum$400$395$450$420 Gold$375 $400$380 Silver$350$330$380$340 Bronze$325$300$340$320 Traditional ChoiceCarrier Choice Metal Tier Choice Broad Choice

33. LONG-TERM VISION Larger employers Additional products Coordinated care models Quality and value Buying power

35. The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease. --Thomas Alva Edison

38. Thank You Liz@wecandobetter.org Healthreform.kff.org Health.Oregon.gov Oregon.gov/oha/oei/ CoverOregon.com