1. 1 HEALTH CARE REFORM – Implications for Patients Kenneth W. Kizer, MD, MPH Alaska State Hospital and Nursing Home Association Fairbanks, AK September 7, 2010

2. 2 Presentation Objective To consider some of the implications of health care reform for patients.

3. 3 Implications for Patients Will Depend Primarily On: 1.If you do not have health insurance 2.If you have health insurance, who is your insurer 3.Who you work for 4.What are your health care needs 5.Where you live 6.What is your income

4. 4 Other Factors That Will Shape PPACA’s Implications for Patients 1.The economy in general 2.The capacity to accommodate the influx of newly insured persons 3.How private insurers respond to the new rules 4.How providers respond to the changes in reimbursement 5.The ability of providers to access capital to pay for infrastructure needs 6.Additional legislative changes

5. 5 If You Do Not Have Health Insurance   All individuals required to have “minimum essential coverage” by 2014 or are subject to penalties   Increased insurance availability through state exchanges   Tax credits and cost sharing measures are available on a sliding scale based on family size and income (133% to 400% FPL)   Early retiree reinsurance and a voluntary program for insurance for community living assistance services will be available through employers   Specified exceptions to the mandate

6. 6 If You Have Health Insurance, Who is Your Insurer   Persons who maintain qualified coverage are considered to meet the individual requirement   Having a government-sponsored plan (e.g., VA, Medicare, Medicaid, DoD/TRICARE, IHS) will meet the individual mandate   Government-sponsored plans are not materially affected, but there will be indirect effects resulting from changes in reimbursement and other things   Indeterminate effects on private plan offerings resulting from the changes in insurance practices, but a high likelihood that there will be effects   Greater attention will be focused on coordination of benefits

7. 7 Who You Work For   Will depend on what your employer does to offer insurance   Tax credits available for small businesses   The state of the economy

8. 8 What Are Your Health Care Needs   Increased availability of information about coverage and quality of care   Increased provider attention on quality and coordination of care   Increased coverage for and availability of disease prevention and health promotion services   Increased availability of home care and community services and supports, as well as long term care insurance   Indeterminate and variable effects resulting from expected increased demand for services and local care capacity constraints, transportation, etc.

9. 9 Where You Live   Indeterminate and variable effects depending on availability of caregivers, health care facilities, medical culture, Medicare and Medicaid payment rates, the local economy and other factors   High likelihood of unplanned events and unintended consequences occurring somewhere   In the aggregate, probably good for rural communities

10. 10 What is Your Income   Tax credits and cost sharing measures are available on a sliding scale based on family size and income (133% to 400% FPL)   An increase in Medicare payroll taxes for individuals with earned income over $200,000, $250,000 for families (effective 2013)   A 40-percent nondeductible excise tax on coverage plans above a high-dollar threshold (effective 2018)

11. 11 Overall, health care reform will have considerable and generally positive effects on patients, many of which will not manifest for several years as the legislation is implemented, but as is always the case for complex adaptive systems, there will be unplanned occurrences and unintended consequences