HSA 3111 - CH 2

Changes to ACA in the new administration

1.Elimination of individual mandate 2.Work requirement for Medicaid 3.Availability of "skimpy" insurance plans 4.Subsidies to insurers ended 5.Funds for healthcare.gov navigators cut

US Opposition to National Health Care

Main reasons proposals favoring a national health care system have historically been defeated in the United States 1.No political threats 2.US: constitutionally designed as a decentralized decision-making system of governance with a clear preference against strong central authority (Federalism) 3.Anti-German sentiment during WWI made it difficult to advocate for the German model of national health insurance 4.Unlike other nations, US developed a private sector of health care delivery & financing system 5.Influence of the medical profession 6.Historical opposition from labor unions 7. Beliefs and values of the American middle class 8.Tax aversion

2015 OECD Life Expectancy by Gender and Age 65

•83.1 years for women; 77.9 years for men. •U.S. men: 76.3 years, close to the OECD men's average. •U.S. women: 81.2 years, close to the OECD women's average. •OECD average of years of life at 65 is 19.5 years. •U.S. similar to the OECD average of 19.3. •France, Japan, and Spain exceeded the average.

Four components of healthcare

•Financing •Delivery •Insurance •Payment

ACA Health Insurance Marketplaces

•States would establish health insurance marketplaces so consumers can shop and compare prices for health insurance. •If states did not operate their own website, the citizens could use the healthcare.gov website established by the federal government. •Huge problems with its initial operation. Low enrollment in October, November, December. Huge overhaul of the website. •Enrollment has since increased. Approximately 14 million now have insurance. •Insurance plans must now offer a Summary of Benefits so consumers can compare health insurance plans •Insurance plans must offer essential health benefits such as outpatient services, emergency services, laboratory services, preventive services, prescription drugs •Fines are levied if individuals do not purchase health insurance

Types of Healthcare Systems

•Entirely private •Multi-Payer or Mixed •National (single-payer)

ACA

•Establishment of www.healthcare.gov for consumers to access information about healthcare insurance. •This Health Insurance Marketplace was unveiled on October 1, 2013 so insurance enrollment could begin during open enrollment. Ends on March 31st: It did not work, resulting in a huge controversy •Create a reinsurance program for retirees who are not yet eligible for Medicare •Would end when the Marketplaces opened on October 1st

Measuring outcomes: The importance of statistics

•Statistics are calculated to assess healthcare services in the U.S. •National Center for Health Statistics (CDC) produces an annual report on the health of the nation. •Life expectancy and infant mortality rates are calculated to assess health of nation. •Statistics are calculated to assess healthcare services in the U.S. •National Center for Health Statistics (CDC) produces an annual report on the health of the nation. •Healthcare access has a direct correlation between having healthcare insurance and visiting a provider. •Measures of uninsured and underinsured statistics are calculated to assess WHAT?

What do you know about the Patient Protection and Affordable Care Act?

•The ACA requires most U.S. citizens and legal residents to purchase health insurance if they can afford it or pay a penalty. •The ACA mandates that every state create a consumer-oriented marketplace where individuals are provided information and can purchase healthcare insurance. •The ACA bans health plans from establishing lifetime dollar limits on healthcare insurance reimbursement.

U.S. Values that have shaped our health care system

•The advancement of science •Reliance on the medical model •A champion of capitalism •industries are controlled by private owners for profit •An economic good •Entrepreneurial spirit and self determination •A concern for the underprivileged poor, elderly, disabled •Free enterprise and distrust of government

2015 OECD Statistical Highlights:Infant Mortality Rates

•The average OECD infant mortality rate is 3.9. •The U.S. rate is 5.8: •Higher than the OECD average. •Varies by state: Mississippi is 9.3, and New Hampshire is 4.2. •If we have the most expensive healthcare system in the world, why is the U.S. statistic higher than the OECD average?

Gross Domestic Product

•What is it? The percentage of products or services produced within a country's borders. •In 2017, the U.S. spent 17.9% of its GDP on health care, the highest percentage of the 35 OECD members. •If we spend the most, shouldn't our statistics be the best of the OECD?

Health Indicators in statistics

•such as infant mortality rates, average life expectancy, and health risk behaviors are used to evaluate the health status of a population

Failure of a National Health Care System

Repeated attempts to create a national health care system in the U.S. •1914 - workers compensation - could have served as a model & been expanded beyond worker injuries but private health insurance developed instead •1917 - The American Association of Labor Legislation attempted to expand its social agenda by advocating national health insurance •1935 - during Roosevelt administration, bills on national health insurance introduced in Congress but failed to pass •On November 19, 1945, seven months into his presidency, Truman sent a message to Congress, calling for creation of a national health insurance fund, open to all Americans. •The plan Truman envisioned would provide health coverage to individuals, paying for such typical expenses as doctor visits, hospital visits, laboratory services, dental care and nursing services. •President John F. Kennedy made his own unsuccessful push for a national health care program for seniors after a national study showed that 56 percent of Americans over the age of 65 were not covered by health insurance. •The Clinton Health Plan (Health Security Act of 1994) -> new series of state run agencies called health care alliances which contract with providers for a set package of benefits for enrollees - HMO, PPO, & fee for service available ->Mandated that almost all business (large & small) participate in new system

2015 OECD Statistical Highlights Life Expectancy Rates

•Average life expectancy in OECD countries is 80.6 years. •Japan, Spain, and Switzerland have the highest life expectancy rates of 83.9 years, 83 years, and 82.9 years, respectively. •Lowest is South Africa at 57.4 years. •U.S. average is 78.8 years. Why isn't the U.S. first in life expectancy? •Life expectancy rates are a measurement of mortality for a designated age group in a particular year. Gender has an impact on life expectancy. •Life expectancy is calculated at birth, by ethnicity, age 65, and gender.

ACA Major Provisions

•Eliminate lifetime and unreasonable annual caps or limits on healthcare reimbursement with annual limitations prohibited by 2014. •Provide assistance for the uninsured with pre-existing conditions and prohibit denial of insurance coverage for pre-existing conditions for children. •Develop a temporary national high-risk pool for health insurance for individuals with preexisting conditions who have no insurance. •This ended with the opening of the Health Insurance Marketplaces on October 1, 2013 Extend dependent coverage up to age 26.

Who are Stakeholders?

•Employers consist of both private and public employers. The healthcare industry is the largest U.S. employer. •Hospitals, Nursing and Residential Care Facilities •Physicians and Other Healthcare Practitioners •Home Healthcare Services •Outpatient Care Centers and Ambulatory Healthcare Services

International Healthcare Statistics

•Established in 1961, the Organisation for Economic Co-Operation and Development collects economic and social data worldwide and monitors trends of economic development. •There are currently 35 countries, including the United States, that are members of this organization. •OECD

US access to healthcare statistics

•Health insurance = healthcare access. •Uninsured rates have dropped over 10% since ACA

Stakeholder Perspective

•In the US, in order to provide healthcare services, there are several stakeholders or interested entities that participate in the industry. •From an organizational perspective, the consumer is the most important stakeholder for an organization. •The main group of consumers comprises patients who need healthcare services either from a physician, hospital, or outpatient facility.

OECD Statistical Highlights Infant Mortality Rates

•Infant mortality rates are calculated as a comparison measure of country health status. •According to the OECD, the infant mortality rate is the number of deaths per 1,000 live births occurring among the population of a designated area during the same calendar year.

Life expectancy

•Life expectancy rates are calculated to assess health of nation. •Calculated by gender and ethnicity. •Used internationally as a comparison between nations health status.

2016 Health Expenditures Per Capita and Access to Clinicians

•OECD average health expenditure per capita: $3,500. •U.S. spends $9,892 per person. •Switzerland, $7,919; Luxembourg, $7643. •Practicing doctors per 1,000 population: •OECD average is 3.4. •U.S. rate is 2.6. Varies by geography. •Nurses per 1,000 population: •OECD average is 9. •U.S. rate is 11.3. •More access to clinicians, better health.

2017 OECD Statistical Highlights:Tobacco, Alcohol and Obesity Rates

•OECD average percentage of population who smokes daily: 18.4%. •U.S. has one of the lowest tobacco smoking rates of the OECD countries: 11.4%. •OECD average use of alcohol is 2.4 gallons consumer in 1 year. •U.S. is close to this average. •Obesity is classified as an individual with a body mass index greater than 30. Average OECD rate is 19.4% of the population.

Obesity Rates

•Obesity rate has increased in most OECD countries. •U.S. has one of the highest obesity rates of OECD countries at 38.2% •Japan's rate is 3.7%. •Obesity is a risk factor for heart disease, diabetes, and cancer. •Obesity has become a global public health issue.

Healthcare Reform

•Remember the Iron Triangle? All health care policy concerns a balance between these three essential qualities. •The Affordable Care Act is not the first attempt at reforming health care. •U.S. citizens have taken issue with our health system for decades. •WHAT DO YOU FEEL SOME OF THE PROBLEMS HAVE BEEN?

ACA

•Signed into law in March 2010 •Divisive landmark legislation •Lawsuits against the federal government •The focus is access, quality and cost containment of healthcare •Nearly 50 initiatives implemented over several years •Issues with the implementation of the individual insurance mandate effective January 1, 2014 •Federal website did not work; millions could not enroll in a healthcare plan.