Grace-Marie Turner's May 8, 2013 presentation to the PNC HealthCare 2013 Spring Healthcare Advisory Panel.

1. A not-for-profit
health and tax policy
research organization
/GalenInstitute
www.galen.org
Update on
Health Reform
Grace-Marie Turner
May 8, 2013
PNC HealthCare
2013 Spring Healthcare Advisory Board
Philadelphia

2. Americans agreed on goals for health reform…
• The U.S. needs health reform to:
– make coverage more affordable
– assure quality, and
– expand access to insurance
• Most people rate their own coverage as
good or excellent
• They want stability. Change was for
others.
www.galen.org

3. but many say the ACA changes too much
• 36% of Americans now view the
Affordable Care Act favorably
• 42% view the law unfavorably
• Cost continues to be the biggest
concern
www.galen.org
Kaiser Health Tracking Poll, February 2013. http://www.kff.org/kaiserpolls/upload/8251-F.pdf

9. www.galen.org

10. Americans’ views of health law
after Supreme Court decision
• Americans say it will make things worse rather
than better for
– taxpayers
– businesses
– doctors
– and those who currently have health insurance.
Sources: “Americans: Healthcare Law Helps Some, Hurts Others ,” Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-
Helps-Hurts-Others.aspx?utm_source=add%2Bthis&utm_medium=addthis.com&utm_campaign=sharing#.UARkmBS6osE.twitter. The New York Times/CBS
News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. “Kaiser Health Tracking Poll,” The Kaiser Family Foundation, July
2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf

11. Why the ACA isn’t settled
 38% of Americans supported the law in the
last major poll before the November elections
 Of the 50.6% who voted for President
Obama…
12% said they wanted the law repealed
The election was not about health reform
Source: “Kaiser Health Tracking Poll: October 2012,” The Henry J. Kaiser Family Foundation, October 31, 2012,
http://www.kff.org/kaiserpolls/8381.cfm.

12. NOTE: Don’t know/Refused answers not shown.
SOURCE: Kaiser Family Foundation Health Tracking Poll (conducted March 5-10, 2013)
Majority Say They Don’t Understand How
ACA Will Impact Them, Including Two-
Thirds of Uninsured and Low-Income
Do you feel you have enough information about the health reform law to understand how it will impact you
personally, or not?
30%
33%
41%
68%
67%
57%
Household income less
than $40,000
Uninsured (under age 65)
Total
Yes, have enough information No, do not have enough information

14. Source: Avik Roy, “Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,” Forbes: The Apothecary, August 16, 2012,
http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.
The health law in one graph

16. The paperwork maze
Courtesy of The Wall Street Journal at www.opinionjournal.com

17. Source: Sarah Kliff, “Is ObamaCare too much work for the Obama administration?” The Washington Post, November 12, 2012,
http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/.
An ACA State Exchange

18. Do you qualify for subsidies?
Source: Sen. John Cornyn, Facebook, March 22, 2013,
http://www.facebook.com/photo.php?fbid=10151499130834424&set=a.112318184423.92543.75755694423&type=3&l=83fcd3ca01&permPage=1

19. The Red Tape Tower

20. Source: “Health Reform Poses Biggest Challenges to Companies with the Most Part-Time and Low-Paid Employees,” Mercer LLC, August 8, 2012,
http://www.mercer.com/press-releases/1472805.
Mercer: Employers planning workforce changes
w Mercer study on what employers expect

21. SCOTUS Success
Boot Camp
Employers and health coverage
1. Employers with <50 FTE EE’s have no
3k/2k penalty
2. But employers offering qualified and
affordable coverage may actually be
hurting their employees
Example

22. Generous Subsidies in
ExchangesExamples:
• A person earning $42,000 a year with a family
of 4 qualifies for $14,759 in new health
insurance subsidies
• A single person earning $20,600 qualifies for
$5,156 in new health insurance subsidies
But only if employer doesn’t offer coverage or if
it’s not “affordable” (ie costs >9.5% of income)
www.galen.org

23. Cost of Insurance, Family of 4

24. Impact of new rating rules
James T. O’Connor, Milliman, for America’s Health Insurance Plans. Comprehensive Assessment of ACA Factors That Will Affect Individual Market
Premiums in 2014. http://www.ahip.org/MillimanReportACA2013/ Accessed 4-26-13

26. New and higher Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

27. More new and higher Taxes
Source: Philip Dittmer and William McBride, “Obamacare's New Taxes, And How You May Be Affected,” Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

28. www.galen.org
Some realities:

29. What we know for sure
• CHOICE: Americans value innovation,
diversity and choice to accommodate 300
million people
• VALUE IN HEALTH SPENDING: To realize
the promise of personalized medicine and
achieve overall cost saving, break down
payment silos
• FOCUS ON THE PATIENT: They want
doctors and patients, not government, to
make health care decisions

30. A market-based solution
“Defined contributions” for health coverage
A system that puts doctors and patients in charge of
medical decisions
Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance

31. States have a big role
Seek ways improve their markets
• Enhance competition for more choices of
affordable coverage
• Better safety net with functional high-risk
pools
• Private exchanges?
www.galen.org

32. www.galen.org
Health insurance market

33. 2013 questions
• Will Exchanges be ready by Oct 1?
• Will there be bi-partisan support for delay?
• Will people enroll after they see cost?
• Will the number of uninsured be higher as
people understand guaranteed issue?
• Will private exchanges fill a market need?
www.galen.org

34. Europeans moving toward
patient-centered care/decentralization
• Consumerism
• Value of private enterprise
and competition
• Doctor-patient relationship
• Decentralized
decision-making
www.galen.org

35. The future?
• The global move toward
consumerism is real, driven
by greater patient demand
for more control over
decisions.
• People will seek more
affordable options outside
the ACA’s centralized
control.

36. A not-for-profit
health and tax policy
research organization
/GalenInstitute
www.galen.org
Grace-Marie Turner
Galen Institute
703-299-8900
gracemarie@galen.org
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