Join Business Forward to welcome Arielle Kane, Director of Health Care at the Progressive Policy Institute, for a discussion on the current state of health care access in America. Kane will discuss how improvements to the ACA are more beneficial than repealing the law and moving to a single-payer system.

1. 1
Health care update
Arielle Kane, Director of Health Care at
Progressive Policy Institute

2. 2
Health care to be a top issue in the 2018 midterms
Forces on the current health care market
Health care system
in America
• Democrats poll better on
health care
−Drawing attention to candidates
who voted against protections
for preexisting conditions
−Some calling for “Medicare-for-
all” as a solution
−Disagreement over how best to
solve ongoing woes
• Costs
−Still high out of pocket costs for
many in the individual market
−Medicare/Medicaid costs remain
a concern to lawmakers
−Employers bear large portion of
health care costs
• Businesses are concerned
about health care turmoil
−Don’t want “Medicare-for-all”
−Health care industry is
worried about government
price setting
• Trump administration
−Repeal of the individual mandate
−Stops cost sharing reduction
payments
−Allowing the sale of short term
health plans for up to one year
−Lawsuit challenging the legality of
the ACA in the absence of the
individual mandate

3. 3
After years of turmoil, premiums are stabilizing, but some still slip through the cracks
The ACA is working
Average premiums
fell 1.5 percent for
2019
Insurance companies
increased prices year
after year and finally
have priced them
accurate for the
individual market
population
But premiums are still
high
The average monthly
premium for a mid-level
“silver” plan under the
ACA will be $406 in
2019—69 percent higher
than the average
premium just three
years ago
Those ineligible for
subsidies may not be able
to afford coverage
Those above 400 percent of
the federal poverty level are
ineligible for subsidies, about
6.7 million people. A married
couple in their 50s can easily
pay $25,000 per year in
premiums alone.
Source: 1. https://www.cms.gov/sites/drupal/files/2018-10/10-11-18%20Average%20Monthly%20Premiums%20for%20SLCSP%20and%20LCP%202016-2019_0.pdf 2.
https://finance.yahoo.com/news/obamacare-finally-working-republicans-still-want-kill-125728257.html?ncid=twitter_yfsocialtw_l1gbd0noiom 3. https://finance.yahoo.com/news/health-care-costs-still-crushing-
problem-170955821.html

4. 4
A short history of the Affordable Care Act (ACA)
History
2010
Uninsured
rate: 18.8
percent
Uninsured
rate 12.5
percent of
non-elderly
ACAissigned
intolaw
SCupholdsmajor
provisionsofACA
Healthcare.gov
goeslive
SCrulesfederal
governmentcanprovide
subsidiesforstates
withoutexchanges
PresidentTrumpis
elected
Thegovernment
ceasesCSRpayments
Theindividual
mandateis
repealed
2012 2013 2015 2016 2017 2018
Reasons for remaining
uninsured:
• The cost of health care is still too high
• Immigration Status – undocumented
immigrants are ineligible for Medicaid and for
legal immigrants are only eligible for Medicaid 5
years after receiving qualified immigration
status
Sources: 1. https://www.census.gov/prod/2010pubs/p60-238.pdf 2.
https://www.cdc.gov/nchs/data/nhis/earlyrelease/Insur201808.pdf 3.
http://affordablehealthca.com/timeline-obamacare/ 4.
https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline-affordable-care-act-aca
https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

5. 5
Efforts to undo the ACA
Timeline of recent health care policy decisions
January
2018
Repeal of the
individual
mandate
goes into
effect
August 2018
Administration
approves sale of
“junk” insurance
November
2018
Administration
shortens
enrollment
period and
education and
outreach
October
2017
Ceasing cost
sharing
reduction
payments
February 2018
Lawsuit challenges
constitutionality of
ACA without the
individual
mandate
November
2018
Midterm
elections
July 2017
Sen. John McCain
joins Sens. Susan
Collins and Lisa
Murcowski to
reject ACA repeal
August 2018
Administration
joins lawsuit

6. 6
Medicaid expansion states – a two tiered system
FL
NM
DE
MD
TX
OK
KS
NE
SD
NDMT
WY
CO
UT
ID
AZ
NV
WA
CA
OR
KY
ME
NY
PA
MI
VT
NH
MA
RI
CT
VA
WV
OH
INIL
NC
TN
SC
ALMS
AR
LA
MO
IA
MN
WI
NJ
GA
DC
AK
HI
Expanded
Considering
expansion
Not yet
expanded
Source: https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
There will continue to be debate around Medicaid expansion – work requirements, etc.
– for the next several years

7. 7
In 2018, the annual Kaiser Family Foundation Employer Health Benefits Survey found
the average annual premium for coverage rose 3 percent to $6,896 for an individual
and the average annual premium for family rose 5 percent to $19,616
Employer market: Modest premium growth in 2018 but higher worker contributions
Wages increases are absorbed into health care:
Workers’ wages increased 2.6 percent and inflation
increased 2.5 percent over the past year
Costs are going up: The average premium for
family coverage has increased 20 percent since 2013
and 55 percent since 2008
More expensive at small firms: Workers in small
firms contribute a higher percentage of premiums for
family coverage (38 vs. 26 percent in large firms).
27 percent of workers in small firms are in a plan
where the employer pays the entire premium for
single coverage, compared to 6 percent of covered
workers in large firms.
Source: https://www.kff.org/report-section/2018-employer-health-benefits-survey-summary-of-findings/

8. 8
Health care costs continue to consume a large portion of wages and taxes
Costs
$10,348 $3.3t
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

9. 9
Improving and building upon the ACA will reduce the demand for a government
solution
What can be improved?
Individual market
Greater premium subsidies,
reinsurance, individual
mandate, etc.
02
01
Reinsurance
A permanent reinsurance
program would help bring down
costs and encourage insurer
participation in the individual
market
04
03
05
06
Drug pricing
Better align incentives in the
system to encourage value
and increase transparency in
the PBM sector
Innovation
Health care is a very labor
intensive industry; increasing
and encouraging innovation to
make it easier to deliver and
access care can help bring
down overall costs
Health care costs
Out of pocket costs are still
too high for many
Helping those on the margins
The reality is, while the health care
system works well for a majority of
people, some slip through the
cracks