LinkedIn emplea cookies para mejorar la funcionalidad y el rendimiento de nuestro sitio web, así como para ofrecer publicidad relevante. Si continúas navegando por ese sitio web, aceptas el uso de cookies. Consulta nuestras Condiciones de uso y nuestra Política de privacidad para más información.
LinkedIn emplea cookies para mejorar la funcionalidad y el rendimiento de nuestro sitio web, así como para ofrecer publicidad relevante. Si continúas navegando por ese sitio web, aceptas el uso de cookies. Consulta nuestra Política de privacidad y nuestras Condiciones de uso para más información.
Guide to Health Care Reform
Insurance Reform Option
By Rep. Jim Cooper, July 8, 2009
Get the same health
care as your Congressman
Agreement on the “dog”
• Near-community rating
• Guaranteed issue and renewability
• Large risk pools
• Modernize employer-based insurance
• Shared responsibility for coverage
• Everyone gets more health insurance choices
• Purchase of private insurance should not be
included in federal budget
Why not offer large-group
coverage by state or region?
Everyone is invited to the party and
they wait on you, hand and foot
to serve your needs,
unlike their old attitudes.
Three figments of your imagination:
Tooth Fairy Easter Bunny Boss Claus
There is no such thing as employer-paid
The boss picks, but employees pay…
…by means of foregone pay raises.
The employer system was caused by a historical
accident in 1942
Side-effect of WWII wage & price controls;
never clearly ratified by Congress
Uncle Sam tried to keep lid on…
… but employers outbid
each other to get good
workers. They offered
“free” health and life
insurance and other
Median cash wages have flat-lined for decades
… Sucked up by employer-sponsored fringe
benefits, mainly by health care
Lost pay raises are to health care like oxygen to
a jet engine
2009 pay raise 2009 insurance
2010 pay raise 2010 insurance
2011 pay raise 2011 benefits
We must slow down
health care spending by at least 1%!
Current 3.54 3.76
Trillion of Dollars
$3.0 2.89 3.15
2.7 2.97 Trends under a reformed system
2.32 HAA creates ten-year savings = $1.48 Trillion (4.5%)
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Lewin Group, Cost and Coverage Estimates for the “Healthy Americans Act,” Dec. 12, 2006
Portability: a good set of luggage
You know you can take your insurance coverage with you
Paying for reform
• Decision: New taxes or savings from system?
– Wasting $700 billion annually, so don’t need taxes
– New taxes would add fuel to fire
• Target: $250 billion health insurance tax break
– Unlimited exclusion for employees
– Benefits highest-paid workers at largest firms
– By far the biggest pool of savings for reform
How to “Cap” the Tax Break
• Slow the growth of the tax break for workers
– Soft cap at level above today’s health benefits
• $15,000 or 90th percentile benefits?
• Grandfather union health benefits? High-cost regions?
• Workers understand total cost of benefits; start to shop
– Grow cap with inflation, but not inflation plus
• CPI not medical cost index
• 1% reduction in growth solves 2/3 of entitlement issues
– No fixed cap or freeze; raises $410 billion over 10
• No one is “cut” – ratchets down growth rates
Why not convert boss’ benefits to cash?
Like Healthy Americans Act does?
Some Transition Issues
• Size of exchanges
– Surely “multiple competing exchanges” is a non-starter
– Micro-businesses of 2-10 employees too small
• Exchanges lack bargaining power, scale
• Would help with primary care physician shortage
– Ideally firms with 1,000 or fewer employees join
• Exchanges large enough, but threatens existing coverage?
– Compromise at 200?
• Expand employee choices
– Most workers today get only 1 or 2 choices
– Minimum 3 options?
1st Senate Bill
• Subsidizes up to
400% of poverty
• Income of $88,000 for
family of four
• New disability
• Expensive employer
Senate Finance Proposal
• Leaves insurance
• 7.5x premium
• 100% federal
Medicaid thru 2016
for new populations
• Eliminates wait for
– Buy-in at 55
Omiting Medicaid reform?
• 2nd Class medical care?
– Low reimbursement
– 2/3 doctors shun
– Wide variation between
– Dominating most state
• Long-term care, end-of
life issues ignored
House Tri-Committee bill
-Partial bill –
-no discussion of Pay-Fors or
scoring by Congressional
-National exchange – how to
implement in different regions?
-Subsidize up to 400% FPL
-Weak on delivery system reforms
Healthy Americans Act
• Covers everyone
• No new taxes
• Scored by CBO
• Fits Obama’s 8
The perfect breed?
Guarda las diapositivas más importantes con los recortes.
Los recortes son una forma práctica de recopilar y organizar las diapositivas más importantes de una presentación. Puedes guardar tus magníficos descubrimientos en tableros de recortes organizados por temas.