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What’s coming and what it means for medical practice

Grace-Marie TurnerNovember 16, 2012Southern Medical Association

Americans’ views on the law

• Americans say the health law will make things worse rather than better for taxpayers, businesses, doctors, and those who currently have health insurance.

• Opposition to the law remains as high as it was when the law was enacted.

• Three more states passed ballot initiatives to block the individual mandate – AL, WY, MT

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

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 wanted stability. Change was for others.

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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/.

Taxes and spending in ObamaCare

Generous Subsidies in Exchanges

Examples:

• 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” (costs >9.5% of income)

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Two issues:Taxes. Trust.

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ObamaCare’s New 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.

More ObamaCare 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.

The law fails to meet goals• Health costs and health spending increase

• One-third of businesses may drop insurance

• Young people worried about high cost of policies

• Doctors concerned about Medicaid expansion and fraying the safety net

• Seniors worried about rationing of care and finding a doctor who takes Medicare

• 30 million will remain uninsured -- CBO

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Some realities

Source: Frank Hill, “The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,” Telemachus, July 22, 2012, http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.

The AMA and practicing physicians

• The SGR Medicare payment fix was its key bargaining chip

• The chance for a permanent fix is missed; the president got the AMA endorsement for an empty promise

• Pleas for short-term fixes are likely to continue indefinitely

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The Doctors Co. Survey:– 60% say increased patient volume will

hurt the level of care they can provide

– 43% said they are thinking about retiring in the next five years

– Nine out of ten said they would discourage friends and family members from pursuing a career in medicine

http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671www.galen.org

Physician concerns

• Questions about Accountable Care Organizations

• Authority of HHS Secretary to set new rules for quality of care

• Regulatory requirements impacting private medical practices

• More burdensome record-keeping

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Specific changes to watch

• IPAB — the Independent Payment Advisory Board

• Patient-Centered Outcomes Research Institute and comparative effectiveness “guidelines”

• Physician Quality Reporting Initiative

• Value-based Payment Modifier

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CRS previews impact of health law on physicians

Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, “Medicare Provisions in the Patient Protection and Affordable Care Act, (PPACA): Summary and Timeline,” November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.

PPACA has the potential to change fundamental aspects of how physicians organize, practice, and deliver care in the future.

• Some of these provisions create new structures and entities, like the CMS Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute

• Others seek to develop alternatives to traditional fee-for-service payment, such as the National Pilot Program on Payment Bundling, the shared savings program (including the accountable care organization, or ACO, model), or the value-based payment modifier under the physician fee schedule

In the long run, these provisions combined have the potential to be the most substantial of the PPACA and the Reconciliation Act modifications affecting physicians and related providers.

Health care in 2013

• LegislationSearching for bi-partisan support for fixes; hearings to highlight problems and successes

• Regulation13,000+ pages so far, and they’ve only begun!

• LegalAt least new 35 court challenges proceed

…and the battle over the doc fix continues

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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

• Targeted subsidies for the uninsured

• Portable insurance, equal tax treatment

• More functional high-risk pools• Cutting Medicaid’s red tape

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Even Europeans going the other way

• Consumerism

• Value of private enterprise and competition

• Doctor-patient relationship

• Decentralized decision-making

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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

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The future?

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• The global move toward consumerism is real, driven by greater patient demand for more control over decisions.

• Physicians will find new and creative ways to deliver patient care outside the ACA’s centralized control.

Search for your opportunities!

Why ObamaCare Is Wrong for America

How does the health care law drive up costs?

Is your doctor really in charge of your health care decisions?

Are your Constitutional rights threatened?

Discover the law’s impact on

your life in a new book from four nationally recognized health policy experts

Published by Broadside Books, an imprint of HarperCollins

www.WrongForAmericaBook.com

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A not-for-profit health and tax policy research organization

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Grace-Marie Turner

Galen Institute

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gracemarie@galen.org

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