fapp 2010 hcr final

8/9/2019 Fapp 2010 Hcr Final

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Federal AIDS Policy Partnership MeetingApril 28, 2010

Health Care Reform:Update on Federal Efforts toImprove Access to Care for

People Living with HIV/AIDS

Robert Greenwald & Laura HanenCo-Chairs, HIV Health Care Access Working Group


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Part 1:Why our current health care systemfails to meet the health care needs of

people living with HIV and AIDS

Part 2:

Federal efforts to increase access tocare through health care reform


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HIV/AIDS v. General Population:Health Care Coverage

SOURCE: Kaiser Family Foundation based on Fleishman JA et al., Hospital and Outpatient Health Services Utilization Among HIV-Infected Adults in Care 2000-2002, MedicalCare, Vol 43 No 9, Supplement, September 2005.; Fleishman JA, Personal Communication, July 2006

General Population PWHIV/AIDS

Population: 293 Million


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US Population and Peoplewith HIV/AIDS

Income & Unemployment

SOURCE: Kaiser Family Foundation based on US Census Bureau, 2006; Kaiser State Health Facts Online;Cunningham WE et al. Health Services Utilization for People with HIV Infection Comparison of a Population Targetedfor Outreach with the U.S. Population in Care. Medical Care, Vol. 44, No. 11, November 2006. NOTE: US income datafrom 2005, US unemployment data from 2006. 1998 estimates were also 8% and 5%, respectively, rounded to nearestdecimal; HCSUS data from 1998.

8%

5%

45%

62%

Income


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Medicaid

andMedicare

Entitlement Programs.

Both programs have the same

cruel disability standard !!!

You have to get sick and disabled to getaccess to the health care services thatcould have prevented you from getting

sick in the first place.


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Public Funding HIV/AIDS Care:

Including Ryan White (FY 2008)

Total= 4.3 Billion

edi are

3 %

4.5B

an ite

18%

.6BMedi aid

5 %

7. B


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Number of People Living with AIDS in the USvs. Ryan White Funding (adjusted for inflation)

-10

-5

0

5

10

15

20

25

30

35

2002 2003 2004 2005 2006 2007

% change inthe numberof peopleliving withAIDS

% change inRyan Whitefunding

Sources: Estimated Number of Persons Living with AIDS, Centers for Disease Control and Prevention,http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/table12.htm; Ryan WhiteAppropriations History, Health Resources and Services Administration,

ftp://ftp.hrsa.gov/hab/fundinghis06.xls. Inflation calculated using http://www.usinflationcalculator.com/.


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Private and Public Health Care ProgramsAre Failing People Living with HIV/AIDS

Private Insurance: Employer-based system doesnt work well for low-income

or unemployed

Medicaid/Medicare: Disability care systems, not health care systems

Medicaid Benefits are insufficient & vary by state

Medicare Part D out-of-pocket co-pays too high

ADAP/Ryan White Program: You cant fund the health care needs of an epidemic

through a discretionary program


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44.7

4748.4

39.8

2000 2003 2006 2009

Uninsured in Millions

Number of Uninsured Americans

We are not alone!

The health care system is failing

more and more Americans each year.


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PART 2

Update on health care reform:Efforts to improve access to care

for people living with HIV and AIDS


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Medicare Reform

Improvements: Eliminates cost sharing for some preventive services

Part D donut hole closed by 2020

$250 rebate in donut hole (only in 2010)

ADAP as TrOOP (beginning 2011)

50% brand-name discount (beginning 2011)

Phase-down of consumer co-pay for generics (2011-2020)

Phase-down of consumer co-pays for brand names (201 -2020)

Limitations:

Closing donut hole over 10 years is too slow

Actual out-of-pocket maximum not decreased for

consumers generic medications


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Medicare Part D Coverage:

The Donut Hole in 2010 (pre-reform)

$0- $310

$ +

Consumer Pays

Deductible

Donut Hole

Coverage

Gap

Total

Spending

95%

80% Feds Pay

Reinsurance

15% Plan Pays

CatastrophicCoverage

Federal Government Pays

75% Plan Pays

25% out-of-pocket

5% out-of-pocket

Private plan Pays

$630 $3,610

Consumer

Out-Of-

Pocket

$310

Totalconsumeroutofpocket = $4,550

$2,830 -$6,440$310-$2,830


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Post-Reform Medicare Part D Coverage:

The Donut Hole in 2010

$0- $310

$ +

Consumer Pays

Deductible

Donut Hole

Coverage

Gap

Total

Spending

95%

80% Feds Pay

Reinsurance

15% Plan Pays



75% Plan Pays

25% out-of-pocket

5% out-of-pocket

Private plan Pays

$630 $3,610

Consumer

Out-Of-

Pocket

$310

Totalconsumeroutofpocket = $4,550 - $250 rebate = $4,300

$2,830 -$6,440$310-$2,830


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Post-Reform Medicare Part D Coverage:The Donut Hole in 2020 (brand-name)

$0- $310

$ +

Consumer Pays

Deductible

Donut Hole

Coverage

Gap

Total

Spending

95%

80% Feds Pay

Reinsurance

15% Plan Pays



75% Plan Pays

25% out-of-pocket

5% out-of-pocket

Private plan Pays

$630 $3485Consumer

Out-Of-

Pocket

$310


$2,830 -$7,643$310-$2,830

50%

Manufacturer

Discountas

TrOOP

25% out-of-pocket

25% Plan Pays


$1,203


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Post-Reform Medicare Part D Coverage:The Donut Hole in 2020 (generic)

$0- $310

$ +

Consumer Pays

Deductible

Donut Hole

Coverage

Gap

Total

Spending

95%

80% Feds Pay

Reinsurance

15% Plan Pays



75% Plan Pays

25% out-of-pocket

5% out-of-pocket

Private plan Pays

$630 $3,485Consumer

Out-Of-

Pocket

$310


$2,830 -$17,270$310-$2,830

75% Plan Pays

25% out-of-pocket


$3,610


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Private Health Insurance Reform:

Creation of Exchanges

Exchanges are portals for consumers(individuals and small businesses) tocompare and buy health plans

Exchanges certify plans that are compliantwith all health care reform requirements

States must set up and begin administrationof exchanges by 2014

States have option to include large groupmarket (101+ employees) starting in 2017

Exchanges include new OPM-certified multi-state plans and non-profit coop plans but no

public option


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Additional Private Health Insurance Reforms

Exchange Reforms Increased Coverage creates a new mandatory benefits package

(2014)

Increased Affordability premium subsidies and cost-sharingassistance for people up to 400% FPL (2014)

Increased Access limits variation in premium ratings (2014)

Additional Reforms

Increased Access largely eliminates discrimination based on healthstatus (2010-2014)

Requires individuals to purchase health insurance (2014)

Establishes a temporary high-risk insurance pool to cover those withpre-existing conditions (starting within 90 days)


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Private Health Insurance Reform: Limitations

No national plan, so state variation continues

Insurance reforms do not apply to existing,

large group and self-insured plans

Vision and dental coverage are not includedin mandated benefits package

Subsidies dont fully solve the affordabilitygap


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Total Out-Of Pocket Cost to Consumer:Premium and Cost-Sharing

Maximum Consumer Spending

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

100 150 200 250 300 350 400

Income (% FPL)

Maximu

mT

otalAnnualConsumerShare

$15,000

$2,160 (14%)

$20,000

$2,791 (14%)

$25,000

$4,340 (17%)

$30,000

$5,150 (17%)

$35,000

$6,658 (19%)

$40,000

$7,133 (18%)


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Other Key Provisions: New Investments

Invests in prevention, wellness, and publichealth activities

Invests in efforts to reduce health disparities

Supports clinical workforce development withan emphasis on serving vulnerable populations


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Public Health and Prevention

Prevention and Public Health Fund $500 million in FY10 growing up to $2 billion in FY15 Food fight for resources by agencies and body

parts/diseases

Concern that infectious diseases will be left out Creates the National Prevention, Health

Promotion and Public Health Council Provide coordination and leadership at federal level Develop a national strategy

Community Health Center Fund $11 billion over five years

Expands USPSTF and CPSTF


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Public Health and Prevention Coverage of clinical preventive benefits under all

forms of insurance Eliminates cost sharing for services with A or B under

USPSTF 1% increase in Medicaid FMAP for providing these

services in 2013 Incentives for chronic disease prevention under

Medicaid Medicare annual visit and personalized prevention

plan

Such sums as Necessary grant programs Workforce training both clinical and public health

Community transformation grants

Many others


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Sex Ed Funding

Personal Responsibility Education Program(PREP) $75 million for states for evidence-based

programs to prevent unintended pregnancy

and STIs, including HIV/AIDS, and researchand evaluation If a state does not submit an application for

Fiscal Years 2010 or 2011, Secretary canaward three-year grants to community-based

and faith-based organizations

Reinstitution of the $50 million Title VAbstinence Education Formula Block Grants tostates


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NEXT STEPS:Health Care Reform Implementation

Securing bridge to 2014 Medicaid expansion throughemergency ADAP funding, ETHA and state option tostart expansion early

Ensuring HIV inclusion in prevention, wellness, healthdisparities and workforce investments

Defining essential health benefits package for privateinsurance

Facilitating eligibility and enrollment in temporary high-risk insurance pool

Securing community representation on Community

Preventive Services Task Force and other task forces


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Next Steps for Working Group

Updating presentation for all to use

Creating list of resources

Collecting Q&A and FAQs Timeline of implementation

Fact sheets on various aspects of law

Ryan White and Health Reform document


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Contact Information

Robert Greenwald

TAEP

[email protected](617) 390-2584

Laura Hanen

NASTAD

202-434-8090

[email protected]

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