The Impact of Healthcare Reform on Minority Populations

ong>Theong> ong>Impactong> ong>ofong> ong>Healthcareong> ong>Reformong>on Minority PopulationsAmerican College ong>ofong> Osteopathic Internists72 nd Annual Convention and Scientific SessionsOrlando, FloridaOctober 19, 2012Timothy W. McNichol, Esq.Deputy Executive Director

Overview• Set the Stage for ong>Healthcareong> ong>Reformong>• Discuss History and Status ong>ofong> PPACA• Discuss ong>Impactong> ong>ofong> PPACA on MinorityPopulations• Questions/Discussion

Just the Numbers• U.S. population is approximately 314,467,305.• ong>Theong>re are approximately 46.2 million peopleliving in poverty (15 percent).• ong>Theong>re are approximately 48.6 million peoplewithout healthcare coverage (15.7 percent).

Health Insurance Coverage in the US, 2010Uninsured16%Employer-SponsoredInsurance49%Medicaid17%Private Non-Group5%Total = 305.2 millionMedicare12%* Medicaid also includes other public programs: CHIP, other state programs, military-related coverage. Numbers may not add to 100due to rounding.SOURCE: KCMU/Urban Institute analysis ong>ofong> 2011 ASEC Supplement to the CPS.

Nonelderly Health Coverage byRace/Ethnicity, 2010Employer Medicaid or Other Public Uninsured19%20%14%15%19%14%15% 18%31% 23%22%30% 32%33%28%29%62%72%67%55%59%45% 42% 39%All U.S. White Asian Two orMore RacesNHOPI Black AI/AN Hispanic266.0 Million 165.7 Million 12.6 Million 4.5 Million 0.7 Million 33.7 Million 1.7 Million 47.0 MillionDATA: 2011 March Supplement, Current Population Survey.SOURCE: Kaiser Family Foundation Analyses

Adults with Poorly Controlled Chronic Diseases, by Race/Ethnicity,Family Income, and Insurance Status, 2005–2008Percent ong>ofong> adults age 18+ with diagnoseddiabetes with hemoglobin A1c level ≥ 9%75Percent ong>ofong> adults age 18+ with hypertensionwith blood pressure ≥140/90 mmHg757150505351576348506159514625141122 231612 12211524292500* High refers to household incomes >400% ong>ofong> federal poverty level (FPL); middle to 200%–399% FPL; near poor to 100%–199%FPL; and poor to

Adults with an Accessible PrimaryCare ProviderPercent ong>ofong> adults ages 19–64 with an accessible primary care provider*U.S. Average200220052008555556U.S. Variation 2008WhiteBlackHispanic425360400%+ ong>ofong> poverty200%–399% ong>ofong> poverty

Average Annual Premiums for Single andFamily Coverage, 1999-201219992000200120022003200420052006200720082009201020112012$2,196$5,791Single Coverage$2,471*$6,438*Family Coverage$2,689*$3,083*$3,383*$3,695*$4,024*$4,242*$4,479*$4,704*$4,824$5,049*$5,429*$5,615*$7,061*$8,003*$9,068*$9,950*$10,880*$11,480*$12,106*$12,680*$13,375*$13,770*$15,073*$15,745*$0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000* Estimate is statistically different from estimate for the previous year shown (p

Special Message to the Congress“Millions ong>ofong> our citizens do not now have a fullmeasure ong>ofong> opportunity to achieve and enjoygood health. Millions do not now haveprotection or security against the economiceffects ong>ofong> sickness. ong>Theong> time has arrived foraction to help them attain that opportunity andthat protection.”Harry S. TrumanNovember 19, 1945

ong>Theong> Great Balancing ActCoverageQualityCost

Evolution ong>ofong> ong>Healthcareong> Coverage• 1945• 1965November 19 Special Message to theCongress Recommending aComprehensive Health ProgramH.R. 6675 signed into law to createMedicare and Medicaid• 1972 Social Security Amendments ong>ofong> 1972signed into law to expand Medicare toSSDI beneficiaries

Evolution ong>ofong> ong>Healthcareong> Coverage(Continued)• 1985• 1988• 1989Consolidated Omnibus BudgetReconciliation Act ong>ofong> 1985 (COBRA)signed into law creating EMTALAMedicare Catastrophic Coverage Actong>ofong> 1988 signed into law greatly expandingMedicare coverageMany provisions ong>ofong> the MedicareCatastrophic Coverage Act ong>ofong> 1988 repealed

Evolution ong>ofong> ong>Healthcareong> Coverage(Continued)• 1997• 2003• 2010Balanced Budget Act ong>ofong> 1997 signedinto lawMedicare Prescription Drug,Improvement and Modernization Act ong>ofong>2003 signed into lawPatient Protection and Affordable CareAct (PPACA) signed into law

Goals ong>ofong> the PPACA• Expand health insurance coverage• Improve healthcare quality• Control sky-rocketing costs

Two Bills ong>Reformong> ong>Healthcareong>Delivery System• “Patient Protection and Affordable Care Act(PPACA) (Pub. L. 111-148)• Signed into law March 23, 2010• “ong>Healthcareong> and Education Reconciliation Actong>ofong> 2010 (Pub. L. 111-152)• Signed into law March 30, 2010

PPACA Worked its Way Throughthe Federal Court SystemSupreme Court• June, 2012U.S. Court ong>ofong> AppealsU.S. District Courts• March, 2003

Supreme Court Justices ConsiderPPACA• John G. Roberts, Chief Justice (George W. Bush)• Antonin Scalia (Ronald Reagan)• Anthony M. Kennedy (Ronald Reagan)• Clarence Thomas (George HW Bush)• Ruth Bader Ginsburg (William J. Clinton)• Stephen G. Bryer (William J. Clinton)• Samuel Anthony Alito, Jr. (George W. Bush)• Sonia Sotomayor (Barack Obama)• Elana Kagan (Barack Obama)

Legal Challenges to the PPACA• Court Heard Oral Arguments on FourQuestions Contained in Three Cases• NFIB v. Sebelius (No. 11-393)• HHS v. Florida (No. 11-398)• Florida v. HHS (No. 11-400)• Decision handed down on June 28, 2012

Questions Addressed by theSupreme Court• Does the Anti-Injunction Act apply?• Does the individual mandate exceedcongressional authority?• Do the Medicaid provisions exceedcongressional authority?• Is the individual mandate severable from the restong>ofong> the PPACA?

And the Court Decided…• 9-0• 5-4• 7-2• 5-4Court has jurisdiction to decide casenowMandate is constitutional exercise ong>ofong>congressional power (tax, notcommerce)Medicaid expansion violates Congress’spending clause powerRemedy is to limit withholding federalfunds for Medicaid expansion

Summary ong>ofong> PPACA as Amended• Expands coverage to 32 million Americans.• Employer Requirement• Creation ong>ofong> Health Exchanges• Expansion ong>ofong> Public Programs• Individual Mandate Requirement• Applies to most US citizens and legal residents

Summary ong>ofong> PPACA as Amended(Continued)• Provides a 10 percent bonus payment forphysicians in general internal medicine. (2011-2016)• Creates a 10 percent bonus payment for primarycare physicians who practice in healthprong>ofong>essional shortage areas. (2011-2015)• ong>Reformong>s graduate medical education.

Summary ong>ofong> PPACA as Amended(Continued)• Expands preventive care services.• Establishes various health insurance reforms.• Establishes the Center for Medicare andMedicaid Innovation.• Establishes the Community Care TransitionsProgram.

Summary ong>ofong> PPACA as Amended(Continued)• Establishes the Independent Payment AdvisoryBoard (IPAB).• Creates Accountable Care Organizations(ACO’s).• Creates a national pilot program to look at“bundling.”• Expands the Physician Quality ReportingInitiative (PQRI becomes PQRS).

Summary ong>ofong> PPACA as Amended(Continued)• Expands the Physician Quality ReportingInitiative (PQRI became PQRS).• Increases funding for Community HealthCenters.• Reauthorizes the US Department ong>ofong> Health andHuman Services Office ong>ofong> Minority Health.• Elevates the NIH National Center on MinorityHealth and Health Disparities to a full Institute.

One Additional Factor ong>Impactong>ingFuture ong>ofong> PPACA and Its ProvisionsTUESDAY, NOVEMBER 6

Some Final Thoughts• ong>Theong> PPACA is the law ong>ofong> the land as a result ong>ofong>the Supreme Court ruling.• ong>Theong> Law once fully implemented is certain toincrease access to care for minority populations.• ong>Theong> PPACA and its provisions remains divisive.• ong>Theong> November elections could impact thefuture ong>ofong> the PPACA and its provisions.

Questions andDiscussion

Contact InformationTimothy W. McNichol, Esq.Deputy Executive DirectorAmerican College ong>ofong> Osteopathic Internists11400 Rockville Pike, Suite 801Rockville, MD 208521-800-327-5183tmcnichol@acoi.org