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Health System Reform

The Basics of Health System Reform


Its about: People, patients, families Caregivers and caregiving organizations Community and system(s) supports and technology changes Payers and payment incentives and risk: Medicare leverage

Why Reform?
Increasing Premium Costs
Consumers are Detached from Market Employers Dropping Insurance

Too Many Uninsured


Ineffective Delivery of Care

Vision of Reform
Develop a consumer driven health care and insurance market that provides: Greater choice Better access Individual responsibility Affordability Higher quality Improved health

Seven Significant Features of Health-Care Reform


Requires everyone to have health insurance- the individual mandate Requires those who can afford insurance but dont buy it or obtain it from an employer to pay a penalty Employer Mandate Health Insurance Exchanges Provides subsidies or Medicaid to individuals who cannot afford health insurance. Requires insurance companies to cover all takers Creates minimum coverage and first-dollar preventive care

ANAs Health System Reform Alignment With PPACA


ANA believes health care is a basic human right that should be provided to all individuals. ANA believes that the health care system must ensure access, which means health care services must be affordable, available and acceptable. PPACA substantially addresses these goals: Affordability PPACA provides assistance on health insurance costs through subsidies and credits for individuals and families, varying based on income; and expansion of Medicaid. Availability PPACA prohibits insurer discrimination based on factors such as health status, medical condition or history, claims experience, and genetic information or disability. Acceptability PPACA acknowledges different cultural approaches to health care through workforce provisions promoting cultural competence training of health care professionals and development of a diverse workforce.

ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine

Safe Effective patientcentered Timely Efficient Equitable

Six Areas of Emphasis


Health Insurance Reform Personal Responsibility

Transparency and Value


Maximizing Tax Advantages Optimize Public Programs Modernizing Governance

Influence Market for Health Insurance


A major goal is to keep the health benefit paid with pre-tax dollars Federal law places some limits Employees must not be penalized based on their health status Employees must have access to the same options (guaranteed issue) Contributions do not have to be equal, but cannot be discriminatory

Influence Market for Health Insurance


Advantages to the Employer Simple - The only decision is how much to contribute Expand Benefit Offerings No need to try to make everyone happy with one choice Predictable future costs Next years cost decision is yours, not the insurers Tax Advantages All premium are pre-tax, reducing employers FICA costs

Influence Market for Health Insurance


Advantages to the Employee Individual Control & Choice The employee chooses the plan that works for them Pay with Pre-Tax Dollars Up to 40% off Expansion More employees may be able to participate as new employers join Portability May be able to keep the same plan as they switch employers Premium Aggregation Families can pool contributions from multiple sources Engagement Employees are now in control and have the power to effect change

Influence Market for Health Insurance


Impacts on the health system Informed choice leads to competition Plans respond directly to consumers Consumer involvement leads to better health choices and outcomes

Reference
Health Care Reform. (n.d.). American Nurses Association. Retrieved December 24, 2012, from http://www.nursingworld.org/MainMenuCategories/PolicyAdvocacy/HealthSystemReform EBSCO Publishing Service Selection Page - Ehost2. (n.d.). EBSCO Publishing Service Selection Page. Retrieved December 24, 2012, from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=f3f d4606-dd98-4e4b-8a4ce92af2363c88%40sessionmgr4&vid=7&hid=16

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