HEALTH CARE REFORM: WHAT NEXT?

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HEALTH CARE REFORM WHAT NEXT? Frank J.
ThompsonSchool of Public Affairs and
AdministrationRutgers-NewarkandRutgers Centers
for State Health Policy
Presentation at the Prostate Cancer
Symposium Newark, New Jersey   May 15,
2010     Sponsored by Prostate Net School of
Public Affairs and Administration at
Rutgers-Newark
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THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF
2010
AN HISTORICAL LANDMARK APPROVED ON MARCH 21,
2010 MOST SWEEPING LEGISLATION SINCE
MEDICARE AND MEDICAID   COMPLEX LEGISLATION
MORE THAN 2400 PAGES   EXTEND COVERAGE TO 30
MILLION UNINSURED   UNDOCUMENTED AND CERTAIN
LEGAL IMMIGRANTS EXCLUDED   COST OF 938 BILLION
OVER 10 YEARS   IMPLMENTATION WILL BE THE KEY
WITH STATES FRONT AND CENTER   GUIDING
PRINCIPLE BUILD ON WHATS THERE   COMMERCIAL
HEALTH INSURANCE EMPLOYER AND
INDIVIDUAL MARKETS   MEDICAID   MEDICARE
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INDIVIDUAL MANDATE AND THE EXCHANGES
INDIVIDUAL MANDATE   GET THE YOUNG
INVICIBLES INTO INSURANCE POOLS AND FIGHT
INSURANCE DEATH SPIRAL SUBSIDIES FOR
THOSE UNDER 400 PERCENT OF POVERTY AND
PENALTIES FOR FAILURE TO COMPLY   CREATION OF
STATE BASED EXCHANGES ONE FOR INDIVIDUALS AND
ONE FOR SMALL BUSINESS   PICK A PLAN BY COLOR
BRONZE, SILVER, GOLD, PLATINUM   PENALTIES FOR
EMPLOYERS WHOSE EMPLOYEES USE EXCHANGES   PROJECT
ION THAT 24 MILLION WILL BUY INSURANCE THROUGH
THE EXCHANGES
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MEDICAID THE PLATFORM
BACKGROUND LARGEST FEDERAL GRANT PROGRAM TO
STATES 60 MILLION ENROLLEES ANNUAL COSTS CLOSE
TO 350 BILLION   EXPAND MEDICAID COVERAGE TO
ALL THOSE BELOW 133 PERCENT OF THE POVERTY LINE
  MAINTENANCE OF EFFORT AND ENHANCED
MATCH   16 MILLION MORE ENROLLEES   PROVIDER
PAYMENT AS ACHILLES HEEL WITH IMPLICATIONS FOR
CHARITY CARE
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MEDICARE MODEST EXPANSION AND SOURCE OF SAVINGS
PROGRAM FOR THE ELDERLY AND SOME BELOW 65 WITH
DISABILITIES CLOSE TO 45 MILLION ENROLLEES COST
IN NEIGHBORHOOD OF 450 BILLION   PRESCRIPTION
DRUGS FILL IN THE DOUGHNUT HOLE   SAVE MONEY
THE ADVANTAGE PLANS, REGIONAL VARIATION, AND MORE
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INSURANCE INDUSTRY REGULATION
COVERAGE OF ADULT CHILDREN ON PARENTS HEALTH
INSURANCE   GUARANTEED ISSUE AND RENEWAL NO
RECISSION EXCEPT FOR FRAUD   CONSTRAINED RATING
VARIATION BASED ON AGE   PREMIUM INCREASES
SCRUTINIZED AND HIGHER MINIMUM LOSS RATIO   NEW
JERSEY ALREADY DOES A LOT SO IMPACT NOT SO GREAT
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THE FUTURE OF HEALTH REFORM END OF THE
BEGINNING?
WHAT WILL HAPPEN SOON     THE CHALLENGE OF
ECONOMIC SUSTAINABILITY   HEALTH CARE COST
INCREASES   GOVERNMENT DEFICIT AND DEBT     THE
CHALLENGE OF POLITICAL DURABILITY   THE POLITICS
OF PASSAGE INTENSE PARTISAN POLARIZATION   PUBL
IC OPINION LATEST KAISER SURVEY   AS BEFITS
DEMOCRACY, ELECTIONS WILL MATTER   PREDICTION
FULL REPEAL UNLIKELY