Health Care Reform & the 2012 Election Chad Moore Director of Operations Children s Mercy Pediatric Care Network
Agenda CMPCN (Who We Are, What We Do) Has anything happened in health care since 2008? How is health care policy factoring into the 2012 elections? What else matters? What to expect after the dust settles, i.e., let s play the speculation game! Obama Wins Romney Wins Senate/House (Why it matters?)
Children s Mercy Pediatric Care Network CMPCN is an integrated pediatric care network. Our mission is to improve the health and well being of children through an integrated pediatric network in the greater Kansas City area that is value based, community focused, patient centric, and accountable for the quality and cost of care.
Has Anything Happened Since the Last Time We Talked? The Affordable Care Act Debate (2009) The Congressional Votes (late 2009 early 2010) SCOTUS Upholds ACA as Constitutional, with a Caveat (June 28, 2012) The Bill is Signed (March 23, 2010)
Health Care Policy & the 2012 Elections
Health Care in the 2012 Election; JAMA. 2012;():1-1. doi:10.1001/jama.2012.13696 Copyright 2012 American Medical Association. All rights reserved.
Economy, Budget Deficit, Medicare Top Election Issue Priority List Thinking ahead to the November election, please tell me how important each of the following will be to your vote for President. Extremely important Very important Somewhat important Less important than that The economy 49% 42% 5% 3% The federal budget deficit 41% 36% 15% 6% Medicare 36% 42% 15% 6% Medicaid 30% 44% 17% 8% Spending on the military 30% 37% 21% 11% The 2010 health care law 30% 37% 16% 12% Taxes 29% 43% 20% 7% International affairs 24% 40% 24% 9% Immigration issues 23% 32% 30% 13% Social issues such as abortion and gay marriage 20% 25% 21% 32% Note: Some items asked of separate half samples. Don t know/refused answers not shown. Source: Kaiser Family Foundation Health Tracking Poll (conducted September 13-19, 2012)
80% Public Still Divided On ACA; Favorable Views Tick Up This Month As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it? ACA signed into law on March 23, 2010 Favorable Unfavorable Don t know/refused 60% 46 44 48 50 45 49 44 42 42 50 48 46 41 44 46 43 44 43 51 44 43 44 43 41 43 44 41 44 45% 43 40% 40 41 41 35 43 40 42 40 41 41 43 42 41 42 42 42 39 41 34 37 41 37 42 40 42 37 41 38 38 40% 20% 14 14 10 14 12 11 15 18 18 9 8 13 18 14 12 15 17 16 15 19 17 19 15 19 15 19 18 17 19 14% 0% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 2010 2011 2012 Source: Kaiser Family Foundation Health Tracking Polls
What Else Matters? Post Election & the Fiscal Cliff
Two Laws at Play: Bush Era Tax Cuts extension (2010) & Budget Control Act of 2011
The choices are bad and really bad If the laws expire at the end of 2012 = the budget deficit is reduced, BUT we ll likely fall into a recession, or off the fiscal cliff. If the laws are repealed = there is a considerably less chance of recession, BUT the budget deficit continues to grow, meaning there will no doubt be negative consequences in the future.
Health Care Spending as a Percentage of GDP, 1980 2009 Percent GDP refers to gross domestic product. Source: OECD Health Data 2011 (June 2011).
The Moving Pieces: Medicare/Medicaid with HUGE expansions to come in 2014 Defense 19% Social Security 20% Medicare 1 16% Nondefense Discretionary 18% Medicaid 8% Other 2 13% Net Interest 6% FY 2011 Total Federal Outlays = $3.6 trillion NOTE: FY is fiscal year. 1 Amount for Medicare is mandatory spending and excludes offsetting premium receipts (premiums paid by beneficiaries and state contribution (clawback) payments to Medicare Part D). 2 Other category includes other mandatory outlays and offsetting receipts. SOURCE: Kaiser Family Foundation based on Congressional Budget Office, Budget and Economic Outlook, Fiscal Years 2012-2022, January 2012.
So What s the Political Outlook? 18 Days to the Election
Depiction of the Senate vote on PPACA on 12/24/09, by state 2D Yes 1D Yes, 1R No 1R Yes, 1R No vote 2R No
Depiction of the Senate vote on PPACA on 12/24/09 by state, plus 2010 Senate Outcomes in WI and PA
RCP 2012 Presidential Election Toss Ups as of 10/17/12
I think there s a theme here 8 of the 11 current swing states either had split Senate ACA votes, or lost a senate seat in the 2010 Congressional Elections in which the ACA played a key component. Then again, these are the states where the electorate tends to be consistently so equally divided.
Current Presidential Polling (10/7 10/18) Poll Romney (R) Obama (D) Spread RCP Average 47.7 46.7 Romney +0.3 Rasmussen Tracking 48 48 Tie IBD/TIPP Tracking 46 46 Tie Gallup Tracking 52 45 Romney +7 Harford Courant/UCONN 45 48 Obama +3 ABC News/Wash Post 46 49 Obama +3 Politico/GWU/Battleground 48 49 Obama +1 Monmouth/SurveyUSA/Braun 47 46 Romney +1 FOX News 46 45 Romney +1 Realclearpolitics.com aggregate polling (10/19/12) http://www.realclearpolitics.com
Control of Congress Matters House: Will likely stay GOP but the R s may lose a little ground Senate: VERY tight 45 safe Dems 43 safe GOP 12 Toss Ups IN PLAY Arizona Indiana Missouri Nevada Ohio Virginia Connecticut Massachusetts Montana North Dakota Pennsylvania Wisconsin
Elections Have Consequences: What happens if Obama wins? What happens if Romney wins?
Obama Wins, Senate (D s Control) ACA Implementation Largely Stays on Track Exchanges & Medicaid Expansion (Intact but with State Discretion) 2014 is a huge year: Expansion of coverage 20 million new Americans on Medicaid and 17 million new Americans receive subsidized health by way of the Exchanges Significant Increase in Costs to the Fed/State Governments due to these public program expansions Individual mandate effective Employer penalties kick in for those not providing qualifying and affordable coverage
WILL MEDICAID BE EXPANDED?
Medicaid Expansion The Sell Medicaid expansion will significantly increase coverage and reduce the number of uninsured. The federal government will pay a very high share of new Medicaid costs in all states. Increases in state spending are small compared to increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted.
Cost Implications for Missouri Adds 514,000 new enrollees 5 year spending increase in excess of $430 million
Cost Implications for Kansas Adds 230,000 new enrollees 5 year spending increase in excess of $166 million
And a clear philosophical hurdle: An unwillingness to EXPAND government programs
Obama Wins, Senate (D s Control) The REALITY is that with a big deficit looming a budget deal has to get done in the Spring of 2013 With a GOP House, a grand bargain must be struck Tax increases and defense cuts have limits Delays are likely on the table, i.e., ACA coverage expansions wait a year or two But what do the D s get in exchange for delay Raising Revenue & Tax Code Reform
Romney Wins
Romney Wins, Congress (R s Control) Repeal (remember reconciliation) and Replace Obamacare Replace with what? Block grant Medicaid and other payments to states Limit federal standards and requirements on private insurance and Medicaid coverage Promote public private partnerships, exchanges, and subsidies Promote high risk pools, reinsurance, and risk adjustments Promote consumer choice via purchase of insurance across state lines, more HSAs, more co insurance products, alternatives to FFS medicine If not a gutting of the ACA, it will be filleted and deboned but A lot is already baked in the cake Adult dependent coverage to age 26 Small Business Tax Credits Consumer protections Coverage of Preventive Benefits REALITY is that everything health reform related Slows Down dramatically
More Divided Government? Romney / Senate / House What if Romney Wins, and the D s maintain the Senate? Anyone s head NOT spinning Is it too early to head for the bar? The New HHS Secretary will have a lot of latitude to slow down the regulations needed to enact remaining ACA provisions Waivers will fly out of DC The budget battles will be immense on defunding ACA implementation and with a slim majority, pressure on a couple of D s in the Senate will be significant
Questions? Chad Moore cmoore@cmpcn.org (816) 559 9374