Blueprint for Reform

A Shared Responsibility

Who Is WVAHC?Who Is WVAHC?

OfficersOfficers Renate Pore, Renate Pore,

PresidentPresident Sam Hickman, Sam Hickman,

Vice-President Vice-President Jennifer Boyd, Jennifer Boyd,

SecretarySecretary Sally K. Sally K.

Richardson, Richardson, TreasurerTreasurer

Jim BinderJim Binder Charlie Delauder, WVEACharlie Delauder, WVEA Barbara FleischauerBarbara Fleischauer Dave ForinashDave Forinash Dan FosterDan Foster Todd GarlandTodd Garland Cheri HeflinCheri Heflin John LukensJohn Lukens Ronald McCowanRonald McCowan Sherri McKinney, SEIUSherri McKinney, SEIU W. Grant NormanW. Grant Norman Don PerdueDon Perdue Kenny Perdue, AFL-CIOKenny Perdue, AFL-CIO George PickettGeorge Pickett Emily SpielerEmily Spieler Gary Zuckett, WV-CAGGary Zuckett, WV-CAG

Guiding Principles

Cost containment is essential to preserving existing coverage and extending coverage.

Every West Virginian deserves access to quality, affordable health care.

Every West Virginian should contribute to the health care system based on their ability to pay.

Prevention and personal responsibility should be a focus of health care reform.

National Health Care National Health Care Cost 1960-2004Cost 1960-2004

(In billions)(In billions)

$28 $75$225

$717

$1,359

$1,878

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

1960 1970 1980 1990 2000 2004

Source: Kaiser Family Foundation

Per Capita Spending in the United States: Per Capita Spending in the United States:

1960 - 20051960 - 2005

$148 $356

$1,102

$2,813

$4,790

$5,559 $5,952$6,322 $6,697

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

1960 1970 1980 1990 2000 2002 2003 2004 2005

Increases in Health Insurance Increases in Health Insurance PremiumsPremiums

Compared with Other Indicators, Compared with Other Indicators, 1988–20051988–2005

Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 2007.

12.0

18.0

0.8

7.7

6.1

13.9^

12.9*10.9*

8.2*

5.3*

11.2*

8.59.2*

0

5

10

15

20

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Health insurance premiums

Overall inflation

Workers' earnings

Percent

6

Per Capita Health ExpendituresPer Capita Health Expenditures(Percent of GDP) (Percent of GDP)

(2004)(2004)

U.S.: $6,102 (15.3%)U.S.: $6,102 (15.3%)

Switzerland: $4,077 (11.6%)Switzerland: $4,077 (11.6%)

Canada: $3,165 (9.9%)Canada: $3,165 (9.9%)

France $3,159 (10.5%)France $3,159 (10.5%)

Germany:$3,005 (10.9%)Germany:$3,005 (10.9%)

Denmark: $2,881 (8.9%)Denmark: $2,881 (8.9%)

Australia: $2,876 (9.2%)Australia: $2,876 (9.2%)

Ireland: $2,596 (7.1%)Ireland: $2,596 (7.1%)

U. K.: $2,546 (8.3%)U. K.: $2,546 (8.3%)

Japan: $2,249 (8.0%)Japan: $2,249 (8.0%)

New Zealand: $2,083 (8.4%)New Zealand: $2,083 (8.4%)

Source: Organisation for Economic Co-operation and DevelopmentSource: Organisation for Economic Co-operation and Development

U.S. Outcomes Compared to Other Industrialized Countries

U.S. Ranking in W.H.O. 2000 Report:37th in the World

U.S. Ranking on Infant Mortality:23rd Out of 23 Industrialized Countries

U.S. Ranking on Life Expectancy at Age 60:Tied for Last Among Industrialized Countries (Tied with Portugal, Ireland, Denmark and Czech Republic)

Overall Ranking of 6 CountriesOverall Ranking of 6 Countries     

AUSTRAAUSTRALIALIA CANADACANADA GERMANYGERMANY

NEW NEW ZEALANDZEALAND UKUK USUS

OVERALL RANKING (2007)OVERALL RANKING (2007) 3.53.5 55 22 3.53.5 11 66

Quality CareQuality Care 44 66 2.52.5 2.52.5 11 55

Right CareRight Care 55 66 33 44 22 11

Safe CareSafe Care 44 55 11 33 22 66

Coordinated CareCoordinated Care 33 66 44 22 11 55

Patient-Centered CarePatient-Centered Care 33 66 22 11 44 55

AccessAccess 33 55 11 22 44 66

EfficiencyEfficiency 44 55 33 22 11 66

EquityEquity 22 55 44 33 11 66

Long, Healthy, and Long, Healthy, and Productive LivesProductive Lives 11 33 22 4.54.5 4.54.5 66

Health Expenditures per Health Expenditures per Capita, 2004Capita, 2004 $2,876*$2,876* $3,165$3,165 $3,005*$3,005* $2,083$2,083 $2,546$2,546 $6,102$6,102

* 2003 data

Source: Calculated by The Commonwealth Fund based on The Commonwealth Fund 2004 International Health Policy Survey, The Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, The 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, and The Commonwealth Fund Commission on a High Performance Health System National Scorecard.

Cost ContainmentCost Containment

Chronic Care ManagementChronic Care Management Electronic Prescribing and EMR Electronic Prescribing and EMR Independent Review of New TechnologyIndependent Review of New Technology Personal ResponsibilityPersonal Responsibility End of Life CareEnd of Life Care Annual Budget Review Process for Each Annual Budget Review Process for Each

Sector of Health CareSector of Health Care PCMCPCMC

Public/Private Partnership to Public/Private Partnership to Promote ReformsPromote Reforms

MSBCBS, the Health Plan and Other MSBCBS, the Health Plan and Other Private Insurance Companies in Private Insurance Companies in Conjunction with PEIA, Medicaid and Conjunction with PEIA, Medicaid and CHIP Should Jointly Fund:CHIP Should Jointly Fund: E PrescribingE Prescribing Chronic Care ManagementChronic Care Management Electronic Medical Records (EMRs)Electronic Medical Records (EMRs)

Improves Patient SafetyImproves Patient Safety

Eliminates Handwritten PrescriptionEliminates Handwritten Prescription Fewer Adverse Drug - Drug InteractionFewer Adverse Drug - Drug Interaction Fewer Drug – Allergy InteractionsFewer Drug – Allergy Interactions Reduces Errors in Drug Name, DosageReduces Errors in Drug Name, Dosage Prescriber has Searchable Medication Prescriber has Searchable Medication

Record If Drug Is RecalledRecord If Drug Is Recalled

Source: Concord University & Tygart Technology

Source: Dr. Sarah Chouinard, Clay Primary Care System

Primary Care Doctors Use of Electronic Patient Medical Records, 2006

9892 89

79

42

2823

0

25

50

75

100

NET NZ UK AUS GER US CAN

Percent

Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

Number of Uninsured West Number of Uninsured West VirginiansVirginians

(in thousands)(in thousands)

331

260

302

234255

296 290

322304

245

0

50

100

150

200

250

300

350

1993 1995 1997 1999 2001 2003 2005 2006

Source: United States Census Bureau

Health Consequences of the Health Consequences of the UninsuredUninsured

IOM Report: 18,000 premature deaths IOM Report: 18,000 premature deaths each year nationally.each year nationally.

West Virginia is 0.5% of the nation’s West Virginia is 0.5% of the nation’s uninsured or 94 deaths a year. uninsured or 94 deaths a year.

““The uninsured receive less preventive The uninsured receive less preventive care, are diagnosed at more advanced care, are diagnosed at more advanced disease stages, and once diagnosed tend disease stages, and once diagnosed tend to receive less therapeutic care.”* to receive less therapeutic care.”*

*Source: Kaiser Commission on Medicaid and the Uninsured

The Impact of the Uninsured to Those with Insurance

According to FamiliesUSA: West Virginia Has the Second Highest Cost

Shift for Treating the Uninsured The Cost of Providing Care to the Uninsured

Cost the Average Family Plan in West Virginia $1,800 a Year

That Cost Is Projected to Increase to almost $3,000 by 2010 Unless We Take Action to Cover the Uninsured

Near Universal Health Care

Expand Medicaid to Cover Adults to Expand Medicaid to Cover Adults to 100% of FPL100% of FPL

Employer Responsibility with Small Employer Responsibility with Small Employer ExemptionEmployer Exemption

Individual Responsibility with Individual Responsibility with Subsidized Premiums between 100% Subsidized Premiums between 100% and 300% of FPLand 300% of FPL

Reasons for Medicaid Expansion

Federal Dollars Pays for Health Insurance for West Virginians

Low Administrative Cost -- More Money Goes to Paying for Health Care, Less on Paperwork

Can Provide a Quality Insurance Program for Approximately $650 a Year in State Dollars

Lewin Cost Estimates (2003)

Enrollment

(1,000)

State Cost

(millions)

State Cost per Newly Insured

Parents from 29% to 100% of

FPL18.4 $9.4 $602

Other Adults from 0% to

100% of FPL76.0 $40.8 $636

Totals* 94.4* $50.2* $630*

*Totals Calculated by WVAHC

The Health Care Trust Fund

Purposes: Pay for the Medicaid expansion and the Subsidy for Individuals between 100% and 300% of FPL.

Funded Through: Increases in Tobacco Taxes Increases in Soda Tax Increases in Alcohol Taxes Fees from Non-Participating Businesses and

Individuals Examine Using DSH Payments

Insurance Reform

Guarantee Issuance and Renewal for Individual Market

Modified Community Rating for All Markets Rates Based on Age and Gender Only No Medical Underwriting

Programs for Young Adults Rate Reduction for Businesses that

Currently Cover Their Employees

0%

10%

20%30%

40%

50%

60%

70%80%

90%

100%

U.S. Population Health Expenditures

1%5%

10%

49%

64%

24%

Source: S. H. Zuvekas and J. W. Cohen, “Prescription Drugs and the Changing Concentration of Health Care Expenditures,” Health Affairs, Jan./Feb. 2007 26(1):249–57.

50%

97%

$36,280

$12,046

$6,992

$715

Distribution of health expenditures Distribution of health expenditures for the U.S. populationfor the U.S. population

(2003)(2003)

Conclusion

Relief for Individuals and for Businesses Currently Providing Health Insurance to Their Employees

Basic Coverage for All West Virginians Financed in a Fair and Equitable Manner Restructure the Delivery of Health Care to

Meet the Challenges of Today Everyone Must Be Involved in Change

Ways to Be Involved

Become a WVAHC memberBecome a WVAHC member Register for WVAHC eUpdates Register for WVAHC eUpdates

((www.wvahc.orgwww.wvahc.org)) Write your Delegates and Write your Delegates and

SenatorsSenators Write a Letter to the EditorWrite a Letter to the Editor