· Source: Organization for Economic Cooperation Development, Health at a Glance 2017, Feb 2018 Fig 7.3 on pg 135 and Fig 7.1 on pg 133 (oecd.org)

Presentation Designed & Developed by Witte Design, LLC ©2012-2018 • Tucson, Arizona

www.ConnectTheDotsUSA.com

Med

icaid

/CH

IP

19% 62 Mil

Med

icare

14%

=45 M

illion

7% =

22 MilPlan

s

The

Uninsured28

Million9% =

1%

Veterans

Non-G

roup

Employer Plans

49% = 157 Million

2016

Tricare

1%

©2012

©2012

TM

Source: Kaiser Family Foundation (kff.org) based on Census Bureau March 2016 CPS-ASEC (census.gov)Hierarchy for sorting multi-covered people into only one category: Medicaid, Medicare, Employer, VA/Tricare, Non-Group

©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/11/18

“Crazy-Quilt” metaphor by T.R. Reid, 2009

Med

icaid

/CH

IP

19% 62 Mil

Med

icare

14%

=45 M

illion

7% =

22 MilMilPlan

s

The

UninsuredThe

Uninsured28

Million28

Million9% =

1%

Veterans

Non-G

roup

Employer Plans

49% = 157 Million

2016

Tricare

1%

U.S. Healthcare

System

Skilled Providers

State-Of-The-Art

Technology

Accessible

Affordable

Efficient

©2012

Source: Kaiser Family Foundation (kff.org) based on Census Bureau CPS-ASEC (census.gov)Hierarchy for sorting multi-covered people into only one category: Medicaid, Medicare, Employer, VA/Tricare, Non-Group


Despite Improvements,ACA Still Leaves 28 Million Uninsured

And Millions More Underinsured

Despite Improvements,ACA Still Leaves 28 Million Uninsured

And Millions More Underinsured

VA & Tricare

2016

Medicare14% =

45 Million

Non-Gro

up

7% = 22 Mil

Un

insu

red

9% =

28

Mil

Medicaid/CHIP

19% =62 Million

Employer Plans49% =

157 Million

VA & Tricare

2010

Medicare13%

Non Group

5%

Medicaid/CHIP16%

Uninsured16%

Employer Plans49%

Total Population: 306 Million

Total Population:320 Million

Source: Organization for Economic Cooperation Development, Health at a Glance 2017, Feb 2018Fig 7.3 on pg 135 and Fig 7.1 on pg 133 (oecd.org) and OECD Health Expenditures and Financing (stats.oecd.org)

©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated12/4/18

Health Spending By Country 2016Health Spending By Country 2016

Japan

10.9%$4,519

Austra

lia

9.6%$4,708

Finla

nd

9.3%$4,033

OECD Avg

9.0%$4,003

Norway

10.5%$6,647

United

Kingdom

9.7%$4,192

Denmark

10.4%$5,205

Switzerla

nd

12.4%$7,919

Canada

10.6%$4,753

Germany

11.3%$5,551

Sweden

11.0%$5,488

France

11.0%$4,600

USA

8.5%

8.7%

17.2%$9,892

Private Expenditure

Public (Govt) Expenditure

$ Spending Per Capita (USD PPP)

U.S. spends far more overall($3.5 trillion in 2017), spends fargreater % on private, but still leaves 28 million uninsured and many underinsured.

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%% of GDP

Health Spending Per Capita By CountryHealth Spending Per Capita By Country

Source: Organization for Economic Cooperation Development –Health Expenditures and Financing (stats.oecd.org)


Pu

rch

asin

g P

ow

er P

arit

y (P

PP

) Ad

just

ed

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015NIXON FORD CARTER REAGAN BUSH 1 CLINTON OBAMABUSH 2

USA: $10,209 (Crazy Quilt)

U.K.: $4,246 (Socialized Medicine)

Overall CPI Inflation (US)

Switzerland: $8,009 (Regulated Privatewith Mandate)

Canada: $4,826 (Single Payer)

Denmark: $5,183 (Single Payer)

America’s Healthcare “Crazy Quilt” system is costly and inefficient: We now spend more than twice the per person average of all other industrialized countries.

OECD Avg:$4,003 (2016)

2014 ACA: 20 Million more Americans begin to get coverage.

Source: Kaiser/HRET Employer Health Benefits Survey, Oct 3, 2018, Figures 5 & 2 (kff.org)Family of 4 avg total health spending: 2018 Milliman Medical Index, May 2018 (milliman.com)


Runaway Health Premiums Eat AwayAt Wages & Burden Employers

Runaway Health Premiums Eat AwayAt Wages & Burden Employers

0%

50%

100%

150%

200%

250%

300%

’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ’17 2018

+ 68%+ 51%34%

29%

Cumulative IncreasesTotal Avg Family Premium(Employer Plan)

Worker Contribution

Employer Contribution

Workers’ Earnings

Overall Inflation

+ 239%+ 259%

119%1999 Total: $5,791Worker: $1,543Employer: $4,247

2018 Total: $19,616

Worker: $5,547Employer: $14,069

+ 231%

117%120%

In 2018, avg Total Health Spending for

Family of 4was $28,166!

(Premiums &Out-of-Pocket)

Source for 1995-2013: Blue Cross Rate Sheets for Preferred PPO, Pima County AZ, $1,000 Deductible & 20% CoinsuranceSource for 2014-2018: Healthcare.gov for Pima County AZ, Gold Plan: $1,000 to $1,400 Deductible


Individual Plan Health Premiums: Costs Were Skyrocketing Long Before ACA

Individual Plan Health Premiums: Costs Were Skyrocketing Long Before ACA

$170

100

$ 0

200

300

400

500

600

700

800

900

1,000

1,100

1,200

1995 ’96 ’97 ’98 ’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09 ’10 ’11 ’12 ’13 ’14 ’15 ’16 ’17 ’18 2019

Monthly Premiums(Based on “Gold Level Plan”:approx $1,000 to $1,400 Deductible& 20% coinsurance)

64 yr Male54 yr Female Female Aging 31 to 55 yrs Overall Inflation

ACA Marketplaces Open 2014:Pre-existing conditions & essential benefits must now be covered;No annual or lifetime caps; 80% of enrollees get tax credits that greatly defray these retail prices.

$382$382$403

$140

$457

$215

$587$587

$1,078$1,078

$696

$300

$120$120$121

Projectio

n w/o

ACA

$73 8 in

sure

rs &

119

pla

ns

On

ly 1

insu

rer

& 4

pla

ns

3 in

sure

rs &

16

pla

ns

AC

A P

asse

sM

arch

201

0

80/2

0 R

ule

Take

s Ef

fect

$73 On

ly 1

insu

rer

& 2

pla

ns

$418$418

$801$801

$767$767

Sources: International Federation of Health Plans, “2015 Comparative Price Report,” July 19, 2016 (ifhp.com)“The U.S. Pays a Lot More for Top Drugs than Other Countries,” Bloomberg News, Dec 18, 2015 (bloomberg.com)


••••••••••••••••••••••••••••••••••••••••••••••••••••••$78,318$78,318

avgUSA

$24,059U.K.

$32,480NEW ZEALAND

$765AUSTRALIA

$2,142NEW ZEALAND

HIP REPLACEHIP REPLACE

$29,067$29,067avgUSA

$6,757SPAIN

$16,335U.K.

MRI SCANMRI SCAN

$1,119$1,119avg

USA$503

AUSTRALIA$215

SWITZERLAND

BABY DELIVERYBABY DELIVERY

$10,808$10,808avg

USA

$1,950SPAIN

$5,312AUSTRALIA

HOSPITALSTAY (1-DAY) HOSPITALSTAY (1-DAY)

CORONARY BYPASSCORONARY BYPASS

Because U.S. has a wide range of prices for same procedures, average prices are shown here; Dollars are $US

$155USA $155USA

$74CANADA

$74CANADA

$38GERMANY

$38GERMANY

ADVAIRADVAIR (30-DAY SUPPLY)

$5,220$5,220avgUSA

U.S. Prices Are Too Darn High!U.S. Prices Are Too Darn High!

©2012

Sources: Chris Rock, “Bigger & Blacker,” 1999 and“Wall Street Admits Curing Diseases Is Bad For Business,” Lee Camp, April 24, 2018 (truthdig.com)


— Chris Rock

“There ain’t no money in the cure; the money’s in the medicine.

That’s how you get paid — on the comeback. That’s how a drug dealer makes his money — on the comeback.”

Curing Diseases Is Bad For BusinessCuring Diseases Is Bad For Business

For more on this topic, see Wendell Potter, Deadly Spin: An insurance company insider speaks out on how corporate PR is killing health care and deceiving Americans, 2010


PRE-EXISTING

CONDITION

EXCLUSIONS

LOSE

YOUR JOB;

LOSE YOUR

COVERAGE

POLICY

RESCISSIONS

& CLAIM

DENIALS

SMALL

BUSINESS

PURGING

COVERAGE

GAPSPRICED

OUT OF

MARKET

CRAZY

HIGH

DEDUCTIBLE

PLANS

LIFETIME

& ANNUAL

CAPS

OUT OF

NETWORK

Bef

ore

AC

A

ACA plugged some ofthe worst holes, but more work to be done!

©2012

©2012

©2012

20% –25%Drain:

Admin, Ads, Profits,Excessive Executive

Pay & Bonuses

For more on this topic, see Wendell Potter, Deadly Spin: An insurance company insider speaks out on how corporate PR is killing health care and deceiving Americans, 2010


“We at Big Insurance will even kick sick children to the curb, but we pay a nice juicy dividend to our share-holders (aka our real customers). At least our death panels turn a profit. The more people and claims we deny and delay, the more money we make. The system works for us!”

ACA Banned Cherry-Picking Only The HealthyACA Banned Cherry-Picking Only The Healthy

Source: “What Health Insurance Does Cover, and Doesn’t,” New York Times, April 20, 2011 (NYTimes.com)Based on a report on employer-sponsored health insurance coverage from the Department of Labor


0% 10 20 30 40 50 60 70 80 90 100

Physician Office Visits Hospital Room & Board

ER VisitsOutpatient Mental

Inpatient Drug RehabPhysical Therapy

Durable Medical EquipMaternity Care

AmbulanceOb/Gyn Exams

ProstheticsOrgan/Tissue Transplants

Infertility TreatmentKidney Dialysis

Diabetes ManagementSterilization

Outpatient Drug Rehab

100%99%

91%85%

79%78%

70%67%66%

64%60%

46%45%

27%27%27%26%

2011:% of PrivateEmployer-SponsoredHealth Plansthat Cover a Given Service

“Covered,” benefits often still involve deductibles,copays and cost-sharing

Read The Fine Print: Before ACA,Read The Fine Print: Before ACA,Having Insurance Having CoverageHaving Insurance Having Coverage

Sources: Uninsured–U.S. Census Bureau Report 2011 (census.gov); Deaths – “Health Insurance and Mortality in US Adults,”American Journal of Public Health, Dec 2009; Bankruptcies –“Medical Bankruptcy in the U.S. 2007,” American Journal of Medicine, Aug 2009


©2012

50,000,00050,000,000in U.S. Had No Health Insurance

44,000/yr44,000/yr

600,000/yr600,000/yrWent Bankrupt Due to Medical Bills

Died Because of Lack of Insurance

Before ACABefore ACA

Source: Organization for Economic Cooperation Development, Health at a Glance 2017, pg 59 (oecd.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/8/18

Infant deaths per 1,000 of live birthsin 2015

U.S. Spends The Most, But Has High Infant Mortality Rate

U.S. Spends The Most, But Has High Infant Mortality Rate

Turkey

10.7

Chile7.

2China

9.2

Unit

ed Sta

tes

5.8

Poland4.

0Hungary

4.2

New Zealand5.

0

United Kingdom

3.9

Canada4.

8

Switzerla

nd3.

9

Netherla

nds3.

3

Australia

3.2

Belgium3.

3

France

3.7

Germany

3.3

Denmark

3.7

Italy

2.9

Ireland

3.4

Greece

4.0

Austria

3.1

Portugal

2.9

Sweden2.

5Spain

2.7

Norway

2.3

Finland1.

7Ja

pan2.

1

Iceland2.

0

Mexico12

.5

Source: Organization for Economic Cooperation Development, Health at a Glance 2017, pg 49 (oecd.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/15/18

U.S. Spends The Most, But Has Lower Life Expectancy Than Peers

U.S. Spends The Most, But Has Lower Life Expectancy Than Peers

2015 Health Spending Per Person(U.S. dollars, purchasing power parity)

Life

Exp

ecta

ncy

201

5

$2,000 $4,000 $6,000 $8,000 $10,00070

YEARS

75

80

85

USA

©2012

HUNGARYBRAZIL LITHUANIA

COLUMBIALATVIA

RUSSIA

SLOVAKIAPOLAND

ESTONIA CZECH REPUBLIC

DENMARK

AUSTRIA

NORWAY SWITZERLANDFRANCE

AUSTRALIA

BELGIUM

NETHERLANDS LUXEMBOURG

IRELANDFINLAND

CANADAUK

JAPANITALYSPAIN

NEW ZLD

ICELAND

PORTUGALCOSTA RICA SLOVENIA

GREECEKOREA

ISRAEL

MEXICO

TURKEY

CHILE

CHINA

SWEDEN

GERMANY

Sources: Health Financing – stats.oecd.org; Uninsured Rate and Employer Plan Premium – kff.org Deaths – Extrapolated from Amer. Journal of Public Health, Dec 2009; Bankruptcies – Amer. Journal of Medicine, Aug 2009


Current U.S. Heathcare “Crazy Quilt”Is Complex, Costly And Cruel

Current U.S. Heathcare “Crazy Quilt”Is Complex, Costly And Cruel

31MILLIONUNINSUREDand millions more

underinsured (2017)

600THOUSANDGO BANKRUPT

per year due to medical bills

500BILLIONPAPERWORKwaste per year due to too many payers

28THOUSANDUNINSURED DIE

per year due to lack of insurance

3.3TRILLIONSPENT IN 2016

= 18% of economy; 2/3 is tax-financed

$ 10THOUSANDPER PERSON= more than twice

the OECD avg

$ 19.6THOUSAND2018 PREMIUMemployer family plan(employee paid 28%)

$ 50TRILLION

2019-2028estimated cost

over next decade

$

$©2012

Source: “Premium Support Is the Wrong Direction for Medicare,” AARP Public Policy Institute, Oct 2017 (aarp.org) Note: See cartoon on this theme on the color slides


“It’s a vision that says America can’t afford to keep the promise we’ve made to care

for our seniors. It says that ten years from now, if you’re a 65-year-old who’s eligible

for Medicare, you should have to pay nearly $6,400 more than you would today.

It says instead of guaranteed health care, you will get a voucher. And if that voucher

isn’t worth enough to buy insurance, tough luck — you’re on your own.”

“Put simply, it ends Medicare as we know it.”— President Obama (April 2011)

Cost Shifting Is No Solution

Cagle Cartoon: © 2011 Copyright Dave Granlund. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

Cos

t Shi

ft

Sol

utio

n

For more on this topic: David Sirota, Hostile Takeover: How Big Money & Corruption Conquered Our Government – And How We Take It Back,, 2007, pgs 154-204


Pay Your Doc Chickens!

Death Panels: Govt Bureaucrats Ration Care • It’s profit-obsessed private insurers who regularly deny people and claims.

Buy Insurance Across State Lines• Race-to-bottom to avoid even meager state regulations.

Everyone Gets Care: Just Go To ER!• ER only mandated to stabilize patient: No chemo in the ER!• Most expensive care: Leads to bankruptcies and cost shifting.

High-Risk Pools For Sick People• Premiums way too high, govt subsidies grossly inadequate, coverage skimpy

Health Savings Accts & Even Higher Deductibles• Only suited for relatively wealthy and healthy with extra disposable income.

Tort Reform For “Crisis Of Junk Lawsuits”• Defensive medicine = only 1% to 2% of total health spending. • Capping damages at $250,000 limits patient protection and victims’ rights.

1

2

3

5

6

4

GO

P M

yths

& N

on-S

olut

ions

GO

P M

yths

& N

on-S

olut

ions

Source: U.S. Dept of Health & Human Services, Medical Expenditure Panel Survey,Statistical Brief #455, Oct 2014 (meps.ahrq.gov)


of Patientsof PatientsFiguring out how to

take care of the chronically sick is the trillion dollar question.

Preventive care, coordinated care, education, and getting everyone insured will help decrease costs.

of Costsof Costs

©2012

Source: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 2/19/17

March 2010: Patient Protection & Affordable Care Act (aka ACA) March 2010: Patient Protection & Affordable Care Act (aka ACA)

Preventive Services Must Be Free (No Copay/Deductible)

Young Adults Under 26 Yrs Eligible To Stay On Parents’ Policy

Banned Policy Cancellations When You Get Sick

Banned Lifetime Caps & Gradually Phased Out Annual Caps By 2014

Banned Pre-Existing Condition Discrimination:Began in 2010 for Children Under 19 Yrs Began in 2014 for Everyone Else

Provisions In Effect Since 2010 (or 2014)

Slide 1 of 2

12

34

5


Other Provisions Since 2010 (or 2014)ACA: But Wait, There’s More!ACA: But Wait, There’s More!

6

7

8

9Slide 2 of 2

$3,7

50

$8,4

18

At Least 80% Of Premium Dollars (85% In Large Group Plans) Must Be Spent On Actual Health Services

Small Biz Health Insurance: 35% Tax Credits (50% In 2014)

50% Discount For Seniors Who Fall Into Rx Drug “Donut Hole”; Closes Hole By 2020

2014: Medicaid Expansion and Tax Credits for Individuals & Families to Buy Private Insurance


Jan 1st 2014 (aka “Liberation Day”)Jan 1st 2014

(aka “Liberation Day”)

HEALTH INSURANCEEXCHANGESAH

BEAH

BE

SHOPSHOP

• Companies Compete For Your Business: Easy Comparison Shopping

• Policies Must Meet Minimum Standards (No Junk Allowed!)

• Individuals, Families & Small Biz Welcome

• No Discrimination Based On Health Status, Gender, Job, Etc. *

*Rates can vary only by Geography, Age (3:1) & Tobacco Use (1.5 :1)

Affordable Care Act

©2012-2017 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

NEED TNEED TAXREVENUESREVENUESNEED TAX

REVENUES

GOVTSUBSIDIESSUBSIDIES

GOVTSUBSIDIES

FREE-FREE-RIDERRIDER

PROBLEM

FREE-RIDER

PROBLEM

It’s All Connected:Why Piecemeal Doesn’t Work

It’s All Connected:Why Piecemeal Doesn’t Work

Or go Medicare-For-All:Pay for healthcare like we

pay for roads and military — through the tax system.©2012

ENDENDPRE-EXISTINGRE-EXISTING

CONDITIONDISCRIMINATION

ENDPRE-EXISTING

CONDITIONDISCRIMINATIONGUAR

ANTE

EDIS

SUE MANDATE TO INSURANCE

CO’S

INDIVIDUALMANDATE

INDIVIDUALMANDATE

1993

G

OP ORIGINAL

1986 Emergency Medical Treatment and Active Labor Act (EMTALA) was signed by President Reagan©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

THE ONE-SIDEDTHE ONE-SIDEDTHE ONE-SIDED

Just Shifts Costs To OthersJust Shifts Costs To Others

Cost Shift = Avg $1,000/yr Per Family

1986 Federal mandate that ERs provide stabilizing

treatment to everyone regardless of ability to pay

shifts costs of unpaid services for the uninsured to

hospitals, which then shift the costs to the insured.

Sources: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/28/18

FREE

-RID

E

EMPLOYER

*Exemption for small businesses with

fewer than 50 employees. Subtract first

30 employees from payment calculation.

ANNUAL TAX PENALTY:$2,000 per Full-Time Employee

ACA Tickets To Free-Ride

ACA Tickets To Free-Ride

FREE

-RID

E

INDIVIDUAL

ANNUAL TAX PENALTY: Greater of...

2014: $95/adult or 1% of income

2015: $325/adult or 2% of income

2016: $695/adult or 2.5% of income

Children under 18 yrs are half-price

*Exemptions for religious objections or if cost

of insurance exceeds 8.0% of annual income

after subsidies; No penalty if uninsured less than

3 months of year.

Began Jan 1, 2014

Responsibility Mandates

Responsibility Mandates

Began Jan 1, 2015 for +100 employees & Jan 1, 2016 for 50-99 employees.

GOP made penalty $0 starting 2019 (effectively repealing it)

For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/29/18

Began Jan 1, 2014

Affordable Care Act:Help With Access & Affordability

Affordable Care Act:Help With Access & Affordability

Expands Medicaid Eligibility(Program For Low-Income)

Expands Medicaid Eligibility(Program For Low-Income)Up To 138% Federal Poverty Level

Individuals with incomes below $16,753 (for 2019)

Families (of four) with incomes below $34,638 (for 2019)

Individuals with incomes$12,140 to $48,560 (for 2019)

Families (of four) with incomes $25,100 to $100,400 (for 2019)

To avoid burdening States,expansion of Medicaid*

100% financed by Federal govt 2014 thru 2016. Then phases down to

90% by 2020.

These households will pay as little as 2.08% and no more than

9.86% of income to buy mid-levelinsurance on the exchanges.

Max out-of-pocket costs capped at $7,900/individual and $15,800/family

or lower (2019).

Pre-existingConditionProtection

Hoorayfor ACA!

We’reCovered!

Sliding Scale Of Tax Credits For Low- & Middle-IncomeSliding Scale Of Tax Credits For Low- & Middle-Income

100% To 400% Federal Poverty Level

*Per Supreme Court June 2012 decision, States can opt out of Medicaid expansion. 36 states + D.C. have opted into the expansion as of Nov 2018.

Source: Kaiser Family Foundation, as of Nov 26, 2018 (kff.org)Per Supreme Court June 2012 decision, states can opt out of Medicaid expansion. In 2014, 25 states opted out.


GOP Blocking Medicaid ExpansionIn 14 States — Where Most NeededGOP Blocking Medicaid Expansion

In 14 States — Where Most Needed

Accepting (36 + DC)

Rejecting (14)

MedicaidExpansion

Status

WAMT ND

MN

IA

MO

AR

LA

IL

WIMI

IN OHPA

NY

ME*

NHMA

CTNJ

DE

DCMD

RI

VT

KYTN

MS AL GA

FL

SCNCVA*WV

SD

NE*

KS

OK

ID*

NV

AZ

UT*CO

NM

TX

CA

OR

WY

AK

HI

*4 states approved in 2018 to begin in 2019. Maine approved by ballot in 2017 but was blocked by recently termed-out GOP governor.

©2012©2012

Sources: Incomes as % of FPL (FamiliesUSA.org); Premium calculator (kff.org/interactive/subsidy-calculator) For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)


100%FPL

$12,140

$16,460

$20,780

$25,100

$29,420

138%FPL

$16,753

$22,715

$28,676

$34,638

$40,600

150%FPL

$18,210

$24,690

$31,170

$37,650

$44,130

200%FPL

$24,280

$32,920

$41,560

$50,200

$58,840

250%FPL

$30,350

$41,150

$51,950

$62,750

$73,550

300%FPL

$36,420

$49,380

$62,340

$75,300

$88,260

350%FPL

$42,490

$57,610

$72,730

$87,850

$102,970

400%FPL

$48,560

$65,840

$83,120

$100,400

$117,680

HOUSEHOLDSIZE

1

2

3

4

5

TABLE 1: Incomes as Percentage of 2018 Federal Poverty Level (FPL)

100%FPL

2.08%$21 /mo

$29 /mo

$36 /mo

$44 /mo

$51 /mo

138%FPL

3.42%$48 /mo

$65 /mo

$82 /mo

$99 /mo

$116 /mo

150%FPL

4.15%$63 /mo

$85 /mo

$108 /mo

$130 /mo

$153 /mo

200%FPL

6.54%$132 /mo

$179 /mo

$227 /mo

$274 /mo

$321 /mo

250%FPL

8.36%$211 /mo

$287 /mo

$362 /mo

$437 /mo

$512 /mo

300%FPL

9.86%$299 /mo

$406 /mo

$512 /mo

$619 /mo

$725 /mo

350%FPL

9.86%$349 /mo

$473 /mo

$598 /mo

$722 /mo

$846 /mo

400%FPL

9.86%$399 /mo

$541 /mo

$683 /mo

$825 /mo

$967 /mo

HOUSEHOLDSIZE

Based on Max Annual Premium You Pay as a % of Your Household Income

Base

d on

201

8 FP

Ls a

bove

, whi

ch

will

be

used

for 2

019

subs

idie

s.Ro

unde

d to

nea

rest

dol

lar h

ere.

For general informational purposes only; provided without warranty or guarantee. Consult Marketplace at HealthCare.gov.

TABLE 2: Maximum Monthly Premium You Pay For Benchmark Silver Plan(Federal govt pays any balance of non-smoker Silver premium owed to insurance co.)

12345

In 32 states + D.C. opting in, households below 138% of FPL will qualify for Medicaid expansion instead.

AC

A T

ax C

red

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For more details: Kaiser Family Foundation, “Summary of the Affordable Care Act,” April 23, 2013 (kff.org)Premium calculator: kff.org/interactive/subsidy-calculator; FPL = Federal Poverty Level


Marketplace Plans: The Metal LevelsMarketplace Plans: The Metal Levels

Higher Premiums& Lower Consumer

Cost-Sharing

Lower Premiums& Higher Consumer

Cost-Sharing

100% to 250% FPL also Eligible for Cost-Sharing Subsidies to Reduce Out-of-Pocket Costs. Must enroll in Silver plan for cost-sharing subsidies.

Platinum 90% 10%

Gold 80% 20%

Silver 70% 30%

Bronze 60% 40%

Plan TypePlan Pays

% of Total CoveredExpenses (on Avg)= Actuarial Value

Consumer Paysfor Deductibles,

Co-pays & Coinsurance(on Average)

Max out-of-pocket annual limit of $7,900 individual / $15,800 family(excluding premiums). Lower for households < 250% FPL

Source: Health Tracking Poll: Nov 28, 2018, Kaiser Family Foundation (kff.org)©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 11/28/18

ACA Provisions Very PopularACA Provisions Very Popular% Support(Note: ACA = ObamaCare)

Can stay on parents’ insurance until age 26

Insurance exchanges to compare prices & benefits

Govt financial assistance to help buy coverage

Closes donut hole in Medicare Rx drug plans

No out-of-pocket costs on preventive services

Medicaid expansion to cover more low income people

Large employer mandate to provide health insurance

Bans pre-existing condition discrimination

Increases Medicare payroll tax on high incomes

Favorable opinion of ACA/ObamaCare overall

82%

82%

81%

81%

79%

77%

69%

65%

65%

53%

Quote by T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2010, pg 251 ©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

For All?“(The Affordable Care Act) should extend insurance coverage to

millions of Americans who are uninsured now and end some of the insurance companies’ harsher practices. But the sad truth is

that, even with this ambitious reform, the United States will still have the most complicated, the most expensive, and the

most inequitable health care system of any developed nation.”

Quotes: Steven Brill, “The Bitter Pill: Why Medical Bills Are Killing Us,” Time Special Report, March 4, 2013 ©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • www.ConnectTheDotsUSA.com • Updated 2/9/14

U.S. Healthcare Is No MarketplaceU.S. Healthcare Is No Marketplace“(We) are powerless buyers in a seller’s market

where the only sure thing is the profit of the sellers.”

— Steven Brill, “The Bitter Pill”

“Unless you are protected by Medicare,

the health care market is not a market at all.

It’s a crapshoot. People fare differently

according to circumstances they can neither

control nor predict... (T)hey have little

visibility into pricing, let alone control of it...

They have no idea what their bills mean,

and those who maintain the chargemasters

couldn’t explain them if they wanted to.”

Sources: HealthOverProfit.org; Fix It: Healthcare at the Tipping Point (documentary), 2016 (FixitHealthcare.com) Calculate your savings with “Expanded & Improved Medicare For All Act” (HR 676) at hcfat.org


Medicare-For-All:Healthcare Is A Right1

2

3

4

5

Universal & Comprehensive: Enhances and extends Medicare to all.

Simple & Cost-Effective: Ends maze of for-profit insurance costs, medical bills/debt; Negotiates lower drug prices.

Freedom & Choice: Go to any doctor or hospital in the entire U.S.

Good for Business: Gets insurance burden off backs of businesses; Frees entrepreneurs from job lock.

Big Savings for 95% of Americans

©2012

©2012

©2012

©2012

$$$$$$$$$$

$$$$$$$$

$$

Source: Congressional Budget Office, “Cost Estimate: American Health Care Act,” Mar 13, 2017, Table 2 (pgs 32-33) (cbo.gov)

©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 3/20/17

Ends Medicaid Expansion & Guts Original Medicaid Thru Fed Caps

Skimpier Insurance Premium Tax Credits ($361 B instead of $673 B)Hits older, lower-income, rural and sick Americans especially hard;Ends cost-sharing subsidies that help lower deductibles, co-pays, etc.

Ends Small-Employer Tax Credits

–($ 880 B)

–($ 312 B)

–($ 6 B)

2017-2026

2017-2026

Repeals 0.9% Add. Medicare Payroll Tax on High IncomesRepeals 3.8% Capital Gains Medicare Tax on High Incomes

>$200,000 single/>$250,000 married currently subject to Medicare payroll tax of 3.8% instead of 2.9%; includes investment income over that threshold.Medicare Part A (Hospital) Trust Fund will run out 3 yrs earlier (by 2025)

Repeals Taxes on Big Insurance, Big Pharma & Medical Device Cos.Repeals Insurance Mandate (Individual = $38 B; Employer = $171 B)

More Tax Deductions for Health Savings & Flexible Spending Accts

–($ 117 B)–($ 158 B)

–($ 189 B)–($ 209 B)–($ 37 B)

24 Million Low/Mid-Income Lose Coverage

Wealthy Get HUGE Tax Breaks

Trump/Ryan/GOP “WealthCare” Trump/Ryan/GOP “WealthCare”

©2012

©2012

(in $ Billions)

Sources: Congressional Budget Office, Cost Estimate of AHCA, Mar 13, 2017, Table 4 (pg 34); Cost Estimate of BCRA, June 26, 2017, Table 5 (pg 48) (cbo.gov); Medicare-For-All calculator (hcfat.org)


The

Bes

t Pla

n Is

So

Sim

ple!

The

Bes

t Pla

n Is

So

Sim

ple!

*GOP Plans allow insurance co. to charge 64yr old 5x more than 21yr old (ACA capped this at 3x more).**GOP Plans end ACA cost-sharing subsidies that lower deductibles, co-pays, co-insur. for 100% to 250% FPL.

House GOP Plan = AHCA (aka Ryan/TrumpCare)21 yr old40 yr old64 yr old

$3,900$6,050

$19,500*

$2,450$3,650$4,900

$1,450 (= 5.5%)

$2,400 (= 9.1%) $14,600 (= 55.1%)

65% = Bronze**

HIGH deductible,co-pays, co-insur.)

Senate GOP Plan = BCRA (aka McConnell/TrumpCare)21 yr old40 yr old64 yr old

$4,100$6,400

$20,500*

$1,900$3,400

$14,000

$2,200 (= 8.3%)

$3,000 (= 11.3%)

$6,500 (= 24.5%)

70% = Silver**

MEDIUM deductible,co-pays, co-insur.

Current Law = ACA (aka ObamaCare)21 yr old40 yr old64 yr old

$5,100$6,500

$15,300*

$3,400$4,800

$13,600

87% = Gold**

LOW deductible,co-pays, co-insur.

$1,700 (= 6.4%)

$1,700 (= 6.4%)

$1,700 (= 6.4%)

Medicare-For-All (= Single-Payer)Household pays 3.0% of income (employer payroll tax) $795 (= 3.0%)

100% CoveredNo cost-sharing

Single Individual With Annual Income of $26,500 in 2026Annual Retail

PremiumAge Premium

Tax Credit

Net PremiumPaid by Enrollee(and as % of income)

Actuarial Valueof Plan

(higher % is better)

Cagle Cartoon: © 2011 Copyright Dave Fitzsimmons. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

Cagle Cartoon: © 2009 Copyright Dave Fitzsimmons. All rights reserved. Used here with permission.©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Created 2012

Other Resources: Compare health care systems around the world: international.commonwealthfund.org T.R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, 2010


Medicare-For-All: Action Plan!Medicare-For-All: Action Plan!Learn More: ResourcesConnectTheDotsUSA.com: Medicare-For-All presentationKaiser Family Foundation: kff.org (general health data)Physicians for a National Health Program: pnhp.orgHealthOverProfit.org and hcfat.org (HR 676 Calculator) FixItHealthcare.com Show Up: Push Medicare-For-All Into The Debate

Litmus Test: Must Pledge To Co-Sponsor Medicare-For-All For Your Vote; Support JusticeDemocrats.com Candidates

1

2

3

Former Rep. Alan Grayson quote from email of Jan 4, 2012©2012-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com • Updated 1/13/18

“For God’s sake — every single other industrialized country in the entire world has universal health care. Why can’t we?

How many more people have to die? How many more sacrifices on the altar of Almighty Greed?

Any health care system that denies necessary care on the basis of wealth is evil. It doesn’t matter how

you micromanage it, or tinker with it. It’s evil... End of story.”

— Former U.S. Representative Alan Grayson

PEOPLEOver ProfitsOver Profits

©2012

©2012

©2012

ConnectTheDotsUSA.com

CIVICS AND POLICY BASICS F O R T H E B U S Y M A J O R I T Y ™

“Busy Majority” said by Jon Stewart, Sept 2010 ©2010-2018 Design by Witte Design, LLC • Tucson, Arizona • ConnectTheDotsUSA.com

Presentation updated 12/6/18

Graphic updated 2/26/18

©2010

JOBSWAGESECONOMY

HEALTHCARE

©2012

BUDGETTAXES

©2011

VOTING

FRAMING

TheConnectThe Dots Lady™

Documents

· Source: Organization for Economic Cooperation Development, Health at a Glance 2017, Feb 2018 Fig 7.3 on pg 135 and Fig 7.1 on pg 133 (oecd.org)