A Roadmap for Achievable

Health Care Reform

Karen Ignagni
President and CEO
America’s Health Insurance Plans

November 13, 2007

Access Challenges
Uninsured Trends
Growth in Uninsured Rate from 2004 to 2005
(Percentage Points)

1.2

1.0

0.8

0.6

0.4

0.2

0.0
General Population Low Income (< Moderate Income Upper Moderate
$25,000) ($25,000 to $49,999) Income ($50,000 to
$74,999)

Source: Income, Poverty, and Health Insurance Coverage in the United States: 2005, Census Bureau.
Bumps in the Road: Quality Gaps

 Evidence Based Medicine: Immediate Improvements Necessary

 Results of Studies on the Adoption of Evidence Based Medicine

24% Diabetics who received recommended blood-sugar tests over a

2-year period
65% Hypertensive patients who received recommended care
68% Patients with coronary artery disease who received
recommended care
45% Patients with myocardial infarction who received beta-
blockers
64% Elderly patients who received or were offered a
Pneumococcal vaccine
Source: America’s Health Insurance Plans Issue Brief: Making Evidence-Based Medicine The Cornerstone of the
U.S. Health Care System
Quality Challenges
Variation in Medical Practice

Source: Congressional Budget Office Analysis of Medicare Spending Based Upon the Dartmouth Atlas
Trends
How Rising Costs Affect Coverage
Uninsured Rate
18

16

14

12
Private Health Insurance Premiums
Percent

10

6
National Health Expenditures
4

0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Source for Premiums and Expenditures: Centers for Medicare and Medicaid Services, National Health Expenditures by
Type of Service and Source of Funds. Source for uninsured: U.S. Census Bureau.
Cost Challenges
Technology Spending
U.S. Investment in Health Research and Development ($ Billions)

$120

$100

$80

$60

$40

$20

$0
82

84

86
87
88

90
91
92

96

98
99
00

02

04
83

85

89

93
94
95

97

01

03

05
19

19
19

19

19

19

20
19
19

19
19

19
19

19
19
19
19

19
19

20
20
20
20

20
Sources: NIH Data Book; Research!America, Investment in U.S. Health Research 2001, 2002, 2004 and 2005
Cost Challenges
Cost and Utilization of Care Drive Premium Growth

Source: The Factors Fueling Rising Healthcare Costs 2006; PricewaterhouseCoopers; 2006
Why is U.S. Health Care Spending So
High Compared to Other Nations?
Prevalence of Diseases and Lifestyle Choices
60%

50%

40%

30%

20%

10%

0%
Heart High Blood Cancer Diabetes Obese Never
Disease Pressure Smoked

United States Europe

Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October
2007
Why is U.S. Health Care Spending So
High Compared to Other Nations?
Proportion of Prevalent Cases Reporting Medication Use
Associated with the Condition
100%

80%

60%

40%

20%

0%
Heart Disease High Blood Pressure Chronic Lung High Cholesterol Asthma
Disease

United States Europe

Source: Differences in Disease Prevalence as a Source of the U.S.-European Health Care Spending Gap; Health Affairs; October
2007
What We Have Proposed
Addressing Access

Child Health Universal Health

Credit up to Account with
300% FPL subsidies up to
400% FPL

SCHIP up to Medicaid up to
200% FPL 100% FPL

State Performance Grant

What Voters Think of These Proposals
Ranked by Percent “Support” Rep Ind Dem
Giving a federal tax credit to low 85%
and moderate income parents 83% 83% 88%

Increasing funding for health

insurance program for children 77% 65% 75% 89%

Providing grants from the federal

government 71% 59% 69% 82%

Having the federal government

match contributions 69% 63% 67% 77%

Giving federal tax deduction for

purchase of private insurance 69% 75% 69% 68%

Expanding the federal

government’s Medicaid program 69% 54% 67% 82%

Establishing a tax-free Health

Account for all Americans 65% 66% 64% 65%

Question: Now I am going to read some different ideas that some people have proposed
for providing health care coverage for people who are currently uninsured. Would you please
tell me if you support or oppose each idea.
What We Have Proposed
Addressing Quality
 Create a new entity for comparative effectiveness

 Set a national research agenda to address gaps in evidence

 Accelerate efforts to give patients and their physicians the

necessary information to make value-based decisions

 Emphasize the adoption of best practices

 Develop innovative tools to help physicians and patients manage

chronic conditions

 Create a new medical dispute resolution system to resolve disputes

fast, fairly, and effectively
What We Have Proposed
Addressing Costs
 Disease management, care coordination and prevention
programs
 Pay for performance
 Investments in health information technology
 More information regarding the cost and quality of care
 Consideration of a reinsurance program to help pay for
experimental therapies to make emerging therapies more
accessible
 Medical liability reform
Conclusion
 The challenges are palpable to the public

 Health care is number one domestic policy issue among

voters

 Solutions must appeal to red, blue and purple electorate

 Must address costs, quality and access together to

enact effective reform