1. A not-for-profit
health and tax policy
research organization
What’s coming and
what it means for
medical practice
Grace-Marie Turner
September 25, 2012
Independent Physicians Network
/GalenInstitute
www.galen.org

2. www.galen.org

3. Source: Ari Melber,‖POLL: Half of Americans Don’t Know How Court Ruled on Healthcare,‖ The Nation, July 4, 2012,
http://www.thenation.com/blog/168720/poll-half-americans-dont-know-how-court-ruled-healthcare#.

4. Americans’ views
after Supreme Court decision
• Americans say the health law will make things
worse rather than better for taxpayers, businesses,
doctors, and those who currently have health
insurance.
• Health care will be an extremely or very important
issue for 82% of Americans in deciding their vote
for the president in November.
• Opposition to the law is higher now than before the
Supreme Court decision.
Sources: ―Americans: Healthcare Law Helps Some, Hurts Others ,‖ Gallup, July 16, 2012, http://www.gallup.com/poll/155726/Americans-Healthcare-Law-
Helps-Hurts-Others.aspx. The New York Times/CBS News Poll, July 11-16, 2012, http://s3.documentcloud.org/documents/402362/jul12a-ocr.pdf. ―Kaiser
Health Tracking Poll,‖ The Kaiser Family Foundation, July 2012, http://www.kff.org/kaiserpolls/upload/8339-C.pdf

5. Source: Kaiser Family Foundation, July 2012.

6. Americans agreed on goals for health reform…
• The U.S. needs health reform to:
– make coverage more affordable
– assure quality, and
– expand access to insurance
• Most people rate their own coverage as
good or excellent
• They want stability. Change is for others.
www.galen.org

9. Taxes and spending in ObamaCare
Source: Avik Roy, ―Fact-Checking the Obama Campaign's Defense of its $716 Billion Cut to Medicare,‖ Forbes: The Apothecary, August 16, 2012,
http://www.forbes.com/sites/aroy/2012/08/16/fact-checking-the-obama-campaigns-defense-of-its-716-billion-cut-to-medicare/.

10. Two issues:
Taxes. Trust.

11. ObamaCare’s New Taxes
Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

12. More ObamaCare Taxes
Source: Philip Dittmer and William McBride, ―Obamacare's New Taxes, And How You May Be Affected,‖ Tax Foundation, July 5, 2012,
http://taxfoundation.org/blog/obamacares-new-taxes-and-how-you-may-be-affected.

13. Obamacare's 7 Tax Hikes On
Under $250,000-A-Year Earners
Source: Ebeling, Ashlea, Forbes Staff - "Obamacare's 7 Tax Hikes On Under $250,000-A-Year Earners,‖
http://www.atr.org/important-numbers-obama-a7130.

14. The law fails to meet goals
• Health costs and health spending increase
• One-third of businesses may drop insurance
• Young people worried about high cost of policies
• Doctors concerned about Medicaid expansion
and fraying the safety net
• Seniors worried about rationing of care and
finding a doctor who takes Medicare
• 30 million will remain uninsured -- CBO
www.galen.org

15. Some realities
www.galen.org

19. Source: Frank Hill, ―The High Cost Impact of More Regulation and Admin/Executive Staff on Health Care Inflation,‖ Telemachus, July 22, 2012,
http://www.telemachusleaps.com/2012/07/the-high-cost-impact-of-more-regulation.html.

20. The AMA and practicing physicians
• The SGR Medicare payment fix was its
key bargaining chip
• The chance for a permanent fix is missed;
the president got the AMA endorsement
for an empty promise
• Budget concerns in the Congress mean
short-term fixes are likely to continue
www.galen.org

21. The Doctors Co. Survey:
– 60% say increased patient volume will
hurt the level of care they can provide
– 43% said they are thinking about
retiring in the next five years
– Nine out of ten said they would
discourage friends and family members
from pursuing a career in medicine
http://www.thedoctors.com/TDC/PressRoom/PressContent/CON_ID_004671

22. Physician concerns
• Questions about Accountable Care
Organizations
• Authority of HHS Secretary to set new
rules for quality of care
• Regulatory requirements impacting private
medical practices
• More burdensome record-keeping
www.galen.org

23. Specific changes to watch
• IPAB — the Independent Payment Advisory
Board
• Patient-Centered Outcomes Research
Institute and comparative effectiveness
―guidelines‖
• Physician Quality Reporting Initiative
• Value-based Payment Modifier
www.galen.org

24. CRS previews impact of health law on physicians
PPACA has the potential to change fundamental aspects of how
physicians organize, practice, and deliver care in the future.
• Some of these provisions create new structures and entities, like the
CMS Center for Medicare and Medicaid Innovation and the
Patient-Centered Outcomes Research Institute
• Others seek to develop alternatives to traditional fee-for-service
payment, such as the National Pilot Program on Payment Bundling, the
shared savings program (including the accountable care organization,
or ACO, model), or the value-based payment modifier under the
physician fee schedule
In the long run, these provisions combined have the potential to be the most
substantial of the PPACA and the Reconciliation Act modifications affecting
physicians and related providers.
Patricia A. Davis, Jim Hahn, Paulette C. Morgan, Julie Stone, and Sibyl Tilson, ―Medicare Provisions in the Patient Protection and Affordable Care Act,
(PPACA): Summary and Timeline,‖ November 3, 2010, http://www.politico.com/static/PPM191_timeline.html.

25. Health care in 2012
• Legislation
Depends upon the outcome of the election
• Regulation
13,000+ pages so far
• Legal
Many other court challenges continue
• Political
The voters will ultimately decide on Nov. 6
www.galen.org

26. Americans agreed on goals for health reform…
• The U.S. needs health reform to:
– make coverage more affordable
– assure quality, and
– expand access to insurance
• Most people rate their own coverage as
good or excellent
• They want stability. Change is for others.
www.galen.org

28. Even Europeans going the other way
• Consumerism
• Value of private enterprise
and competition
• Doctor-patient relationship
• Decentralized
decision-making
www.galen.org

29. A market-based solution
“Defined contributions” for health coverage
A system that puts doctors and patients in charge of
medical decisions
Restructuring financing for a 21st century health
sector
• Medicare
• Medicaid
• Private Insurance

30. Common themes
Focus on:
• Personal responsibility by recipients
• Better coordination of care
• Incentives for patient participation
• Doctors, not bureaucrats, decide
• Greater focus on patients

31. Why ObamaCare Is Wrong for America
How does the health care law
drive up costs?
Is your doctor really in charge of
your health care decisions?
Are your Constitutional rights
threatened?
Discover the law’s impact on
your life in a new book from
four nationally recognized
health policy experts
Published by Broadside Books,
an imprint of HarperCollins www.WrongForAmericaBook.com
www.galen.org

32. Grace-Marie Turner
A not-for-profit
health and tax policy
research organization
Galen Institute
703-299-8900
gracemarie@galen.org
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