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Advocacy >  Regarding Health Care Reform

Last update: 04/21/2014

Reform Updates | Ground rules for Debates | Recognizing Misinformation |
  Background Data | Expert Perspectives NEJM

Affordable Care Act  Resources
for Patients
* Healthcare.gov: The ACA insurance exchange 

* NPR:  Understanding the ACA Marketplaces  | * Q&A

ahip.org, April 25, 2013:
Comprehensive Assessment of ACA Factors That Will Affect Individual Market Premiums in 2014 http://bit.ly/1md7vB8

PubMed - Medical Bankruptcy in the United States, 2007: Results of a National Study

"62.1% of all bankruptcies in 2007 were medical; ... Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. "
NEJM: Perspective - The $640 Billion Question — Why Does Cost-Effective Care Diffuse So Slowly?

by Victor R. Fuchs, Ph.D., and Arnold Milstein, M.D., M.P.H.
PBS.org - Health Care Systems -- The Four Basic Models
About the Affordable Care Act the Full Law by Section healthcare.gov
Insuring Your Health:
Looking At The Changes 2011 Brings

Michelle Andrews speaks with KFF's Jackie Judd about changes in lifetime insurance limits, keeping children insured, the new high-risk pools.  
Finder - which program meets your needs? http://finder.healthcare.gov/

Economic Rationale for Reform:

1) Rosenbaum, J.D., and Gruber, Ph.D. write:

"… the uninsured consume more than $50 billion in uncompensated care, the costs
of which are passed through health care institutions to insured Americans.
Moreover, medical expenses not covered by insurance are one of the leading
causes of bankruptcy in the United States ...

Source: NEJM, 2010, Buying Health Care, the Individual Mandate, and the
Constitution: http://bit.ly/9FElMG

2) CBO Publications Related to Health Care Legislation, 2009-2010 http://www.cbo.gov/ftpdocs/120xx/doc12033/12-23-SelectedHealthcarePublications.pdf

CBO Estimated Budgetary Impact of the Healthcare Legislation

"CBO and JCT estimate that enacting both pieces of legislation—H.R. 3590 and the reconciliation proposal—would produce a net reduction in federal deficits of $143 billion over the 2010–2019 period as result of changes in direct spending and revenues (see Table 1). That figure comprises $124 billion in net reductions deriving from the health care and revenue provisions and $19 billion in net reductions deriving from the education provisions. Approximately $114 billion of the total reduction would be onbudget; other effects related to Social Security revenues and spending as well as spending by the U.S. Postal Service are classified as off-budget. CBO has not completed an estimate of the potential impact of the legislation on discretionary spending, which would be subject to future appropriation action."


About CBO: http://www.cbo.gov/aboutcbo/factsheet.cfm


Health Insurers Break Profit Records
as 2.7 Million Americans Lose Coverage  http://bit.ly/92JBoC
NEJM: Buying Health Care, the Individual Mandate, and the Constitution http://bit.ly/9FElMG
NAIC: Why does the law require me to purchase health insurance coverage? 

"The key goal of the health care reform law is to ensure that nobody can be denied coverage or be priced out of coverage due to a health problem.

If you allow people to wait until they have a health problem to purchase insurance, the health insurance market simply will not work. There would be a small number of very expensive choices for everyone.

So, the law requires that everyone have minimum coverage, creating a larger pool of both sick and healthy individuals."
(NAIC: National Association of Insurance Commissioners)
More Q&A: http://bit.ly/9E5RKJ
About the NAIC (National Association of Insurance Commissioners) naic.org
Be Not Afraid, NEJM - Len M. Nichols, Ph.D.  http://bit.ly/aamAPV

"The objective truth is that we cannot begin to get our fiscal house in order until we control the growth of costs in Medicare, Medicaid, and the entire health care system. We cannot achieve this without government action.
Not a government takeover, but government action. Only government can rewrite the rules of private insurance markets so that insurers thrive by helping enrollees find high-value care, not by excluding the sick."
Kaiser Family Foundation:

Implementation Timeline http://bit.ly/bZlsbh | Summary http://bit.ly/aDHmgC 
What does the health-care law mean to me? http://bit.ly/d9XF4n

"This tool estimates what it could mean for your health coverage and taxes based on your income, family size and current insurance status."
ASCO on Patient Protection and Affordable Health Care Act http://bit.ly/94zNrl
CBS: A Look At What's in the Health Care Bill http://bit.ly/aAtl5f |

Text of Bill (Read it, before you critique it!)

Government Reports and Updates on Health Care Bill

Kaiser Family Foundation: Implementation Timeline http://bit.ly/bZlsbh 
Summary http://bit.ly/aDHmgC 
What does the health-care law mean to me? http://bit.ly/d9XF4n

"This tool estimates what it could mean for your health coverage and taxes based on your income, family size and current insurance status."
ASCO on Patient Protection and Affordable Health Care Act http://bit.ly/94zNrl
CBS: A Look At What's in the Health Care Bill http://bit.ly/aAtl5f | Text of Bill
Congressional Budget Office (CBO) projects Savings
statement of cost of current Health Care Bill, March 2010:

"CBO and JCT now estimate that, on balance, the direct spending and revenue effects of enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits of $118 billion over the 2010–2019 period.

Source:  http://www.cbo.gov/ftpdocs/113xx/doc11307/Reid_Letter_HR3590.pdf
 Health Care Costs and Trends of Journal- Health Affairs:

Increased health spending and decreased GDP combined to increase health care's share of the economy by 1.1 percent – the biggest one-year jump since the government began tracking the numbers in 1960. According to CMS economists writing in the journal, Health Affairs. Health expenditures are estimated to have consumed 17.3 percent of GDP last year.

Source: http://www.politico.com/static/PPM136_100203_health_projections.html
H. R. 3200 ‘‘America’s Affordable Health Choices Act of 2009’’  http://energycommerce.house.gov/Press_111/20090714/aahca.pdf 

Related documents

Another important conversation among experts … that won’t be read by the American public http://bit.ly/agMklW 
President Obama's statement and goals: whitehouse.gov

Ground rules for constructive debate

We ask that our representatives work in a cooperative manner so that cancer patients, and individuals facing other serious medical conditions, can receive high-quality care they urgently need in a timely manner ... today and in future. 

There's an urgent need to establish facts about the healthcare system and shared objectives, and to condemn the strategic dissemination of misinformation.  


Define terms


Cite references to study data

Forming opinion based on opinion of others

Write letters, raise hand

Shout down speakers

Respect and address opposing opinion

Demonize opposing persons and opinions

Read source documents: Verify facts from independent sources - non-partisan, expert, non-profit ...

Relying on interpretations of others without verifying facts

Risk/benefit analysis (trade offs)

Focus exclusive to risks or exclusive to benefits (black and white)


Non-expert: focus on questions

Non-expert: focus on judgment


Recognizing Bias and Misinformation

Arthur Caplan, Ph.D   http://www.msnbc.msn.com/id/32372258/ns/health-health_care/ 
Video: Fox News Kondracke blames Rush Limbaugh for inciting town hall disruptions examiner.com
Health Care 2009: "American Values" — A Smoke Screen in the Debate on Health Care Reform
New England Journal of Medicine, A. S. Brett Extract | FREE Full Text | PDF
Kill Grandma? Debunking A Health Bill Scare Tactic,
by Julie Rovner  NPR.org  | PAL Blog

Non-partisan Data / Background on US Health Care:

Based on published studies and expert testimony

  1. National Coalition on Health Care  http://nchc.org/facts-resources

    Founded in 1990, non-profit and rigorously non-partisan
  2. Impacts of Health Care Reform:

    KENNETH E.THORPE ,Ph.D . Robert W. Woodruff Professor and Chair
    Department of Health Policy and Management Rollins School of Public Health
    Emory University
  3. The Henry J. Kaiser Family Foundation. 
    The Uninsured: A Primer, Key Facts About Americans without Health Insurance. October 2006. www.kff.org/uninsured/
  4. Health Care Reform:  Cost of Failure http://bit.ly/93t0oi
    Robert Wood Johnson Foundation 

    Number of Uninsured Americans Could Reach 65.7 Million Within 10 Years

    "In the worst case scenario, the number of uninsured Americans would increase to 57.7 million in 2014 and to 65.7 million in 2019. In the best case, the number grows to 53.1 million in 2014 and 57 million in 2019. All of these estimates assume that states would continue to maintain current eligibility levels for public coverage. Without this, the number of uninsured would be even higher."
    THE ECONOMIC CASE FOR HEALTH CARE REFORM EXECUTIVE SUMMARY, June 2009  www.whitehouse.gov/administration/eop/cea/TheEconomicCaseforHealthCareReform/ 
  6. American Hospital Association. "Uncompensated Hospital Care Fact Sheet," November 2005.
  7. Center on Budget and Policy Priorities. 
    The Number of Uninsured Americans is at an All-Time High. 29 August 2006 www.cbpp.org/8-29-06health.pdf
  8. The Henry J. Kaiser Family Foundation. 
    Employee Health Benefits: 2008 Annual Survey. September 2008. www.kff.org/insurance/7672/index.cfm
  9. Institute of Medicine
    Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003 http://www.iom.edu/Report.asp?id=12313
  10. National Committee for Quality Assurance. The State of Health Care Quality, 2008, Industry Trends and Analysis. Washington, DC, 2007. The State of Health Care Quality 2008 is available to the public on NCQA’s Web site, www.ncqa.org/sohc 
  11. Health Plan Report Card, log on to http://reportcard.ncqa.org
  12. WHO ranking of Health Care Systems, 2000  http://www.who.int/whr/2000/en/whr00_en.pdf

    See table, on page 152: Annex Table 1 Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997
  13. Testimony of Wendell Potter, former Insurance Executive, Before the U.S. Senate Committee on Commerce, Science and Transportation pbs.org  

    "As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted."

Expert Perspectives: NEJM articles - links to free full text.

  1. NEW Experts on Health Care Reform 2009 at http://healthcarereform.nejm.org/ 
    Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., Debra Malina, Ph.D., and Jeffrey M. Drazen, M.D.

    "A growing series that currently includes almost 100 Journal articles and online features, a diverse group of authors representing all parts of the health care system and all points of view have wrestled with the issues the country faces. The articles provide thoughtful commentary on universal coverage, comparative-effectiveness research, outcomes research, health information technology, economic challenges and cost containment, and new delivery systems." nejm.org 

  2. Health Care Reform — Toward More Freedom, and Responsibility, for Physicians Harold S. Luft, Ph.D.  http://content.nejm.org/cgi/content/full/361/6/623  
  3. A Bumpy Road for Reform
    J. K. Iglehart Extract | FREE Full Text | PDF
  4. A Time for Revolutions — The Role of Clinicians in Health Care Reform
    A. Darzi Extract | FREE Full Text | PDF
  5. Achieving Health Care Reform — How Physicians Can Help
    E. S. Fisher, D. M. Berwick, and K. Davis  Extract | FREE Full Text | PDF
  6. Health Care 2009: Congressional Action on Health Care Reform — An Update
    J. K. Iglehart Extract | FREE Full Text | PDF
  7. Health Care 2009: A Lifeline for Primary Care
    T. Bodenheimer, K. Grumbach, and R. A. Berenson Extract | FREE Full Text | PDF
  8. Health Care 2009: Easing the Shortage in Adult Primary Care — Is It All about Money?
    R. Steinbrook Extract | FREE Full Text | PDF
  9. Health Care 2009: The Role of Medical Liability Reform in Federal Health Care Reform
    M. M. Mello and T. A. Brennan Extract | FREE Full Text | PDF
  10. Health Care 2009: A Win–Win Approach to Financing Health Care Reform
    J. Gruber Extract | FREE Full Text | PDF
  11. Health Care 2009: The Individual Mandate — An Affordable and Fair Approach to Achieving Universal Coverage
    L. J. Blumberg and J. Holahan Extract | FREE Full Text | PDF
  12. Health Care 2009: A Strategy for Health Care Reform — Toward a Value-Based System
    M. E. Porter Extract | FREE Full Text | PDF
  13. Finding Money for Health Care Reform — Rooting Out Waste, Fraud, and Abuse
    J. K. Iglehart Extract | FREE Full Text | PDF
  14. Prioritizing Comparative-Effectiveness Research — IOM Recommendations
    J. K. Iglehart Extract | FREE Full Text | PDF
  15. Comparative-Effectiveness Research — Implications of the Federal Coordinating Council's Report
    P. H. Conway and C. Clancy Extract | FREE Full Text | PDF
  16. Comparative Effectiveness — Thinking beyond Medication A versus Medication B
    K. G. Volpp and A. Das Extract | FREE Full Text | PDF
  17. Health Care 2009: The Burden of Health Care Costs for Working Families — Implications for Reform
    D. Polsky and D. Grande Extract | FREE Full Text | PDF
  18. Health Care 2009: "American Values" — A Smoke Screen in the Debate on Health Care Reform
    A. S. Brett Extract | FREE Full Text | PDF
  19. The Next Wave of Corporate Medicine — How We All Might Benefit
    D. M. Cutler Extract | FREE Full Text | PDF
  20. The Shifting Mission of Health Care Delivery Organizations
    R. M.J. Bohmer and T. H. Lee
    Extract | FREE Full Text | PDF
  21. Keeping the Patient in the Equation — Humanism and Health Care Reform
    P. Hartzband and J. Groopman Extract | FREE Full Text | PDF

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