1. Who Makes HC Policy?
a. State differences – access, price and coverage
b. Individuals affected –
i. 17M buy insurance
ii. 29M don’t have insurance
iii. MCare & Medicaid not affected – State expansion of Medicaid, but higher rates of inflation in Red States
2. Hospital Closures & Medicaid Expansion
a. ACA improving health care?
i. Hospitals closed in States rejecting Medicaid
1. States expanding Medicaid – lower and falling hospital closures
2. ACA – improved hospital financial performance w/lower probability of closure for rural markets and counties w/large amt of uninsured
3. Supreme Court left Medicaid expansion to the States
4. Hospital closure leads to loss of well-paying and skilled jobs
3. Wall Street – Another Option for Paying For Health Care Benefits
a. Sell wealth management to individuals
i. Lower cost method to gain new customers
ii. Morgan Stanley, Goldman, Fidelity, Charles Schwab, E*Trade, Amazon/JPMorgan/Berkshire Hathaway
iii. Wall St has the analytics to redeploy investment dollars to benefits
iv. Same as insurance brokers?
v. TPA/PBM – middleman model to transactional model
4. Geography Matters – John Wennberg, MD
a. Dartmouth Atlas of Health Care – cost of living, site of care, volume of services delivered, hospital/MD salaries
b. Example –
i. SF Chronicle reports cost in No. CA 30% > So. Ca d/t UC Berkeley Petris Center on Health Care Markets and Consumer Welfare
ii. Primary reasons -- D/t consolidation in hospitals, insurance and MD practices b/w 2010-2016 (adj for higher cost of living and wages)
iii. Result – mergers/acquisitions in health care = HP+PBMs, MD practices, Plans, Pharmacies lead to higher costs
iv. Marketplace competition, technology, telehealth, international competition, competitor ads leverage cost differences
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