The Evolving Health Policy Landscape: What s in Store for 2018

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1 The Evolving Health Policy Landscape: What s in Store for 2018 Winnetka Rotary November 16, 2018 Peter W. Butler Professor and Chairman, Department of Health Systems Management Rush University

2 Health Care Back in the Forefront

3 New End-Arounds Pushing for Greater Health Care Coverage Maine just resoundingly became the first state to expand Medicaid by ballot initiative Washington Post November 8, 2017

4 Tax Reform (Maybe), Then Along Comes a December 8 Government Shutdown? Potential issues on the December 8 government funding bill: Spending caps CHIP reauthorization (9 million kids with coverage) Obamacare CSR subsidies to stabilize marketplaces DACA (Dreamers) Funding for the border wall Hurricane relief Best bet may be another stop gap funding bill to punt issues to January

5 Government Versus Private Market Bernie Sanders Democrats Government Run Current State Private Market Medicare 55 million Medicaid 74 million Employer- Based 155 million Individual (exchanges) 18 million Republicans Rand Paul

6 How Many People Should Have Coverage? CBO Weighs In and Changes the Trajectory

7 Most Want Bi-Partisan Effort

8 Public Opinion Moving to the Left

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11 Where You Live Matters There is up to a 16-year gap in life expectancy between the Loop and West Side neighborhoods

12 Bi-Partisan Support for Addressing Drug Pricing

13 Current Balance of Power in Congress U. S. Senate 52 Republican 46 Democrat 2 Independent Paul Ryan (R-WI) Speaker of the House Kevin McCarthy (R-CA) Majority Leader Nancy Pelosi (D-CA) Minority Leader Mike Pence (R-IN) U.S. Vice President Senate President Mitch McConnell (R-KY) Majority Leader Chuck Schumer (D-NY) Minority Leader U. S. House of Representatives 240 Republican 194 Democrat 1 Vacant 13

14 Congressional Election Landscape

15 Congressional Election Landscape 2018 House Races 2018 Source: Roll Call 15

16 Illinois General Assembly D Illinois House 67 R 51 Seventy-one votes are needed to override a Governor s veto in the House. Illinois Senate D 37 R 22 Speaker Madigan Thirty-six votes are needed to override a Governor s veto in the Senate. President Cullerton 16

17 Illinois Election Landscape 2018 $200 Million Governor s Race??? Governor Bruce Rauner (R) incumbent J. B. Pritzker (D) candidate Chris Kennedy (D) candidate Bruce Rauner (age 60) is the 42nd Governor of Illinois. Prior to his election, he was the Chairman of R8 Capital Partners and Chairman of the private equity firm GTCR. On November 4, 2014, Rauner won the election, beating Democratic incumbent Pat Quin, with 50.27% of the vote. He carried every county except Cook. Rauner's net worth is estimated at several hundred million dollars. He accepts only $1 in salary and no benefits from his office. His philanthropic endeavors projects for the Red Cross, the YMCA, charter schools, and scholarship programs for disadvantaged public school students. He is a graduate of Dartmouth College and earned his MBA at Harvard University. He is the father of three children from his first marriage and three children with his wife, Diana, president of the non-profit Ounce of Prevention Fund. Jay Robert Pritzker (age 52) is managing partner and co-founder of the Pritzker Group, a private investment firm, and president of the Pritzker Family Foundation, which funds innovative research and programs serving children in poverty. He is a member of the well known Pritzker family who own the Hyatt Hotel chain. JB s estimated personal net worth is $3.4 billion. He graduated Duke University and Northwestern University School of Law. He is the father of two children with his wife of 24 years. Pritzker served as national co-chairman of the 2008 Hillary Clinton for President campaign and as a delegate to the 2008 & 2016 Democratic National Convention. He supported President Barack Obama in the 2008 general election and helped unite the Clinton and Obama campaigns in Illinois. In 1998, he finished third among five candidates in the Democratic primary in Illinois's 9th U.S. Congressional District. Chris Kennedy (age 54) is Chair of Joseph P. Kennedy Enterprises, Inc. He is a son of former U.S. Senator Robert F. Kennedy. His personal net worth is unknown, but the estimated Kennedy family net worth is $1 billion. He served as Chair of the Board of Trustees for the University of Illinois from 2009 to Until April 2012, he was president of Merchandise Mart Properties, a commercial property management firm. In May 2012, Kennedy founded Top Box Foods, a Chicagobased hunger-relief non-profit. He has served on the Executive Committee for the Chicago Community Trust, and has been a board member of the Catholic Theological Union, Interface, Inc. and Knoll Inc. He has also served as Chairman of the Board of the Greater Chicago Food Depository, and is a member of the board of trustees for Ariel Investments. Kennedy graduated Boston College and earned his MBA at Northwestern University. He is the father of four children with his wife of 30 years. 17

18 The move from volume to value The move away from a fee-for-service is growing as insurance risk tied to per capita spending is being passed along from government to insurers and providers. Over 30% of Medicare Beneficiaries Are Enrolled in a Medicare Advantage Health Plan

19 The Looming Impact of Baby Boomers Too Few Workers To Support Social Security and Medicare (Part A) through FICA