The Patient Protection &
Affordable Care Act(PP ACA)
The Patient Protection &
Affordable Care Act(PP ACA)Will it Help
Public Health?Will it Help
Public Health?
American Association of American Association of Public Health PhysiciansPublic Health Physicians
San Francisco, CA, October 28, 2012San Francisco, CA, October 28, 2012
Jonathan Weisbuch, MD, MPHJonathan Weisbuch, MD, MPH
[email protected]@mac.com
Information Information ResourcesResources
Information Information ResourcesResources
• www.healthcare.govwww.healthcare.gov• www.healthcare.govwww.healthcare.gov
• www.aarp/getthefactswww.aarp/getthefacts• www.aarp/getthefactswww.aarp/getthefacts
• http://healthreform.kff.ohttp://healthreform.kff.orgrg
• http://healthreform.kff.ohttp://healthreform.kff.orgrg
• HR 3590: The Patient HR 3590: The Patient Protection and Protection and Affordable Care ActAffordable Care Act
• HR 3590: The Patient HR 3590: The Patient Protection and Protection and Affordable Care ActAffordable Care Act
• http://www.apha.org/NR/rdonlyres/http://www.apha.org/NR/rdonlyres/
• [email protected]@apha.org• [email protected]@apha.org
AgendaAgenda
History behind ACA Problems in the PH System PP ACA Benefits to Public Health
The Future: The Election of 2012
Will we Keep What We Have, Will we Keep What We Have, Regress, Regress,
Or Expand PH & Medicare for ALL?Or Expand PH & Medicare for ALL?
History behind ACA Problems in the PH System PP ACA Benefits to Public Health
The Future: The Election of 2012
Will we Keep What We Have, Will we Keep What We Have, Regress, Regress,
Or Expand PH & Medicare for ALL?Or Expand PH & Medicare for ALL?
Egypt & China John Adams: Merchant Seaman Act, 1798 Dorothea Dix & Franklin Pierce, 1854
Theodore Roosevelt: Bull Moose Party
Lyndon Johnson: Medicare & Medicaid Barack Obama: Affordable Care Act, 2010
Egypt & China John Adams: Merchant Seaman Act, 1798 Dorothea Dix & Franklin Pierce, 1854
Theodore Roosevelt: Bull Moose Party
Lyndon Johnson: Medicare & Medicaid Barack Obama: Affordable Care Act, 2010
History
Problems in American Problems in American MedicineMedicine
Problems in American Problems in American MedicineMedicine
Cost: $2.6 trillion in 2010 Access: 50 million uninsured Quality: US is #37 in World Profits outrank Service “Let the Market Decide” “No Socialized Medicine” “Repeal ‘ObamaCare’! ”
Cost: $2.6 trillion in 2010 Access: 50 million uninsured Quality: US is #37 in World Profits outrank Service “Let the Market Decide” “No Socialized Medicine” “Repeal ‘ObamaCare’! ”
Again, You have heard it all; so let’s go on!Again, You have heard it all; so let’s go on!
Federal Agencies: USDA, EPA, OSHA, FEMA, DEd, DEnerg, etc., and
DHHS: PHS (CDC, Prison Hlth, Niosh), FDA, INH, HRSA, etc.
Congress: Do they have a Clue? States: 55 Health Depts. Counties and Cities: 3000 Assns: ASTHO, NACCHO, APHA, AAPHP, etc.
Federal Agencies: USDA, EPA, OSHA, FEMA, DEd, DEnerg, etc., and
DHHS: PHS (CDC, Prison Hlth, Niosh), FDA, INH, HRSA, etc.
Congress: Do they have a Clue? States: 55 Health Depts. Counties and Cities: 3000 Assns: ASTHO, NACCHO, APHA, AAPHP, etc.
Problems in American PProblems in American Public Health Systemublic Health System
Problems in American PProblems in American Public Health Systemublic Health System
LEADERSHIP??LEADERSHIP??
Needs in American Public Needs in American Public Health SystemHealth System
Needs in American Public Needs in American Public Health SystemHealth System
PhysicalPhysical
Socio-Cultural-Socio-Cultural-EconomicEconomic BiologicBiologic
Health System
Health System
Air Pollution Air Pollution ControlControl
Occupational Occupational SafetySafety
Drinking Drinking WaterWater
Transportation Transportation SafetySafety
Health Ed & Health Ed & PromotionPromotion
School School Health Health Prison Prison Health Health
Food Food Safety Safety
Emergency Emergency Mgmt.Mgmt.Epidemic Epidemic ControlControl
Chronic Disease Chronic Disease ControlControl
Vital Vital Records Records
Pub Health Pub Health LabLab
VaccinVaccines es PH PH
ClinicClinics s
Family Family Planning Planning
STDs STDs
Climatic Climatic Hazards Hazards
Where does PH fit into a $2.6 Where does PH fit into a $2.6 trillion Health System?trillion Health System?
COMMUNITY
Public Public HealthHealth
Prim Prim CareCare
Sec Sec CareCare
Tert Tert CareCare
LTC LTC CareCare
Home Home CareCare
Pre- Pre- Hosp Hosp CareCare
Ambulatory
Care
Hospital
Care
$60 B $750 B $900 B $216 B $53 B< $50 B
2010 2010
CosCost:t:
(est)(est)Number:Number: 312million
16 million runs
587 millio
n vsts.
6 Mil Patients
35 Mil Admts.&
166 Mil Bd--Dys
3 Mil Patients
PreventionPrevention
451 million vsts.
The ACA has assigned $650 Million for PH &The ACA has assigned $650 Million for PH &Expanded Prevention Services Expanded Prevention Services
A.A. Community Prevention Community Prevention: $ 298 Mil. State & local: $ 222 Tobacco Prevention: $ 60 Obesity & Fitness: $ 16
B.B. Clinical Prevention Clinical Prevention: $ 182 Wellness & Prevention (vac): $ 112 Behavioral Health & 1O Care: $ 70
A.A. Community Prevention Community Prevention: $ 298 Mil. State & local: $ 222 Tobacco Prevention: $ 60 Obesity & Fitness: $ 16
B.B. Clinical Prevention Clinical Prevention: $ 182 Wellness & Prevention (vac): $ 112 Behavioral Health & 1O Care: $ 70
And More….And More….
How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?
C.C. PH Infrastructure & PH Infrastructure & Training: $ 137 MilTraining: $ 137 Mil PH Infrastructure: $ 40 PH Workforce: $ 45 PH Capacity: $ 52
D.D. Research & Tracking: Research & Tracking: $ 133$ 133 Healthcare Surveillance: $ 84 Prevention Research (USTFPS): $ 49
C.C. PH Infrastructure & PH Infrastructure & Training: $ 137 MilTraining: $ 137 Mil PH Infrastructure: $ 40 PH Workforce: $ 45 PH Capacity: $ 52
D.D. Research & Tracking: Research & Tracking: $ 133$ 133 Healthcare Surveillance: $ 84 Prevention Research (USTFPS): $ 49
How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?How are PH & Prevention Funds Allocated?
Total for Prevention: $ 650 MillionTotal for Prevention: $ 650 Million
COMMUNITY
Public Public HealthHealth
Prim Prim CareCare
Sec Sec CareCare
Tert Tert CareCare
LTC LTC CareCare
Home Home CareCare
Pre- Pre- Hosp Hosp CareCare
A.A.Tobacco & Obesity/Fitness Tobacco & Obesity/Fitness ($60 M)($60 M)
B.B. Wellness & Wellness & Behavioral Health Behavioral Health
($182)($182)
State & local State & local ($ ($ 222 M)222 M)
C.C.PH Training & PH Training & Infrastructure Infrastructure
($137)($137)
D.D. Health Care Surveillance & Prevention Health Care Surveillance & Prevention Research Research ($133)($133)
Are These Enough? NO!! But they are a START!Are These Enough? NO!! But they are a START!Are These Enough? NO!! But they are a START!Are These Enough? NO!! But they are a START!
Which Elements of the System will Benefit Which Elements of the System will Benefit from $650 Million from the ACA? from $650 Million from the ACA?
But First, let us Consider Who But First, let us Consider Who Gets Care & Who Generates CostsGets Care & Who Generates CostsBut First, let us Consider Who But First, let us Consider Who Gets Care & Who Generates CostsGets Care & Who Generates Costs
Healthy Insured
58%
14%14%
14%14%
16%16%
1.6%1.6%Population Distribution Health Expenditure %
$1.3 trillion$1.3 trillion 58% 58%
15%15%
$335 billion
19%$450 billion 4%
InsuredInsured (Healthy): 165 million165 million
InsuredInsured (Unhealthy):(Unhealthy): 42 million42 million
Medicare, Elderly: 42 million42 million
Medicare, SSI: 4.8 million4.8 million
Uninsured: Uninsured: 48 million48 million
30% of Population: 30% of Population: the Elderly & Unhealthy Insured
uses 81% of Resourcesuses 81% of Resources
25% of Insured (25% of Insured (50 million50 million) ) are on Medicaidare on Medicaid
Now Let us ask: “Where Do We In Public Health go from
Here?
Ancients: Egypt/ China
Ancients: Egypt/ China
2013
?2013
?Merchant Seaman
1798
Merchant Seaman
1798
Medicare/ Medicaid
1965
Medicare/ Medicaid
1965
Affordable Care Act
2010
Affordable Care Act
2010
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are needed to see this picture.
The SCOTUS Ruling on the The SCOTUS Ruling on the ACA May HelpACA May Help
The SCOTUS Ruling on the The SCOTUS Ruling on the ACA May HelpACA May Help
What About TAXES?What About TAXES?What About TAXES?What About TAXES?
Congress may use a Tax to Achieve its OBJECTIVE
IMPLICATION for Pub Hlth A Tax can be used for PH goals
A Tax can Influence Behavior Tax is triggered by a Situation
Invites Targetted Taxes
Congress may use a Tax to Achieve its OBJECTIVE
IMPLICATION for Pub Hlth A Tax can be used for PH goals
A Tax can Influence Behavior Tax is triggered by a Situation
Invites Targetted Taxes
Some ExamplesSome ExamplesSome ExamplesSome Examples Tax on Tanning Salons Tax on Pollution Taxes on Tobacco & Alcohol Or a TAX on PEOPLE who SMOKE A Tax on Body Mass, Or a Tax Credit for Weight LOSS
Or a Credit for Vaccinating Children
And More….
Tax on Tanning Salons Tax on Pollution Taxes on Tobacco & Alcohol Or a TAX on PEOPLE who SMOKE A Tax on Body Mass, Or a Tax Credit for Weight LOSS
Or a Credit for Vaccinating Children
And More….Ref: Mello, MM, & Cohen, IG, NEJM.org, Oct 17, 2012
But Caveats ExistBut Caveats ExistBut Caveats ExistBut Caveats Exist
Taxes can be used for PH Goals
But they can be Blocked as Well
Legislatures do not always Agree
Nor do the VOTERS who may Balk
Taxes can be used for PH Goals
But they can be Blocked as Well
Legislatures do not always Agree
Nor do the VOTERS who may Balk
BUT the Supreme Court Decision BUT the Supreme Court Decision
Will Not Determine the FUTUREWill Not Determine the FUTURE
The 2012 Election The 2012 Election
will Determine the will Determine the
FutureFuture
The 2012 Election The 2012 Election
will Determine the will Determine the
FutureFuture
Four Options ExistFour Options Exist
Option #1 Option #1 (similar to 111th (similar to 111th Congress)Congress)
Option #1 Option #1 (similar to 111th (similar to 111th Congress)Congress)
US House: US House: RepublicanRepublican
Rep: 256Rep: 256Dem: 178Dem: 178
US Senate: US Senate: DemocraticDemocratic
Rep: 46Rep: 46Dem: 52Dem: 52
Ind: 2Ind: 2
Presidency: Obama, Democrat
Option #2 Option #2 (House & Senate go (House & Senate go RED)RED)
Option #2 Option #2 (House & Senate go (House & Senate go RED)RED)
US House stays US House stays RepublicanRepublican
Rep: 256Rep: 256Dem: 178Dem: 178
US Senate goes US Senate goes RepublicanRepublican
Rep: 52Rep: 52Dem: 46Dem: 46
Ind: 2Ind: 2
Presidency: Obama is Re-elected
Option #3Option #3Option #3Option #3
US House: US House: RepublicanRepublican
Rep: 256Rep: 256Dem: 178Dem: 178
US Senate: US Senate: RepublicanRepublican
Rep: 53Rep: 53Dem: 46Dem: 46
Ind: 1Ind: 1
President: Romney & VP:
Ryan
Option #4Option #4Option #4Option #4
US HouseUS House
Dem: 225 Dem: 225 Rep: 205Rep: 205
US SenateUS SenateDem: 55 Dem: 55 Rep: 44Rep: 44Ind: 1Ind: 1
President O O b a m ab a m a
Is Re-Is Re-electedelected
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Given Four Options, Given Four Options, What is the FUTURE What is the FUTURE for Public Health & Health Care after for Public Health & Health Care after
2012?2012?
Given Four Options, Given Four Options, What is the FUTURE What is the FUTURE for Public Health & Health Care after for Public Health & Health Care after
2012?2012?
RepublicansRepublicans will Repeal will Repeal ACAACA; ;
Privatize Privatize
MedicareMedicare and and Eliminate Eliminate
MedicaidMedicaid
Affordable Care Affordable Care Act will be Solid; Act will be Solid;
Medicare Medicare for Allfor All; ; might might
be Considered.be Considered.
MedicaidMedicaid, WHO , WHO KNOWS?? KNOWS??
Option 1 or 2: Who Knows? More Gridlock?Option 1 or 2: Who Knows? More Gridlock?
Option 3: Option 4:
PUBLIC HEALTH. PUBLIC HEALTH. Could ProsperCould Prosper
If Public Health is to If Public Health is to Prosper, We Must Achieve Prosper, We Must Achieve
Option #4Option #4
If Public Health is to If Public Health is to Prosper, We Must Achieve Prosper, We Must Achieve
Option #4Option #4 We must then work with Congress; through AMA, AMA, APHA, NACCHO, ASTHO, APHA, NACCHO, ASTHO, APPHPAPPHP
We must continue to work our local POLITICALPOLITICAL Game,
If Obama loses, we will be in entrenchment mode.
We must then work with Congress; through AMA, AMA, APHA, NACCHO, ASTHO, APHA, NACCHO, ASTHO, APPHPAPPHP
We must continue to work our local POLITICALPOLITICAL Game,
If Obama loses, we will be in entrenchment mode.
We Must Work to Improve the We Must Work to Improve the ACA. Work to Prevent RepealACA. Work to Prevent Repeal
Regardless of the Regardless of the ElectionElection
Regardless of the Regardless of the ElectionElection
BUT WE WILL SURVIVEBUT WE WILL SURVIVE
Questions?Questions?
& Discussion& Discussion
HistoryEgypt: ~2500 BCE; Health Insurance (?)Egypt: ~2500 BCE; Health Insurance (?)
And China: ~1600 BCE; HMOs (?)
US HistoryUS History
Signed into Law, the Merchant Seaman’s Act of Merchant Seaman’s Act of 17981798, which Required all Seaman to buybuy Insurance
giving the US the resources to create a Federal Health System in all US Seaports, serving Seamen and other Federally qualified groups,
President John Adams, 1798
It became the basis for the It became the basis for the Public Health Service; and Public Health Service; and the VA Hospital System.the VA Hospital System.
Early 20th Century Early 20th Century HistoryHistory
TR, Franklin & HarryTR, Franklin & Harry
All failed to pass Universal Health CareAll failed to pass Universal Health Care
1912 1937 1949
More History
LBJ: In 1964 the Election Mattered
LBJ: In 1964 the Election Mattered
And LBJ signed Medicare & Medicaid And LBJ signed Medicare & Medicaid in Independence, MO, July 30, 1965in Independence, MO, July 30, 1965
Painful History
ClintonClinton: 1993-94
QuickTime™ and a decompressor
are needed to see this picture. The Failure of Clinton’s The Failure of Clinton’s Health Reform Legislation, Health Reform Legislation, opened the Flood Gates to opened the Flood Gates to
an Expanded Private an Expanded Private Health Insurance IndustryHealth Insurance Industry
And Yesterday’s History
President Obama, in 2010,
with a Democratic Majority in the House and Senate
Signed the Patient Patient
Protection Protection Affordable Care Affordable Care
Act, ACAAct, ACA
March 23, 2010
Fundamental Issues in Health Fundamental Issues in Health Care that ACA will try to SolveCare that ACA will try to SolveFundamental Issues in Health Fundamental Issues in Health
Care that ACA will try to SolveCare that ACA will try to Solve
CostCost
AccessAccess
QualityQuality
40 to 50 million Americans
are UninsuredUninsured
Docs, Pts, Hosps, are
all FrustratedFrustrated
17% of GNP 17% of GNP and rising and rising
Below 37 other Below 37 other nationsnations Too much Service, not enough BenefitToo much Service, not enough Benefit
150,000 unnecessary deaths a year150,000 unnecessary deaths a year Infant Mortality: High, especially in MinoritiesInfant Mortality: High, especially in Minorities Life Expectancy: Below Japan, Europe, CanadaLife Expectancy: Below Japan, Europe, Canada
AccessAccess for 310 million CostCost Reduction QualityQuality Improvement:
Longer Life, Lower Infant Mortality, Lower Chronic Disease by Age
Expanded Primary Care More Preventive Services
AccessAccess for 310 million CostCost Reduction QualityQuality Improvement:
Longer Life, Lower Infant Mortality, Lower Chronic Disease by Age
Expanded Primary Care More Preventive Services
WHERE Do WE Want to BE?WHERE Do WE Want to BE?(Goals)(Goals)
WHERE Do WE Want to BE?WHERE Do WE Want to BE?(Goals)(Goals)
2012:2012: Elect Progressives in November Elect Progressives in November 2013:2013: Federalize Medicaid early Federalize Medicaid early
Cover Cover ALLALL Pregnant Women & Infants Pregnant Women & Infants Expand Medicare Coverage to Expand Medicare Coverage to LTC & NHsLTC & NHs Increase Payroll Deduction to 4.0% and Increase Payroll Deduction to 4.0% and
Eliminate FICA Cap of $106,000Eliminate FICA Cap of $106,000 --> --> $320± B$320± B Enact a Financial Activity Transfer Tax: Enact a Financial Activity Transfer Tax: $0.50/shr --> ~ $550 billion/ $0.50/shr --> ~ $550 billion/ year from NYSEyear from NYSE
Total Input to Medicare Trust Fund: ~ $900 BTotal Input to Medicare Trust Fund: ~ $900 B
2012:2012: Elect Progressives in November Elect Progressives in November 2013:2013: Federalize Medicaid early Federalize Medicaid early
Cover Cover ALLALL Pregnant Women & Infants Pregnant Women & Infants Expand Medicare Coverage to Expand Medicare Coverage to LTC & NHsLTC & NHs Increase Payroll Deduction to 4.0% and Increase Payroll Deduction to 4.0% and
Eliminate FICA Cap of $106,000Eliminate FICA Cap of $106,000 --> --> $320± B$320± B Enact a Financial Activity Transfer Tax: Enact a Financial Activity Transfer Tax: $0.50/shr --> ~ $550 billion/ $0.50/shr --> ~ $550 billion/ year from NYSEyear from NYSE
Total Input to Medicare Trust Fund: ~ $900 BTotal Input to Medicare Trust Fund: ~ $900 B
HOW Do WE Get THERE?HOW Do WE Get THERE?(Phase I)(Phase I)
HOW Do WE Get THERE?HOW Do WE Get THERE?(Phase I)(Phase I)
20142014: Expand : Expand MedicareMedicare Age Eligibility: Age Eligibility: Add 50 to 65 age group;Add 50 to 65 age group; Add 1 to 20 year olds to eligible groupAdd 1 to 20 year olds to eligible group Increase FICA to 7% of Payroll --> $560 B ± Increase FICA to 7% of Payroll --> $560 B ±
20152015: Make 35 to 50 : Make 35 to 50 MedicareMedicare Eligible Eligible Increase Payroll Deduction to 8.5% (+ $120 B)Increase Payroll Deduction to 8.5% (+ $120 B)
20162016: Add 20 to 35 to : Add 20 to 35 to MedicareMedicare Eligibility Eligibility Increase Payroll Deduction to 11% --> ~ $1,100 BIncrease Payroll Deduction to 11% --> ~ $1,100 B Total Annual Input to MTF: $900 + $550 + $350* =Total Annual Input to MTF: $900 + $550 + $350* =
$2,000 Billion$2,000 Billion* General Fund for Medicaid Costs* General Fund for Medicaid Costs
20142014: Expand : Expand MedicareMedicare Age Eligibility: Age Eligibility: Add 50 to 65 age group;Add 50 to 65 age group; Add 1 to 20 year olds to eligible groupAdd 1 to 20 year olds to eligible group Increase FICA to 7% of Payroll --> $560 B ± Increase FICA to 7% of Payroll --> $560 B ±
20152015: Make 35 to 50 : Make 35 to 50 MedicareMedicare Eligible Eligible Increase Payroll Deduction to 8.5% (+ $120 B)Increase Payroll Deduction to 8.5% (+ $120 B)
20162016: Add 20 to 35 to : Add 20 to 35 to MedicareMedicare Eligibility Eligibility Increase Payroll Deduction to 11% --> ~ $1,100 BIncrease Payroll Deduction to 11% --> ~ $1,100 B Total Annual Input to MTF: $900 + $550 + $350* =Total Annual Input to MTF: $900 + $550 + $350* =
$2,000 Billion$2,000 Billion* General Fund for Medicaid Costs* General Fund for Medicaid Costs
Getting THERE: Getting THERE: (Phase II(Phase II ) )
Getting THERE: Getting THERE: (Phase II(Phase II ) )
2011 is Where We Begin2011 is Where We Begin2011 is Where We Begin2011 is Where We Begin
$450 B
Medical Costs
$100 B$100 B
$350 B
$400 B
$300 B
$20 B$20 B
1,000,0001,000,000
$30 B$30 B
$70 B$70 B
$250 B
$250 B
309,500,000 $2,000 B
Population UninsuredAge Gps 2013
80 - 8575- 80 42,386,118 0% - 70- 7565- 7060- 6555- 60 47,532,368 13% 6,179,208 50- 5545- 5040- 45 70,884,743 18% 12,404,830 35- 4030- 3525- 30 64,176,375 30% 13,512,912 20- 25 -4,100,00015- 20 44,211,683 0% - 10- 155 - 10 42,887,656 0% - 1 - 5
Total Population: 312,078,943 Female Male Total Uninsured 27,996,950
% Uninsured 9.0%
Reduction in Uninsured 21,789,926
Annual Cost
Billions
$450
$120
$ 16
$686Total
2013 to 2014
Total Reduction in Uninsured:
Reduces # of Uninsured Mothers & Children by 13.5 millionReduces # of Uninsured Mothers & Children by 13.5 million
2013-14
If Democrats are ElectedIf Democrats are ElectedIf Democrats are ElectedIf Democrats are Elected
(4,000,000)(4,000,000)
Population UninsuredAge Gps 2014 to 2016
80 - 8575- 80 42,386,118 0% - 70- 7565- 7060- 6555- 60 47,532,368 0% - 50- 5545- 5040- 45 70,884,743 18% 12,404,830 35- 4030- 3525- 30 64,176,375 30% 17,612,912 20- 2515- 20 44,211,683 0% - 10- 155 - 10 42,887,656 0% - 1 - 5
Total Population: 312,078,943 Female Male Total Uninsured 30,017,742
% Uninsured 9.6%
Reduction in Uninsured 6,179,208
In 2014: Add 50 to 65 year olds
4a.4a.
Annual Cost
Billions
$465
$120
$ 16
$931Total
$330
2015 to 2016
Total Reduction in Uninsured: 19,769,134
Next 2 yrs.
Population UninsuredAge Gps 2016 to 2018
80 - 8575- 80 42,386,118 0% - 70- 7565- 7060- 6555- 60 47,532,368 0% - 50- 5545- 5040- 45 70,884,743 0% - 35- 4030- 3525- 30 64,176,375 30% 17,612,912 20- 2515- 20 44,211,683 0% - 10- 155 - 10 42,887,656 0% - 1 - 5
Total Population: 312,078,943 Female Male Total Uninsured 17,612,912
% Uninsured 5.6%
Reduction in Uninsured 12,404,830
In 2016: Add 35 to 50 year olds
4b.4b.
Annual Cost
Billions
$490
$120
$ 16
$1,186Total
$332
$355
2017 to 2018
Total Reduction in Uninsured: 32,173,964
Years 5 & 6
Population UninsuredAge Gps 2018 to 2020
80 - 8575- 80 42,386,118 0% - 70- 7565- 7060- 6555- 60 47,532,368 0% - 50- 5545- 5040- 45 70,884,743 0% - 35- 4030- 3525- 30 64,176,375 0% - 20- 2515- 20 44,211,683 0% - 10- 155 - 10 42,887,656 0% - 1 - 5
Total Population: 312,078,943 Female Male Total Uninsured -
% Uninsured 0.0%
Reduction in Uninsured 12,404,830
In 2018: Add 20 to 35 year olds
4c.4c.
17,612,912
Annual Cost
Billions
$504+ ($300)
$120
$ 211
Total
$336
$355
Final 2 years
$1,826
Total Reduction in Uninsured: 49,786,876