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1 D

2 Employer-based healthcare delivery system

3 U.S. Census Bureau Income, Poverty, and Health Insurance Coverage in the United States:Issued September P, Social Security Act End Stage Renal Disease ESRD, A B D,, CMS Center for Medicare Medicaid Service A B C D GDP

4 U.S. Census Bureau The Statistical Abstract, - Federal Outlays by Detailed Function A Hospital Insurance HI Social Security Tax Medicare Tax OASDI OASDI A Social Security AdministrationMedicare covered employment Quarter of Coverage QC OASDI ESRD OASDI A A,,

5 OASDI QC QC % A, A. A HI B D SMI A HI,, B Supplementary Medical Insurance SMI B A B B,, X A B X. B

6 HI SMI A B D C,,,, The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,, p.. A B A % B %

7 ,,,,,,,,,,,,,,,, Centers for Medicare & Medicaid Services, Medicare & You, p.. ; Social Security Administration, Monthly Medicare premiums for. SMI B D SMI % SMI SMI,,, C Balanced Budget Act of C C C A B D D

8 Medicare Prescription Drug Improvement and Modernization Act of D D A B A B, D FDA D D OASDI B D A B D,,,, %,,,,,,.,,,,.,,,,.,,. Centers for Medicare & Medicaid Services, Medicare & You, p..

9 D D Medicare Advantage D OASDI B D availability affordability D %

10 % B Patient Protection and Affordable Care Act PPACA PPACA PPACA PPACA

11 PPACA D % % PPACA Community Care Transition Program Center for Medicare & Medicaid Innovation Centers for Medicare and Medicaid Services Value-Based Purchasing program: VBP PPACA FPL Federal Poverty Level % % % FPL % %

12 Community First Option CMI patient's rights PPACA Pre-ExistingConditions HI SMI

13 PPACA,,. %. %. %. % B,,,, D PPACA %

14

15 PPACA Sponsored by Shanghai Pujiang Program U.S. Census Bureau Income, Poverty, and Health Insurance Coverage in the United States: Issued September The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds,, p.. OASDI Old-Age,Survivors,and Disability Health Insurance OASDI OASDI

16 Centers for Medicare & Medicaid Services, Medicare & You, September, p.. Centers for Medicare & Medicaid Services, op.cit., p. p. Centers for Medicare & Medicaid Services, op.cit., p. A B % p.. p.. D Susan Alder Channick, The Medicare Prescription Drug, Improovement, and Modernization Act of :Will It Be Good Medicine for U.S. Health Policy? ELDER L.J. Ken Frino, U.S. Health Review & Preview, A.M. BEST Special Report, January,. U.S. Department of Health & Human Services, The HHS Poverty Guidelines for the Remainder of, August. FPL Federal Poverty Level FPL,,, U.S. Department of Health& Human Services, The HHS Poverty Guidelines for the Remainder of, August. % % % % % Alex Wayne and Kathleen Hunter, Rough Road Ahead for Overhaul, CQ Weekly, November, Alex Wayne and Adriel Bettelheim, Tight Maneuvering on the Hill, CQ Weekly, March, Centers for Medicare & Medicaid Services, Medicare & You, September

17 Healthcare.gov Ken Frino, U.S. Health Review & Preview,A.M. BEST Special Report, January,. Michael Birnbaum and Elizabeth M. Patchias, Measuring Coverage for Seniors in Medicare Part A and Estimating the Cost of Making It Universal Journal of Health Politics, Policy and Law February Social Security Administration, Monthly Medicare premiums for. The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, The White House, HEALTH CARE Health Reform in Action visited September, U.S. Census Bureau Income, Poverty, and Health Insurance Coverage in the United States: Issued September pubs/p -.pdf U.S. Census Bureau, The Statistical Abstract U.S. Department of Health & Human Services, The HHS Poverty Guidelines for the Remainder of, August. poverty.shtml _.html

18 /Repmatsusyoshi.pdf

19 Elderly Healthcare Policy and Healthcare Reform in U.S. Medicare Linhui XU Abstracts This paper evaluates the achievement of U.S. Patient Protection and Affordable Care Act (PPACA) and predicts the future development of U.S Elderly healthcare policy. The implementation of the PPACA reduces the burden of medical expenses and Premium on patients. In addition, it contributes to improving the preventive medical service system and filling the Donut Hole formerly existing in Medicare. Given the analysis of this ongoing U.S. health insurance reform, we provide several recommendations for elderly healthcare policy reform in Japan as follows:1) Reduce medical expenses by enhance and expanding preventive healthcare service. 2) Provide patients more options of health insurance.3) Expand the health insurance for the elderly through increasing taxes on the wealthy and improving the quality and efficiency of the existing system Keywords Patient Protection and Affordable Care Act (PPACA), Medicare, Medical Expenses, Donut Hole, Elderly Healthcare Policy Correspondence to: Linhui XU Ph.D.(Ritsumeikan University, Japan) Visiting Scholar of Harvard University Associate Professor in Institute of National Economy, Shanghai Academy of Social Sciences, China 7/622 Huaihai Zhonglu, Shanghai , China

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