Transcript Significance of Federal Policy as it Impacts Advocacy in

Is a Healthcare Tsunami
Really Here?
Cancer Center Administrators Forum
Harry Holmes, Ph.D.
In Health Care, it was HR 3590
Patient Protection and Affordable Care Act
Sponsor: Rep. Charles B. Rangel [NY-15] Cosponsors (40)
9/17/2009 Introduced in House
10/8/2009 Passed/agreed to in House: Agreed to by the
yes and Nays: (2/3 required): 416 - 0
12/24/2009 Passed/agreed to in Senate: Passed Senate with
an amendment and an amendment to the
Title by Yea-Nay Vote. 60 - 39.
3/21/2010 Resolving differences -- House actions: On
motion that the House agree to the Senate
amendments Agreed to by vote: 219 – 212.
HR 3590 (cont.)
3/21/2010
3/22/2010
3/23/2010
3/23/2010
Cleared for White House
Presented to President
Signed by President
Became Public Law No: 111-148
HR 3590 and HR 4872 when merged became the
Accountable Care Act (ACA)
Health Reform Law (2) – H.R. 4872
• Health Care and Education Reconciliation Act of
2010 by Rep. John M. Spratt, Jr. [SC-5].
• Introduced 3/17/2010
Became Public Law No: 111-152
• Made a number of health-related
financing and revenue changes to the Patient
Protection and Affordable Care Act
(H.R.3590) and modified
higher education assistance provisions
H.R. 4872 (cont.)
• Passed Senate w amendments by vote: 56 –
43, 3/25/2010
• Resolving differences --House agreed to the
amendments vote: 220 – 207, 3/25/2010
• Signed by President, 3/30/10
• Together, H.R. 3590 and 4872 are called the
“Accountable Care Act” (ACA)
ACA in 2010
● Review of Health Plan Premium Increases
● Changes in Medicare Provider Rates
● Medicaid and CHIP Payment Advisory
Commission
● Comparative Effectiveness Research
● Prevention and Public Health Fund
● Medicare Beneficiary Drug Rebate
● Small Business Tax Credits
● Medicaid Drug Rebate
HR in 2010, cont.
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Coordinating Care for Dual Eligibles
Generic Biologic Drugs
New Requirements on Non-profit Hospitals
Medicaid Coverage for Childless Adults
Reinsurance Program for Retiree Coverage
Pre-existing Condition Insurance Plan
New Prevention Council
Consumer Website
Tax on Indoor Tanning Services, Medicaid
Coverage of Smoking Cessation
HR – Year 1, cont.
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Expansion of Drug Discount Program
Adult Dependent Coverage to Age 26
Consumer Protections in Insurance
Insurance Plan Appeals Process
Coverage of Preventive Benefits
Health Centers, National Health Service Corps
Coverage of costs of clinical trials
Health Care Workforce Commission
Medicaid Community-Based Services
HR – Year 1, cont.
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Minimum Medical Loss Ratio for Insurers
Closing the Medicare Drug Coverage Gap
Medicare Payments for Primary Care
Medicare Prevention Benefits
Center for Medicare and Medicaid Innovation
Medicare Premiums for Higher-Income
Beneficiaries
• Medicare Advantage Payment Changes
• Medicaid Health Homes
HR – Year 1, cont.
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Chronic Disease Prevention in Medicaid
CLASS Program
National Quality Strategy
Changes to Tax-Free Savings Accounts
Breast Cancer Education, Research and
Prevention
• Creates Cures Acceleration Network (CAN)
in NIH for translational research
Health Reform – Year One
Highlights
• March 23, 2010 - President signs reform law
• Same day, governors and attorneys general in
19 states challenge individual mandate in
Florida federal court
• Virginia AG Ken Cuccinelli files his own
lawsuit in Virginia.
• June 10 - "early deliverable“ for seniors: $250
Medicare prescription drug rebate checks
mailed
• 4 million beneficiaries expected to receive
checks to fill prescription drug "doughnut hole"
HR – Year 1, cont.
• June 22 - Three-month anniversary of ACA
• ACA Patient's Bill of Rights - new patient
protection released
• New regulations cover annual, lifetime limits
on benefits, rescissions, pre-existing conditions
for children, consumers' choice of MD and
access to out-of-network emergency care
• September - New regs prohibit health plans
from denying coverage to sick children
• Benefits suffer setback when plans stop issuing
new children-only policies in 29 states
HR – Year 1, cont.
• October - OCIIO grants 30 temporary waivers
from the law's $750,000 floor on annual benefits.
It has granted more than 1,000 waivers covering
2.6 million people to date
• Nov. 2 - Democrats suffer major losses at the
polls, losing 63 seats in the House and six in the
Senate. Repealing healthcare reform is a key
platform for Republicans.
Election 2010
● US Senate
● Pre-election: 60-40 Democratic Caucus
Majority (with Lieberman and Sanders)
● Post-election: 57-43 Democratic Caucus
● House
● Pre-election: 257-178 Democratic Majority
● Post-election: 242-193 Republican Majority
Senate Leadership - 2011
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Sen. Harry Reid (D-Nev.), Majority Leader
Sen. Richard Durbin (D-Ill.), Majority Whip
Sen. Mitch McConnell (R-Ky.), Minority Leader
Sen. Jon Kyl (R-Ariz.), Minority Whip
Senate Cmte Leadership - 2011
Appropriations Committee
• Sen. Daniel K. Inouye (D-Hawaii), Chair
• Sen. Thad Cochran (R-Miss.), Ranking
Appropriations Labor-HHS Subcmte
• Sen. Tom Harkin (D-Iowa), Chair
• Sen. Richard Shelby (R-Ala.), Ranking
Committee on Health, Education, Labor and Pensions
(HELP)
• Sen. Tom Harkin (D-Iowa), Chair
• Sen. Michael B. Enzi (R-Wy.), Ranking
House Leadership - 2011
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Rep. John Boehner (R-Ohio), Speaker
Rep. Eric Cantor (D-Va.), Majority Leader
Rep. Kevin McCarthy (R-Calif.), Majority Whip
Rep. Nancy Pelosi (D-Calif.), Minority Leader
Rep. Steny Hoyer (D-Md.), Minority Whip
House Cmte Leadership - 2011
Appropriations Committee
• Rep. Harold Rogers (R-Ky.), Chair
• Rep. Norm Dicks (D-Wash.), Ranking
Appropriations HHS Subcmte
• Rep. Denny Rehberg (R-Mont.), Chair
• Rep. Rosa DeLauro (D-Conn.), Ranking
Energy and Commerce Committee
• Rep. Fred Upton (R-Mich.), Chair
• Rep. Henry Waxman (D-Calif.), Ranking
HR – Year 1, cont.
• Nov. 5 - HHS announces choice of high-risk
pool plans for patients with pre-existing
conditions
• About 12,000 enrolled in pools during the first
six months, even though millions are eligible.
• Jan. 19 - House Republicans fulfill their
electoral promise and repeal healthcare reform,
245-189
• Only three Democrats — Reps. Dan Boren (OK),
Mike McIntyre (NC) and Mike Ross (AR) — join
all GOP members to vote for repeal.
HR – Year 1, cont.
• Jan. 31, 2011 - Federal judge in Florida strikes
down entire ACA
• Sets up Supreme Court showdown, possibly as
early as this summer
• Judge in Virginia struck down the ACA
individual mandate
• Three judges — in Michigan, Virginia and
District of Columbia found ACA constitutional.
• Feb. 2 - Vote to repeal in the Senate fails on a
47-51 party-line vote.
ACA Legal Scorecard
Tracking the status of 25 cases:
● Court overturned law or part of law: 2 cases
● Court ruled law constitutional and dismissed case: 6
cases
● Court dismissed for lack of standing or procedural
problems: 4 cases
● Court dismissed but gave plainiff right to refile: 1 case
● Court decision pending: 12 cases
OPT OUT –
Be careful what you ask for!
• Feb. 28, 2011 - President announces support for
bipartisan legislation allowing states to apply as
early as 2014 for a waiver from certain
requirements of the law, including its
individual mandate
Opt Out (cont.)
• In speech to NGA President supports legislation
allowing states waivers for alternatives to ACA
• States could opt out, beginning in 2014, from the
requirement that individuals buy insurance
• Polls show mandate is deeply unpopular with the
public
• Opt out bill is S. 248 by Sens. Ron Wyden (D-OR),
Scott Brown (R-MA) and Mary Landrieu (D-LA)
• Would let states opt out of many of ACA mandates in
2014
Gotcha!
• Waiver provision comes with a catch
• State’s waiver proposal must show that it is
capable of providing coverage that is at least as
comprehensive and affordable as that offered
through new state-run health insurance
exchanges, which also open in 2014
• The state must also provide coverage to as
many residents as the exchanges would have,
and the proposal must not increase the federal
deficit
HHS Opt Out
• March 12 - Department of Health and Human
Services (HHS) issued rules for states that want
to opt out of certain requirements under the
ACA and instead implement their own
insurance reform
• States can receive a "state innovation waiver"
that allows them to opt out of some federal
requirements in the ACA starting in 2017 if they
successfully enact a state-specific plan to cover
as many people as the ACA would cover, at a
similar cost
HHS Opt Out, cont.
• States could create own system
• Would receive federal money that would have
otherwise been spent there to provide insurance
subsidies to residents who couldn't afford to
buy insurance on their own.
• ACA bars insurance companies from imposing
lifetime limits on plans. It also requires them to
cover young adults on their parents' plans until
their 26th birthday; cover preventive services
with no cost-sharing; and have medical loss
ratio of at least 80%
HHS Opt Out, cont.
• In 2014, more provisions, like expansion of preexisting medical condition prohibition take
effect
• States receiving a waiver would be required to
keep those insurance company provisions in
place
• Each application from a state seeking a waiver
must explain state plan will meet goals of
coverage expansion, affordability, coverage
comprehensiveness, and lower costs
Opt Out, cont.
• State must also provide actuarial certification
and economic analyses to prove plan will meet
ACA requirements
• Analysis of what happens to a resident’s access
to healthcare services when leaving state
• How plan will deter waste, fraud, and abuse
• Submit quarterly reports that track how state
plan is performing
Another HHS ACA Waiver
• March 8 - Maine is first state to get a waiver from
medical-loss ratio requirement
• Requires individual and small-group plans to spend
at least 80 percent of premiums on healthcare benefits
or give consumers a rebate
• Six other states — Georgia, Florida, Kentucky,
Nevada, New Hampshire and North Dakota — have
applications pending
An After Shock Hits NCI
• Feb. 8 - at National Cancer Advisory Board
meeting, NCI Director Harold Varmus said
cuts to NCI programs were coming
• Varmus indicated he was considering
reductions to cancer center awards, contracts
and inflationary increases for non-competitive
awards
Varmus, cont.
• Varmus said top priorities will be:
• Sustain the same number of new grant awards
in FY2011 as was awarded in each of the past
two years,
• Ensure cancer genomics programs are
supported
• Pay for the ongoing improvements to the
clinical trials program.
President’s Budget
• Feb. 14 President submitted FY 2012 budget to
Congress
• For NIH, the President's budget proposed
$31.748 billion, an increase of $745 million (2.4
percent) over the FY 2010 funding level
• NIH projects the Biomedical Research and
Development Price Index (BRDPI) will increase
by 3.0 percent in FY 2011 and 2.9 percent in FY
2012
President’s NIH Budget, cont.
President’s budget emphasized four areas for NIH
“investment:”
• Advancing translational sciences, including the
creation of the National Center for Advancing
Translational Sciences (NCATS)
• Accelerating discovery through technology
• Enhancing evidence base for health-care
decisions
• Encouraging new investigators and new ideas.
House Budget - H.R. 1
• Feb. 19 House approved H.R. 1, an omnibus
appropriations bill for remainder of FY 2011
• Would cut federal discretionary spending by
more than $61 billion from FY 2010 levels
• $1.6 billion cut to NIH and substantial cuts for
the Title VII and VIII health professions
programs and the National Health Service
Corps
• H.R. 1 fails to pass Senate on March 9 and
alternative proposal by Senate Appropriations
Chair Daniel Inouye (D-HI)
House Budget, cont.
• NIH budget cut of $1.6 billion reduces agency's
total budget to $29.6 billion, a 2008 level
• Interestingly, cuts are not across the board specific line items are cut:
• Global AIDS Transfer fund, Project Bioshield
Special Reserve Fund Transfer
• Funds for buildings and facilities
• Inflation adjustment for non-competing grants
and NIH Common Fund
• $640 million is a general reduction to 2008
levels, and would directly impact the National
Cancer Institute
Budget by Continuing
Resolution (CR)
• March 17 - Senate voted, 87-13, to approve
three week extension of funding until April 8
• This CR (H.J.R. 48) is sixth for fiscal year that
began Oct. 1, 2010
• House passed this latest CR on March 16 by a
vote of 271-158
HJR 48
• House Joint Resolution (HJR) 48 continues
funding for most federal programs at FY 2010
levels
• Cuts $6 billion in spending by reducing or
ending 25 programs and eliminating certain
earmarks
• Latest CR does not affect funding for NIH or
Health Resources and Services Administration
(HRSA)’s Title VII and VIII health professions
programs.
Budget End Game for FY 2011
• House and Senate leaders say they believe they
can reach agreement on FY 2011 spending plan
with cuts estimated at $33 billion
• Alternative is a government shutdown in April
• Frustration with piecemeal approach growing
• Conservative House members also are unhappy
with the CRs because they do not include H.R. 1
funding cuts and policy riders to derail ACA
In Change There is Opportunity but
We’re Going to Need a
Bigger Boat!