Health Care Reform 2009

Where We Are… Where We Are Heading…

Current Situation

       47 Million Uninsured Americans 25 Million Underinsured Health Spending Accounts for 17% of Gross Domestic Product (GDP) Health Care Spending Continues to Rise Current Inefficiencies Denials Based on Pre-Existing Conditions Restraints on Access to OT

President Obama

Major Component of the Presidents Campaign Platform Top domestic policy priority  “I am not the first President to take up this cause, but I am determined to be the last.” -- President Barack Obama, September 9, 2009  “I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year." – President Barack Obama, February 24, 2009

House Minority Leader: Representative John Boehner (R-OH)

“Despite our differences on some important health care-related issues, we are convinced there are areas offering potential for common ground on health care reform among Republicans and Democrats.”

Congress

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5 Committees of Jurisdiction

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Senate

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Health Education Labor and Pensions (H.E.L.P)

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Finance

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House “Tri-Committees”

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Education and Labor

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Energy and Commerce

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Ways and Means

House of Representatives

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House Tri-Committee Bill:

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America’s Affordable Health Choices Act (H.R. 3200)

 Single bill drafted by House Leadership and Committee Chairs  Amended separately in each Committee The 3 versions of the bill must be merged before being brought to the floor for passage.

Senate

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H.E.L.P. Committee

– Passed legislation on July 15, 2009 on a party line vote – Passing of Senator Edward Kennedy (D-MA) – Senator Tom Harkin (D-IA): New Chairman

Senate

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Finance Committee Passed Bill Oct. 13

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“Gang of Six” worked together for months

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Bipartisan group of Finance Committee Members

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Democrats: Chairman Max Baucus (D-MT), Kent Conrad (D ND), Jeff Bingaman (D-NM)

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Republicans: Ranking Member Charles Grassley (R-IA), Olympia Snowe (R-ME), Mike Enzi (R-WY)

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Only Republican vote: Olympia Snowe $829B cost —lowest of all bills Summary: www.finance.gov

Senate Finance America’s Health Futures Act

   Less expensive than House proposals Provides insurance subsidies for some Allows establishment of insurance co-ops  Medicare cuts: SNFs, HH

AOTA Victories in Finance Bill

 Expected to specifically include rehabilitation services   Two-year cap exception extension  Study allowed on direct access to all outpatient services —includes occupational therapy, not just physical therapy  Harmful orthotics/prosthetics provision defeated Home health flexibility for OT pending – May be floor amendment

Key Healthcare Reform Issues

     Benefits Insurance Reforms Who is Covered?

Financing Medicare Reforms

Benefits

 Minimum Benefits Package – Actuarial Values Based on % of Current Plans  Tiered Plans Ranging from Platinum to Bronze   Required Benefits Categories – Hospital Services, Physician Services, Outpatient, Mental Health, Rehabilitation and Habilitation Services* Establishment of Advisory Commission – Commission to Advise the Secretary Regarding Essential Benefits that would be Specific After Passage

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Insurance Reforms

Elimination of denials based on pre-existing conditions

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Portability of health insurance when changing jobs

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Establishment of a central health insurance exchange regulated federally and operating across state lines

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Proposed Public Option to Compete with Private Insurance Products within the Exchange*

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Increased emphasis on prevention and wellness

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Caps on annual out-of-pocket expenses as well as prohibiting life-time and annual limits on benefits

Who is Covered?

 Individual mandate for purchasing coverage – Subsidies for lower income citizens  Employer mandated contributions – Small business exemptions – Enforced through tax penalties  Expands Medicaid and maintains Medicare  Does not provide coverage for illegal aliens*

Financing

  Medicare Provider Cuts ($313b) Health Industry Taxation – Insurance and Pharmaceutical Companies – Hospitals  Health Care Surcharge – High Income Individuals – Extensive Benefit Plans Exceeding $8000/year  Taxation of Alcohol and Tobacco products

MEDICARE PROPOSALS

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Pros…

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Physician Fee Schedule Update

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Extension of the Therapy Cap Exceptions Process Part D Assistance RX Improvements Incentives for Prevention and Wellness And Cons…

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Proposed Provider Cuts ($313b)

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SNF’s HH Agencies

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Post-Acute Care Bundling Pilot

Opponent Concerns

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Increased costs for health coverage for the currently insured Unwillingness of health professionals to participate in the public option or in the exchange Public Option potential first step to a government run single payer system Reduced access to care in Medicare because of reimbursement cuts Increased health care workforce shortages Market forces not allowed to work Savings not equal to increased costs

House Republican Alternative/Part 1

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Expand federal block grants for state high-risk pools, no caps Create association/small business health plans, individual membership associations Allow purchase of insurance across state lines Enact comprehensive medical liability reform Expand and improve Health Savings Accounts Allow employer to offer a “defined contribution” for health plans Require citizenship verification for Medicaid beneficiaries

House Republican Alternative/Part 2

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Allow employers to offer discounts for healthy behavior through wellness/prevention programs Allow private insurance vouchers for Medicaid and SCHIP Expand funding for Fraud and Abuse control Prohibit comparative effectiveness research used to ration or deny care Provide tax incentives to purchase long-term care insurance Prohibit insurance companies from rescinding a policy unless there was proof of fraud

Argument vs. Debate Words of Caution:

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Be careful of rhetoric versus reality

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Visit AOTA’s Health Care Reform Hub for detailed arguments from both sides of the debate.

AOTA Position on Health Care Reform

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AOTA is Non-Partisan AOTA has not taken a position in support or opposition of any of the current proposals

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AOTA has taken positions on particular provisions in the various proposals (e.g. Autism coverage, workforce issues, extension of the therapy caps

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Occupational Therapy in Health Care Reform

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Minimum Benefits Package

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Rehabilitation and Habilitation Hospital and Outpatient Services

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Expanded Potential for Occupational Therapy in Telehealth and in the Use of Health Information Technology

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Medicare Payment Changes

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Therapy Cap: 2 Year Extension OT as a Home Health Initiating Service

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Workforce Definitions, Expansions of programs

AOTA Position on Health Care Reform

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There is a need for reform in the American health care system to address problems including coverage for the uninsured, access to care, quality, cost growth and workforce shortages.

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A national debate and discussion about health care is needed.

Occupational Therapy: Part of the Health Care Solution

   AOTA promoting evidence-based rationale for OT involvement in: – Care coordination – Chronic care management – Prevention – Primary care coordination – Medical home systems See fact sheet at Health Care Reform Hub www.aota.org

Legislative Action Center

AOTA Reform Principles

( Representative Assembly 2008)

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Health care must have a proactive, prevention focus.

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Health care must address the whole person across the lifespan and across needs for acute and chronic care.

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Mental health and substance abuse parity must be included for all.

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The provision of health care services should be integrated across facilities, communities, and settings, including services where people live, work and participate in society.

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Access to quality, affordable care for all should be the goal of reform.

AOTA Principles Continued…

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Ensuring access to supportive services for people with disabilities or chronic conditions is essential.

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Investments are needed in our health care education system to ensure availability of qualified occupational therapy practitioners to meet growing needs.

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Occupational therapy should be covered to provide preventive services, rehabilitation and habilitation in all settings.

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Use of health information technology must be maximized to improve the efficiency and effectiveness of care.

What’s Next

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INTENSE Legislative Activity:

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Bills in House, Senate melded for each chamber

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Votes on the floor of each —November?

Conference to iron out differences

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Senate may not vote until November

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House expected to wait for Senate action

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House will include broader approach on public option or related alternatives

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President Obama has asked Congress to have a bill to him by mid-October: he will wait probably until December

ADVOCACY

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With the Health Care Reform Debate Heading Around the Final Turn…..

Now is the time to advocate for the protection and advancement of OT: for your clients, for your profession and for yourselves.

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Utilize the Tools Available on AOTA’s Legislative Action Center to Keep up to Date and Take Action

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