Transcript Slide 1

The Status of Health Reform
Melanie Hobbs
Director, Public Policy and Government Relations
St.Vincent Health
Tory Callaghan Castor
Vice President, Government Relations
Clarian Health Partners
Updated
December 14, 2009
Important Players
• The White House
• House “Tri-Committee”
• House Speaker Nancy Pelosi
• Ways and Means (Rep Charles Rangel – D., NY)
• Energy and Commerce (Rep Henry Waxman – D., CA)
• Education and Labor (Rep George Miller – D., CA)
• Senate
• Senate Majority Leader Harry Reid
• Health, Education, Labor and Pensions (HELP Committee) – (Sens. Dodd & Harkin – D., Ct, IA)
• Finance Committee - (Sen Max Baucus – D., Mont)
• Ben Nelson
• Olympia Snowe
• Joe Lieberman
• Blue Dog Democrats
• The Congressional Budget Office
• Industry Trade Groups
Next Steps: Senate Action
HOUSE
SENATE
Energy &
Commerce
Ways &
Means
Education
& Labor
Passed
July 31
Passed
July 16
Passed
July 17
COMMITTEES
HELP
Passed
October 13
Passed
July 16
Twobills
billstocombined
into into
oneone
Two
be combined
Three bills combined into one
October 29
Finance
FLOOR
CONSIDERATION
November 18
Regular Order
Reconciliation
Two Amendments Considered;
One Adopted
Unlimited floor debate
Limited floor debate
Filibuster
November 7
Cloture (60 votes)
Limits on non-budgetrelated provisions
Limited floor debate – One Day
HOUSE VOTE
Passed 220-215
House-Senate
Conference Committee
Full Senate vote on bill
(simple majority to pass)
What the White House Wants
House Bill (HR3962)
Senate Bill (HR3590)
“Affordable Health Care for America Act”
“Patient Protection and Affordable Care Act”
Passed: November 7, 2009 (220-215)
Currently Being Debated on the Senate Floor
Cost
$1.2 Trillion over 10 Years
$849 Billion over 10 Years
Coverage
36 Million
(Currently, the House bill covers 96% of those legally residing
and 94% of those residing in the country.)
31 Million
(Currently, the Senate bill covers 94% of those legally residing
and 92% of those residing in the country.)
Public Option
(negotiated rates with “corridors”)
Public Option with Opt-Out Provision (Current)
(Federal Employee Health Benefits-type model with Medicare
buy-in and public option trigger---being scored by CBO.)
Individual Mandate
Yes. Individuals must purchase insurance or pay a penalty of
2.5% of income.
Yes. Individuals must purchase insurance or pay a penalty.
Those obligated to buy coverage who fail to do so would pay a
fine starting at $95 in 2014 and rising to $750.
Employer Mandate
Yes. Employers must pay 65% of family premiums or pay a
penalty based on payroll. Small businesses with less than
$500,000 on payroll are exempt. Payrolls up to $750,000 have
a reduced contribution.
No, the bill would not require employers to offer health
insurance. However, medium and large employers who do not
offer coverage would have to reimburse the government for
each full-time employee receiving a health-care affordability
tax credit.
Revenue Raisers
The original proposal imposed a surcharge on families with
incomes above $350,000 and individuals with incomes above
$280,000. House leaders are considering limiting the surtax to
singles who earn more than $500,000 and families who earn
more than $1 million.
Fees on insurance companies, drug makers, medical device
manufactures. Medicare payroll tax would increase to 1.95%
on income of more than $200k/yr for individuals; $250k/yr for
couples. New 5% tax on elective cosmetic surgery. Tax on
“Cadillac plans” ($8,500 annually for individuals and $23,000
for families).
No denial of coverage based on pre-existing conditions. No
higher premiums based on gender/age. (2013)
No denial of coverage based on pre-existing conditions. No
higher premiums based on gender/age/family size. Children
up to age 26 can stay on parents insurance. No lifetime limits
on coverage. (2014)
Medicaid Expansion
Yes. Expanded to 150% FPL.
Yes. Expanded to 133% FPL.
Insurance Subsidies
Yes. Available to households earning up to
400% FPL.
Yes. Available to households earning up to
400% FPL.
Government-Run
Insurance
Insurance Reforms
Delivery System Reform
Increase Healthcare “Value”
The Goal
Accountable Care
Organizations
Bundled Payments
Reduce Hospital
Acquired Conditions
Reduce Preventable
Readmissions
Electronic Health Records
Prerequisite
Value-Based
Purchasing
Tactics
Reduce Costs
Improve Quality
Public Opinion
The Role of Physical Therapists
APTA-Supported Policy Principles for Health Care Reform:
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Systematic health care reform that provides:
•
Guarantee Issue
•
Guarantee Renewal
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Guarantee Choice
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Ensure that rehabilitation services, provided by licensed health care professionals, are an
essential element of a standard benefits package in any proposal to reform the insurance
delivery system.
•
Enact insurance reforms that:
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Eliminate arbitrary limits on annual or lifetime benefits;
•
Prohibit cost shifting by increased co-payments, deductibles, and/or premiums; and
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Ensure non-discrimination on benefits or providers.
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Reform Medicare payment policies:
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Permanently repeal the Sustainable Growth Rate (SGR) formula
•
Permanently repeal arbitrary outpatient therapy caps on services; and
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Eliminate certification of the plan of care for patients to access outpatient physical
therapy services.
The Role of Physical Therapists
APTA-Supported Policy Principles for Health Care Reform:
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Ensure that policies regarding bundling payments meet the following criteria:
•
•
•
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Enhance initiatives to develop an adequate health care workforce.
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•
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Bundled payments should not be implemented without evaluation of its feasibility as
a payment model for post-acute care services.
Patient safeguards should be established to ensure patient choice and access to
the full range and continuum of post-acute and outpatient care.
Post-acute care should be defined as Part A services within the first 30 days post
discharge from an acute care hospital stay delivered by inpatient rehabilitation
facilities, skilled nursing facilities, home health agencies, and/or long-term acute
care hospitals.
Enable physical therapists to participate in current initiatives, such as the NHSC.
Expand federal funding for clinical education, fellowships, and faculty development
in physical therapy.
Reduce unnecessary regulatory burdens on physical therapists to enhance efficiency and
effectiveness in delivering health care to their patients at the right time and place.
Questions