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Healthcare Reform Legislation: Magic Elixir or Bitter Pill?
Presented by:
Katie O. Orrico, Director, AANS/CNS Washington Office
January 23, 2010
Health Reform Has Run Into a Buzz Saw: Now What?
Drivers of Health Reform
12- 15 M American UNINSURED and cannot buy coverage
Denial of Coverage for PRE-EXISTING CONDITIONS and routine INAPPROPRIATE DENIALS for medical services
DEFENSIVE medical practice ($210 B/ yr)
Unsustainable COST Increases (20% GDP)
Looming MANPOWER SHORTAGES in surgical and medical specialties (49,000 by 2025)
Current SGR formula will jeopardize access to specialty care
Environment for Reform
1994 2009U.S. Senate 56 D’s; 44 R’s 58 D’s; 40 R’s; 2 I’s
Uninsured 39.7 million(15.2%)
45.7 million(15.3%)
% of Americans w/employer health insurance 60.9% 59.3%
Health spending as % of GDP 13.6% 17.6%
Medicare/Medicaid as % of GDP 3.5% 4.9%
Change in employer health benefit costs (avg. over 3 yrs) 3.0% 6.3%
Unemployment Rate 6.5% 8.5%**
Budget Deficit as % of GDP 2.9% 13.1%
COST Containment is Paramount
Key Legislation
House
H.R. 3200, America's Affordable Health Choices Act– Initial bill “marked-up” by House committees
H.R. 3962, Affordable Health Care for America Act – PASSED 220-215 (Nov. 7)
– H.R. 3961, Medicare Physician Payment Reform Act– PASSED 243-183 (Nov. 19)
Key Legislation
Senate
S. 1679, Affordable Health Choices Act and S. 1796, American’s Healthy Future Act– Marked-up in Senate HELP and Finance Committees
S. 1776, Medicare Physicians Fairness Act
– REJECTED 47-53 (Oct. 21)
S. 3590, Patient Protection and Affordable Care Act– PASSED 60-39 (Dec. 24)
Road to the White House
HELP Committee
Bill
Health, Education, Labor & Pensions
(HELP ) Committee
Finance Committee
Bill
House Bill
Finance Committee
Ways & Means Committee
Energy & Commerce Committee
Education & Labor Committee
Senate Debate & Vote
House Debate &
VoteRules
Conference
Senate Vote
House Vote
President’s desk
Why don’t the AANS and CNS support these healthcare reform measures?
Neurosurgery’s Healthcare Reform Principles
Principle House Senate
Cover the uninsured
Lower healthcare costs and fully pay for reform w/out adding to deficit
Choice of health plans…but no public insurance option or single payer system
Eliminate denials for pre-existing conditions
No government interference in doctor-patient relationship
Neurosurgery’s Healthcare Reform Principles
Principle House Senate
Ensure patients’ right to choose their doctor, have direct access to specialists and enter into private fee arrangements
Proven medical liability reform
Fix workforce shortages in all specialties not just primary care
No government regulation of GME
Repeal SGR
Neurosurgery’s Healthcare Reform Principles
Principle House Senate
No budget neutral increases in primary care reimbursement
No Independent Payment Advisory Board or “shadow” RUC
Quality of care to be determined by the medical profession
Continue to allow physician ownership of ancillary services (imaging, specialty hospitals, ASCs)
Current Program: Rules, Regulations, Liability and Payment Policies Affecting
Doctors
House Healthcare Reform: Rules, Regulations, Liability and Payment Policies Standing
Between Patients and Doctors
A Word About Medical Liability Reform…
Medical Liability Reform Saves Money
CBO there is "limited evidence currently available about the effects of tort reform on health outcomes is much more mixed than the larger collection of evidence currently available about the effects of tort reform on health care spending."
Medical Liability Reform
“The reason that tort reform is not in the bill is because the people that wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth.”
Howard Dean, MD, Former Chair
Democratic National Committee
Why does the AMA support these healthcare reform measures?
Addiction to Repeal the Sustainable Growth Rate (SGR)
Medicare Payments cut 40% from 2010-2016
Physician Costs up 20% from 2009-2016
22% Cut
$200+ billion
AMA’s Priority Issues
AANS/CNS Actions
Letters to Congress
Letters to AMA and ACS
Media Campaigns
Operation Patient Accesswww.operationpatientaccess.org
Physicians United for Patients
www.operationpatientaccess.org
Issued Press Releases
Newspaper Ads
Radio Ads
Letters to the Editor
Neurosurgery in the News
Next Steps
GAME CHANGER
Effects of Massachusetts Special U.S. Senate Election
Outstanding Issues – Before Election
• Abortion• Immigration• National vs. State Regulation of Health Exchanges• Increasing Taxes
– Taxing “Cadillac” Health Plans– Taxing wealthier individuals
• Individual and Employer Mandates• Rationing
– Independent Payment Advisory Board (IPAB)– Comparative Effectiveness Research
FINAL House-Senate Agreement – Before Election
No formal House-Senate Conference Committee– Ping-Pong Process Instead– Behind the scenes
negotiation with Reid, Pelosi, Obama
House will take up Senate bill (H.R. 3590) and make amendments… send to Senate and then continue this process until agreement is reached
The Negotiations – Before Election
Outlook for Final Reform Bill
• Ram it through before Brown gets certified in the Senate– Not going to happen
• House folds and passes Senate bill as is + “side car” bill to reflect House-Senate compromises on taxes and other issues– Not likely to happen
• Budget Reconciliation for the entire package– Not likely to happen
Outlook for Final Reform Bill
• Go for Snowe – Not likely to happen
• Series of Small Bills on key issues + budget reconciliation on financing issues– Not likely to happen
• Bipartisan compromise on significantly scaled back bill– Not as easy as it sounds
Scaled Backed Bill Not So Easy
Insurance Reforms
Small Bill
Bigger Insurance
Pool
Individual/Employer Mandates
Premium Subsidies
Increased Spending
Higher Taxes, Medicare Cuts & Delivery Reform
BIG Bill
Outlook for Final Reform Bill
• Total collapse – no health reform legislation– Likely… but not yet (take a break
from healthcare for a few weeks)
YesterdayThursday
Jan 21Tuesday Jan 19
Sunday Jan 17
Ram it through 1% 1% 10% 25%
House folds 4% 15% 30% 25%
Reconciliation 1% 1% 1% 3%
Deal with Snowe 1% 1% 2% 2%
Two bills = House folds w/a reconciliation “sidecar" 3% 5% 2% -
Collapse 90% 77% 45% 45%
What A Difference A Week Makes
Outlook for Final Reform Bill
For More Information
More information is available:
http://www.aans.org/legislative/aans/Neuro_HealthCareReform.asp
http://www.cns.org/advocacy/wc/nsHealthcareReform.aspx
Katie O. Orrico, DirectorAANS/C NS Washington Officekorrico@neurosurgery.org202-446-2024
Questions?
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