© Ascension Health System Office Advocacy and Access Department, August 2009 Healthcare Reform Update: Healthcare That Leaves No One Behind

© Ascension Health System Office Advocacy and Access Department, August 2009

Healthcare Reform Update:Healthcare That Leaves No One Behind

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A Historic Time for Healthcare Reform

© Ascension Health System Office Advocacy and Access Department, 2008, Beth Fuchs author

1930s & 1940s•Private Health

Insurance•Employee

Benefits•State Insurance

Regulation•Hospital

Construction•Universal

Coverage Fails

1980s•Reconciliation

Bills Initiated•Full Risk Plans

Enter Medicare•Medicare

Prospective Payments

•Means Testing for Catastrophic Benefits

1990s•HIPAA•FAS 109 (Retiree

benefits)•State Child Health

Insurance Program

•Universal Coverage Fails -- Again

2000 -- Present•Medicare Drug

Benefit•More Incentives

for Private Plans•Quality

Reporting/Payment

•Patient Safety•New

Administration•Health Care

Coverage Redefined as an Economic Issue

•Stakeholders Blink

1960s •Medicare &

Medicaid•Community

Health Centers

1970s National Health

Planning (CON)•ERISA •HMO Act•Price/Hospital

Cost Controls•Congressional

Budget Act•Universal

Coverage Fails -- Again

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What, and For Whom, is 100% Access and 100% Coverage?

100% access and 100% coverage means that all persons, particularly those persons who are uninsured or underinsured, receive healthcare services and health insurance that:

2020 Goal and Associated Strategies ofHealthcare That Leaves No One Behind

1. Creates and supports the best journey to improved health outcomes for each individual, and

2. Is financed in an adequate and sustainable fashion.

National Legislative Leader

National Public Policy

Partner

Access Model

Catalyst

Voice of the

Voiceless

2020 Goal

Strategies


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Our Guiding Features of a Reformed Healthcare Policy

Ensure 100% Access

to Healthcare Services

Achieve Destination of 100% Coverage

Reform Insurance Rules; Shared Obligation and

Responsibility for Coverage

Make Health Insurance

Affordable and Equitable

Eliminate Coverage and Service Gaps, Particularly for

the Vulnerable

Ensure Economic Viability Through Shared Financial

Responsibility

Improved Health for Our Community

We are committed to redesigning the healthcare delivery system

and partnering with policymakers

to achieve 100% access and 100% coverage.

Approved by Ascension Health Board of Trustees, December 2007© Ascension Health System Office Advocacy and Access Department, August 2009

Ascension Health’s Guiding Feature

Congressional Health Reform Proposals

Ensure 100% Access to Healthcare Services

The bills include delivery system initiatives to improve quality, value and transparency, and seek to improve patients’ capacity to navigate the healthcare delivery system. Ascension Health will continue to monitor proposals to assure that the role of the federal government in delivery system initiatives is to accelerate the delivery system’s effectiveness.

Achieve Destination of 100% Coverage

The Administration and Congress have set as a reform goal coverage for all (excepting undocumented immigrants). Coverage expansions are expected to begin as of 2013, with the target of 97% coverage in all bills. Premium subsidies at 400% of the federal poverty line in the House bills would provide needed assistance to many low income Americans to purchase health insurance. Ascension Health will continue to offer constructive policy options leading to 100% access, recognizing, however, that staging may be needed in order to be sustainable.

Reform Insurance Rules: Shared Obligation and Responsibility for Coverage

The bills include reforms in the individual and group markets to require guaranteed issue, eliminate pre-existing condition exclusions, and limit price differences based on health status. Bills include a version of an individual and employer mandate to purchase and offer insurance respectively. Ascension Health will continue to support financing options that spread burdens fairly and do not harm our most vulnerable citizens.

Make Health Insurance Affordable and Equitable

All the bills include rating rules and other insurance reforms as referenced above. All include premium and cost sharing subsidies to help lower-income Americans purchase health insurance and medical services. All will likely require benefit packages to meet a minimum level of coverage and reasonable cost sharing. Ascension Health will continue to scrutinize the details of the proposals to assess where affordability gaps may be found.

Eliminate Coverage and Service Gaps, Particularly for the Vulnerable

Medicaid expansions are a part of each reform proposal. The benefit package includes key services such as mental health and pharmaceuticals which are critical for vulnerable populations. The provision for adequate and ongoing safety net funding will continue to be a concern.

Ensure Economic Viability Through Shared Financial Responsibility

The proposals rely on a variety of techniques to fund coverage expansions that require individual, employer, physician, hospital and insurance company participation in funding. Ascension Health will seek financing solutions that share the financing burden in a fair and sustainable way.

100% Campaign: Ascension Health’s Guiding FeaturesCompared to the Health Reform Bills Under Consideration

August – Early September 2009


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Health Reform Timeline

February March

March 24: Insurers release letter supporting guarantee issue coupled with an

individual mandate

March 27: Health Reform Dialogue group (“strange

bedfellows”) issues reform recommendations

Feb 4: President Obama signs HR 2,

the Children’s Health Insurance

Reauthorization Act of 2009 (CHIPRA),

expanding coverage for 4 million children

at a cost of $30 billion paid with

tobacco tax

Feb 17: HR 1, the American Reinvestment

and Recovery Act, is passed and includes $150 billion in new

healthcare spending

Feb 24: President Obama releases FY 2010 Budget that includes $634 billion

reserve fund for health reform


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April May

May 7: President Obama issues 8 principles for healthcare reform;

New Democrat Coalition (progressive House Ds) release

“Prescription for Health Care Reform”

May 8: Blue Dog Coalition (fiscal conservative House Ds)

issue “Principles for Health Care Reform”

April 2: House and Senate

Budgets passed (without GOP support) with

“deficit-neutral” health reform

reserve fund and back-up reconcil-

iation clause

April 8: Executive Order signed establishing new

White House Office of Health Reform

May 6: Health Care Solutions Group (GOP) – “Vision of Health

Care Reform” released

April 28: Senate Finance Committee releases policy options

for transforming healthcare delivery system


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May

May 20: Patients’ Choice Act of 2009 (Republican alternative) is introduced

by Senators Burr (R-NC) & Coburn (R-OK) and Reps.

Ryan (R-WI) & Nunes (R-CA)

May 11: Finance Committee

releases policy options to expand

healthcare coverage

May 13: President Obama meets with Speaker Pelosi, who pledges

to have a health reform bill out of the House before August recess

May 11: President Obama hosts the “Gang of Six” at the White House;

Stakeholders agree to “voluntarily” reduce healthcare costs by

1.5% over 10 years (AHA,AHIP, PhRMA, AMA,SEIU, AdvaMed)

May 18: Senate Finance Committee releases policy

options to finance healthcare reform


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Health Reform Timeline: Looking Ahead

June July

Late July-Early September: House E & C passes health reform legislation 7/31.

House to bring legislation to the floor vote as early as the week of 9/7

June 1- June 12: HELP

Committee draft released 6/9;

HELP & Finance Cmte. Member

Walk-thrus. President

Obama meets with Dem.

Leadership to finalize timeline

for reform

Week of June 15: HELP markup beginning 6/17; Finance Cmte.

continues deliberations. House draft bill released June 19.

July 14 - House releases “America’s Affordable Health Choices Act of 2009. July

15 - Senate HELP Committee reports out comprehensive health bill. Senate Finance

continues deliberations in search of bipartisanship.

July 17- W&M and Ed. & Labor pass House reform legislation out of committee

Mid September-October ’09: Finance committee to release bill by September 15. Senate aiming for floor vote by early October. Congress aiming for Final vote on conference report to meet President Obama’s deadline for a bill “on the desk” by the end of October.

August September/October


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Status of Health Reform BillsStatus of Health Reform Bills Moving Through Congress

Senate HELP (Health, Education, Labor and Pensions) Committee

Kennedy bill, not yet numbered, approved 13-10 on 7/15/09.

Senate Finance Committee Senators Baucus, Grassley, Conrad, Bingaman, Enzi and Snowe (the “gang of six”) continue to try to develop a bipartisan draft proposal. Timing of committee action unclear.

Full Senate Timing unclear. Democrats may have to use the budget reconciliation procedures to avoid GOP filibuster.

House Education and Labor Committee HR 3200, as amended, approved 26-22 on 7/17/09.

House Energy and Commerce Committee HR 3200, as amended, approved 31-28 on 7/31/09.

House Ways and Means Committee HR 3200, as amended, approved 23-18 on 7/17/09.

House Rules Committee Will work with Democratic Chair and Leadership to produce a melded version of HR 3200 for a floor vote.

Full House Vote possible in late September.

Conference Committee of the Senate and House

???

House and Senate chambers vote approval of conference report

In time for House and Senate adjournment in late 2009.

Presidential signature ???

Sen

ate

Hou

seJo

int

Pre

si-

den

t


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Post Health Reform

Opportunities ChallengesAmericans Access to Affordable Health Insurance

Focus on Prevention, Primary Care to Improve Health Transparency to Improve Personal Responsibility

Unknowns on New Costs/Taxes to Consumers

Individuals with Rich Benefit Packages May See Changes

Young People May See Premiums Increase

Self-insured Employers

ERISA Plans Untouched Tax on Employee Benefits Above $ Value

Future Premium Cost Shift?

Small Businesses

Employees Gain Access to Affordable Insurance Mandate to Offer / Contribute

Healthcare Services

Patients Have Access to Insurance Charity Care/Bad Debt Obligations Contained

Future Payment Rates Unknown

Health Insurance Industry

Mandate to Purchase Insurance Pools Broadened New Customers

Insurance Rules Tightened Limits on Premiums Competition no Longer on Risk

Selection

Pharmacy Industry

Drug Coverage Likely Part of any Credible Coverage Expansion of 340B to Inpatient May Be Part of Health Reform

Pressure to Reduce Costs to Help Fund Health Reform

Government States Given Transitional Federal Assistance to Expand Medicaid

Federal Government will Lead Health Reform Parameters


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Trajectory Towards Healthcare Reform

• Unwavering Presidential Intent

• Insurance, Drug, Hospital Interest Groups Began by Supporting Coverage Expansions and Insurance Reforms

• Democratic “Filibuster Proof” Majority

• Public Support for Healthcare Reform Due to Economic Realities Personalizing the Fear of Losing Health Insurance

• Healthcare Reform Defined as Democrat’s Agenda

• Country is Divided Politically and Vulnerable to Rhetoric

• State Healthcare Reform Efforts on Hold

• Momentum Stalled for Early Bill Passage

• Interest Groups are Positioning Their Business Interests for “Post-Reform” World and Beginning to Distract the Focus

• Political Stakes for the Republican Party May Trump Healthcare Issues

• CBO Has Not Scored Adequate Funding to Pay for Any Bill


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System Influence:New Administration and

Congressional Leadership

Health Ministries’ Influence:

Congressional Delegation and

Governors

Partnerships, Coalitions, Forums

Voice to Maintain Momentum

The Role of Ascension Health Leaders


14© Ascension Health System Office Advocacy and Access Department, August 2009

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Leaders’ Obligation

• Lead Health Reform Momentum– Statesmen and Stateswomen

• Raise Positive Voices During August Congressional Recess– Voice with Members, Staff– Leadership Voice in Our Communities

• Remember Who We Are– Mission Compels Us


Documents

© Ascension Health System Office Advocacy and Access Department, August 2009 Healthcare Reform Update: Healthcare That Leaves No One Behind