7th Annual Indiana Rural Health Public Policy Forum:

Washington Rural Health Policy Update

Tim Fry, Government Affairs Manager National Rural Health Association

Fry@NRHArural.org / 202-639-0550

Agenda

• Change comes to Washington– New players and new power for old players– Regulations on hold…

• Health reform coming to Washington?– Stimulus package– The Jigsaw Puzzle of health reform

• Be a rural advocate!

NRHA MissionThe National Rural Health Association is a national membership organization with more than 18,000 members whose mission is to provide leadership on rural issues through advocacy, communications, education and research.

Change comes to Washington…

• Jan 20, 2009: Inauguration Day

• Obama had served on the HELP cmte.

• Assumption that Biden will focus on foreign policy

• Campaign promises on health

Health Leadership Team

• Sen. Tom Daschle, Sec. of HHS & WH policy• Rep. Rahm Emanuel, Chief of Staff• Peter Orszag, Budget Director

House of Representatives

• Democrats gained 21– Vacant NY (Gildebrand)– Vacant IL (Emanuel)

• New leader in E&C• Who will take the lead?

– Rangel troubles?– Stark get his way?

• Republicans opposition – work with President?

Senate

• Democrats gained at least 7 seats (58)– MN recount make 59

• Need 60 votes to end filibuster

• Republicans will get a chance to play a role

Regulations on hold

• No political appts.– Rural Health Clinics– Health Professional

Shortage Areas– Hospital outpatient

oversight issue– Other changes…?

Health Reform:Desire for change

• Is this the year?• Most buzz since…

– 92-93 – HillaryCare– 70s – too much for Nixon– 60s - Medicare/Medicaid– 12? - T. Roosevelt’s

failed campaign

• Campaign promise

First stab? - stimulus

• $787 billion package– $87b for Medicaid– $1.1b for comp.

effect research– Includes rural

• Rural broadband • Rural water projects• Workforce training• Prevention/wellness

Rural facility developmentGrants specific to health

• $500m Indian Health Srv• $1b Veterans Admin• $2b Community Health

Centers

Rural development loans

• $130 million for rural community facility development– Translate to well over $1

billion in guaranteed loans for rural facilities, including health care facilities

– In addition grants through USDA for facilities, including health care

Health Information Technology• $2b for grants and office of HIT coord.

• Incentive payments for meaningful adoption:• RHC/FQHC

– 30% needy patients

– Medicaid cover no more than 85% of IT costs

• Eligible providers– Medicare up to 41k

– Medicaid, if 30% Medicaid – 85% of IT costs

• CAHs– Depreciation value of

Medicare IP % plus 20%

– Paid same yr. as becoming meaningful

• PPS Hospitals– Base of 2m plus

amount per discharge up to 23k

– Paid over four year period

Down payment on reform?

• Stimulus got contentious

• Only 3 Rs voted with President

• HIT seen as precursor

• But so many other challenges…

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-203.3

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69.2

125.6

236

128

-158

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-248

-161

-455

1989 1993 1997 2001 2005 2009

Not to mention no money

Uni

fied

Sur

plus

/Def

icit

in B

illio

ns

of D

olla

rs

Sources: Office of Management and Budget; Congressional Budget Office

Overall DebtLast 10 Years v. 2009

Sources: Office of Management and Budget; Congressional Budget Office

Impetus for reform• Nearly 50 million

uninsured• Global economy is

hurting companies ability to offer care

• Providers burdened with paperwork and lots of no-pay patients

Obama Campaign Plan

1. Lower costs– HIT, care coord.

2. Universal (or close)– Today’s system plus

3. Public health– Preventative

services and prepare for emergency

1. Lower Cost

• Health information technology– Stimulus package

• Prevention and disease management – Less long-term costs

• Catastrophic coverage

• Quality payments– Transparency of care

measures

• Drug/insurance– Insurance comp.– End MA

overpayments– Drug price

negotiations

2. Increase Coverage

• End prior condition denial

• New plan options– Health Exchange to

monitor options– Assure these options

are as good as public plans

– Portability

• Tax credits for businesses and ind.

• Employer requirements

• Children required• Expand SCHIP and

Medicaid• State flexibility

3. Public Health

• Worksite and school based initiatives

• Workforce development– Need more primary

care and preventive providers

• Personal responsibility – Encourage families

decisions

• Government, at all levels, have a role

Obama and Rural Health

• Seems committed– Responded to NRHA– Transition teams– Feedback wanted

• Reimbursement equity

• Workforce• Infrastructure

Photo taken by Tim Fry at the Inauguration of President Barack H. Obama, 44th President of the United States

Provider impact?

• Payment cuts?– Likely long-term

• Less “no pays”– Possibly

• Rural payments?– Likely to continue

• Federal control– Likely more

We Need You!

• You are your own best voice

• Your member of Congress listens when you speak

• You will have more success than I

Thank you!

Tim Fry, Government Affairs Manager National Rural Health Association

Fry@NRHArural.org / 202-639-0550

Photo taken by Tim Fry at the Inauguration of President Barack H. Obama, 44th President of the United States