Grassroots Call, July 12, 2011:Emergency GAC Call

Today’s Call• 1. Debt Ceiling

• 2. Rumors rural cuts

• 3. Cantor’s Proposal

Background

• Debt ceiling/August 2 Deadline

• Must have agreement soon. Will take time to draft legislation

• This week is critical.

• Gang of 6 failed

• Joe Biden negotiations failed

• President has taken over negotiations

• “everything is on the table” including rural Medicare payments.

Who’s in the room• President Obama

Senate• Reid – D-NV• Durbin – D-IL• McConnell – R-KY• Kyl – R-AZ

House• Boehner – R-OH• Cantor – R-VA• Pelosi – D-CA• Hoyer – D-MD

• Earlier Biden proposals may have included reworking cost-based reimbursement.

• Now Cantor proposal:• $16 billion in specific rural cuts.

Inside and Outside Strategy

• NRHA has hit and will continue to hit key Congressional targets

• Administration; WH call, HRSA• Outreach to all rural associations

• Grassroots must be fully mobilized• Call and email Member• Go to District Office• Letters to editor

STATE CAH RHCAlabama 2 75Alaska 13 2Arizona 14 18Arkansas 29 72California 31 285Colorado 29 54Florida 13 146Georgia 34 94Hawaii 9 2Idaho 27 44Illinois 51 221Indiana 35 63Iowa 82 142Kansas 83 179Kentucky 30 150Louisiana 27 106Maine 16 39Massachusetts 3 1Michigan 36 157Minnesota 79 81Mississippi 31 168Missouri 36 366

STATE CAH RHC

Montana 48 53Nebraska 65 138Nevada 11 8New Hampshire 13 11New Mexico 7 11New York 13 7North Carolina 23 84North Dakota 36 58Ohio 34 17Oklahoma 34 43Oregon 25 64Pennsylvania 13 63South Carolina 5 109South Dakota 38 57Tennessee 17 62Texas 79 316Utah 11 18Vermont 8 15Virginia 7 46Washington 38 129West Virginia 18 54Wisconsin 58 50Wyoming 16 18

Critical Access Hospitals and Rural Health Clinics By State

RRC MDH SCH

AK 0 0 3

AL 8 8 9

AR 5 3 11

AZ 1 0 6

CA 6 1 14

CO 0 1 11

CT 2 0 1

DE 1 0 0

FL 5 3 6

GA 12 6 10

HI 0 0 5

IA 2 6 2

ID 1 0 1

IL 5 9 7

IN 9 3 1

KS 1 5 11

KY 16 10 3

LA 5 10 5

MA 0 1 1

ME 1 4 4

MI 5 3 13

MN 0 3 8

MO 5 6 10

RRC MDH SCH

MS 13 11 10

MT 2 0 4

NC 8 10 2

ND 0 0 1

NE 1 1 2

NH 1 0 0

NM 1 0 12

NV 0 0 4

NY 4 8 13

OH 8 5 5

OK 6 8 15

OR 2 0 1

PA 9 9 9

SC 3 1 5

SD 0 0 4

TN 6 24 6

TX 7 17 45

UT 0 0 7

VA 3 7 11

VT 0 1 1

WA 3 0 3

WI 2 4 7

WV 6 4 4

WY 0 0 10

Rural Referral Centers, Medicare Dependent and Sole Community Hospitals

Big Plan vs. Little Plan

• $2.4 trillion - $4 trillion

• SGR fix?

• Rural Extenders

The costly Doc Fix• Congress consistently blocks scheduled cuts from taking effect, and

has to come up with new offsets each time.

• According to the AMA, a permanent SGR repeal would have cost $48 billion in 2005 — compared with a price tag of nearly $300 billion to block the cuts that are scheduled for January.

• "An agreement on the debt ceiling legislation provides the best — and perhaps only — opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner," the AMA and other organizations said Monday in a letter to President Obama.

Rural Provisions set to expire at same time as SGR

• Positive adjustments in the GPCI• Outpatient hospital hold harmless provisions• Extension of the Medicare Dependent Hospital

Program• Section 508 Hospital Payments (reclassification) • Rural Ambulance Super bonus• Technical component cost for certain pathology

services• Low volume/high quality adjustment

The Message

• Don’t support debt ceiling proposal that contains devastating cuts to rural health care.

• $16 billion in Medicare cuts to rural providers will decimate the delivery of health care to the 62 million who live in rural American.

• Rural hospitals are critical to the patients they serve and to the rural economy.