Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing

““New Frontiers: A Call to New Frontiers: A Call to

Policy Action for Health ReformPolicy Action for Health Reform””May 13, 2011May 13, 2011

For: For: Delaware Association for Healthcare Quality (DAHQ).Delaware Association for Healthcare Quality (DAHQ).

Bethany Hall-Long, PhD, RNC, FAANBethany Hall-Long, PhD, RNC, FAANDE State Senator, District 10 DE State Senator, District 10 Professor, School of NursingProfessor, School of Nursing

University of DelawareUniversity of Delaware

OverviewOverview IntroductionIntroduction

Driving Forces & Legislative/Regulatory Structures, Health Policy & Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics HighlightsPolitics Highlights

Legislative & Regulatory ProcessesLegislative & Regulatory Processes

State: Example Bills, Regs., Policy ProposalsState: Example Bills, Regs., Policy Proposals

Review of Health Professionals Role in the Political ProcessReview of Health Professionals Role in the Political Process

Summary, Call to Action, & Q & ASummary, Call to Action, & Q & A

ObjectivesObjectives

List 3-4 relevant health care quality List 3-4 relevant health care quality issues, legislation &/or regulations at the issues, legislation &/or regulations at the state and national levelsstate and national levels

Discuss the legislative and public policy Discuss the legislative and public policy processes in Delaware processes in Delaware

Describe the role of health professionals Describe the role of health professionals in the political process and relevant in the political process and relevant political strategies. political strategies.

Questions?Questions?

When you hear the words “Health Care When you hear the words “Health Care Reform” what one word comes to mind?Reform” what one word comes to mind?

When you hear the word “Health Quality” When you hear the word “Health Quality” what word comes to mind?what word comes to mind?

When you hear the word “Politics” what When you hear the word “Politics” what comes to mind?comes to mind?

Local, State, National & International Policy Local, State, National & International Policy Forces Forces

Fiscal Constraints (16% GDP Fiscal Constraints (16% GDP Health Care)Health Care)

Health Professions Health Professions Resources/ShortagesResources/Shortages

Technology & Informatics Technology & Informatics Gaps/DemandsGaps/Demands

Ethics (i.e., HIPPA, DNR Ethics (i.e., HIPPA, DNR Orders)Orders)

Local, State, National & International Local, State, National & International Policy Forces (Continued)Policy Forces (Continued)

Surge in Chronic Surge in Chronic Disease & AgingDisease & Aging

Bio-Terrorism, War & Bio-Terrorism, War & Global Disaster RisksGlobal Disaster Risks

Scope of Practice, Scope of Practice, MalpracticeMalpractice

OtherOther44thth Branch of Branch of

Government: Government: MediaMedia

Uninsured in DEUninsured in DE

Over the past few years uninsured in DE has Over the past few years uninsured in DE has risen from 9.9% to 11.2%risen from 9.9% to 11.2%

Approximately 101,000 are without insurance at Approximately 101,000 are without insurance at any given time- (this is a 2008 estimate)any given time- (this is a 2008 estimate)

Approximately 28% or 28,000 are eligible for Approximately 28% or 28,000 are eligible for public benefit through Medicaid (21,000 or CHIP public benefit through Medicaid (21,000 or CHIP 7,000)7,000)

Who are the uninsured?Who are the uninsured?

23% - under the age of 1923% - under the age of 1954% - male54% - male69% - white69% - white59% - own or are buying their home59% - own or are buying their home21%- live alone21%- live alone80% - are above the poverty line80% - are above the poverty line34%- with household income over %50,00034%- with household income over %50,00059% - are working adults59% - are working adults9% - are self-employed9% - are self-employed21% - are non citizens21% - are non citizens

Health System Actors & GovernmentHealth System Actors & Government

Actors:Actors:

ConsumersConsumers

ProvidersProviders

EmployersEmployers

GovernmentGovernment

InsurersInsurers

Interest GroupsInterest Groups

OtherOther

FUNCTIONS:FUNCTIONS:•FundingFunding•RegulationsRegulations•Service Service •DeliveryDelivery•Research & Research & DevelopmentDevelopment•OtherOther

Central Driving Policy Issues Central Driving Policy Issues

QualityQuality

AccessAccess

CostCost

CostsCosts

Health Care Costs Health Care Costs - $6.5 billion was spent on personal health care $6.5 billion was spent on personal health care

($7,485 per person) in DE in 2008 – highest ($7,485 per person) in DE in 2008 – highest point in 10 years. point in 10 years.

- Average rate of increase is 5% per year.Average rate of increase is 5% per year.– Largest share of spending is on: Largest share of spending is on:

Hospital care at 39%Hospital care at 39%

Physicians at 25.4%Physicians at 25.4%

Prescription drugs at 14.8%Prescription drugs at 14.8%

Health Policy:Health Policy:

Course of Course of actionaction or or inactioninaction by the by the government regarding the public’s government regarding the public’s health and welfarehealth and welfare

Impact on the Nursing Profession?Impact on the Nursing Profession?

Legislative Process: Application of Legislative Process: Application of Evidenced Based PracticeEvidenced Based Practice

Bill to LawBill to LawIdea, Drafted Idea, Drafted Legislation, Assigned Legislation, Assigned a # (HB,SB..), a # (HB,SB..), Introduced, Assigned Introduced, Assigned to Committee, to Committee, Hearings (mark-up), Hearings (mark-up), Voted on -Voted on - Other Other Chamber (Same Chamber (Same Process), Vote…Process), Vote…

Executive Branch RoleExecutive Branch Role

To Executive Branch: law To Executive Branch: law or vetoor vetoCurrent Obama Current Obama Administration’s Health Administration’s Health Care Reform ActCare Reform Act

**Regulation**Regulation,, if if Override as needed Override as needed passed.passed.

(see (see **Federal **Federal Registry)Registry)Know State RegulationsKnow State Regulations

Audience Questions/CommentsAudience Questions/Comments

List 2-4 key public policy or political issues List 2-4 key public policy or political issues for quality measures in health care for quality measures in health care

List 2-4 Pressing Public Policy issues List 2-4 Pressing Public Policy issues (federal or state)(federal or state)

Identify 2-4 clinical problems you feel must Identify 2-4 clinical problems you feel must be addressed to improve patient care, be addressed to improve patient care, outcomes costs etc..outcomes costs etc..

Obama Reform Obama Reform (PL111-148)(PL111-148): Purpose : Purpose

Expand Coverage and access to careExpand Coverage and access to care– 32 million uninsured will be covered (estimated 32 million uninsured will be covered (estimated

18,000 -25,000 additional Delawareans)18,000 -25,000 additional Delawareans)New Insurance Exchange with Premium Sharing New Insurance Exchange with Premium Sharing Subsidies, and Cost Sharing CapsSubsidies, and Cost Sharing CapsLarge Expansion of Medicaid EligibilityLarge Expansion of Medicaid Eligibility

Significant Insurance Market ReformsSignificant Insurance Market Reforms• Emphasis on PreventionEmphasis on Prevention• Bending the Cost Curve over time Bending the Cost Curve over time

Expanding CoverageExpanding Coverage

Coverage for Dependents (IRS Definition) (6 months – Coverage for Dependents (IRS Definition) (6 months – September 23, 2010):September 23, 2010):– Must provide coverage to a beneficiary’s dependent child until Must provide coverage to a beneficiary’s dependent child until

the child turns 26 the child turns 26 – Child does not have to live at homeChild does not have to live at home

Temporary High Risk Pool (90 days- July 2010- to 2014)Temporary High Risk Pool (90 days- July 2010- to 2014)– Citizens with pre-existing conditions who were uninsured 6 Citizens with pre-existing conditions who were uninsured 6

months prior to applying for coverage in the poolmonths prior to applying for coverage in the pool– $5 billion provided$5 billion provided– Pool operated by HHS or statesPool operated by HHS or states– Delaware participates in HHS Pool – Premiums Delaware participates in HHS Pool – Premiums

Health Benefits Advisory Committee led by Surgeon Health Benefits Advisory Committee led by Surgeon General will recommend essential benefits package General will recommend essential benefits package (established in 60 days)(established in 60 days)

Expanding Coverage (cont)Expanding Coverage (cont)

Expands Medicaid eligibility to 133 % of Federal Expands Medicaid eligibility to 133 % of Federal Poverty Level (2014) Poverty Level (2014) - - • approximately $14,600/ individual; $29,400/family of 4 approximately $14,600/ individual; $29,400/family of 4 • Includes childless adultsIncludes childless adults• Provides national base of seamless coverageProvides national base of seamless coverage

Federal Share (FMAP):Federal Share (FMAP):• 100% for newly eligible first 3 years (2014 – 2016)100% for newly eligible first 3 years (2014 – 2016)• Phases down to 90% for 2020 and subsequent yearsPhases down to 90% for 2020 and subsequent years• Provides full funding for Provides full funding for CHIPCHIP through 2015 and continues through 2015 and continues

authority through 2019. Children on CHIP would be authority through 2019. Children on CHIP would be transitioned to Medicaid or into Exchange.transitioned to Medicaid or into Exchange.

DE FocusDE Focus

Medicaid ExpansionMedicaid ExpansionStates are required to extend Medicaid eligibility to States are required to extend Medicaid eligibility to everyone younger then 65 with incomes up to 133% of everyone younger then 65 with incomes up to 133% of FPL($29,327 family of 4).FPL($29,327 family of 4).

2014 – 2016 - Federal government pays 100%2014 – 2016 - Federal government pays 100%2017 – Delaware will pick up 5% of cost2017 – Delaware will pick up 5% of cost2020 - 90% of cost2020 - 90% of cost

ShiftShiftDelaware currently provides expanded coverage to Delaware currently provides expanded coverage to 27,000 Delawareans up to 100% FPL27,000 Delawareans up to 100% FPL

Currently - Federal government pays 53% of the costCurrently - Federal government pays 53% of the cost2014 – the federal match will increase to 75% and by 2020 up to 2014 – the federal match will increase to 75% and by 2020 up to 90% of cost90% of cost

Other Key Changes:Other Key Changes:

Market Reforms & EmployersMarket Reforms & EmployersEmployer & Individual ResponsibilitiesEmployer & Individual ResponsibilitiesSmall Business Coverage Small Business Coverage (i.e. tax credits)(i.e. tax credits)

Streamline PracticesStreamline PracticesInsurance Markey ReformInsurance Markey ReformHealth Benefit Exchanges Health Benefit Exchanges (SHOP)*(SHOP)* Quality* Quality*Health Promotion & WellnessHealth Promotion & WellnessOther Other

DE Health ReformDE Health Reform

www.Healthcare.govwww.Healthcare.govwww.dhcc.delaware.govwww.dhcc.delaware.gov

Other/CommentsOther/Comments

146th DE General Assembly : 146th DE General Assembly : Example DE Policy Issues Example DE Policy Issues New 146New 146thth 1/11 1/11

Example Health Related BillsExample Health Related Bills - Medical Offices:Safety/Unsanitary - Medical Offices:Safety/Unsanitary

ReportingReporting- BPA and child products- BPA and child products - License Bills- License Bills - RN Title Bill- RN Title BillChronic IllnessChronic Illness

Cancer (SB90 – Tanning Beds)Cancer (SB90 – Tanning Beds)Cardiovascular Disease Office (HB352)Cardiovascular Disease Office (HB352) HIV (Needle Exchange)HIV (Needle Exchange)

OtherOther Insurance (i.e.Chip Updates)Insurance (i.e.Chip Updates) Prescriptions (i.e Prevent MD Shopping)Prescriptions (i.e Prevent MD Shopping) Education FundingEducation FundingOthers EtcOthers Etc

* Must Act & Advocate* Must Act & Advocate

DE General Assembly ActionDE General Assembly Action

Money CommitteesMoney Committees

**Authorized versus Appropriated**Authorized versus Appropriated

State Budget—Operating & Capital State Budget—Operating & Capital (Bond) & Rainy Day Fund, (Bond) & Rainy Day Fund, Special Funds (i.e. Tobacco)Special Funds (i.e. Tobacco)

Bill with a Fiscal Note over 50KBill with a Fiscal Note over 50K

Joint Finance CommitteeJoint Finance Committee

AppropriationsAppropriations

DE Health Related CommitteesDE Health Related Committees

““THINK OUTSIDE THE THINK OUTSIDE THE HEALTH HEALTH BOX: Quality & Health”BOX: Quality & Health”

Senate & House Committees- Senate & House Committees- - Examples to consider- Examples to consider SenateSenate Health, Agriculture, Insurance & Health, Agriculture, Insurance &

Elections, Veterans Affairs, Highways, Small Elections, Veterans Affairs, Highways, Small Business, Banking, etc.Business, Banking, etc.

HouseHouse Health & Human Development, Health & Human Development, Homeland Security, Labor, Natural Resources Homeland Security, Labor, Natural Resources and Environment, Education, Public Safety, and Environment, Education, Public Safety, Judiciary, etc.. Judiciary, etc..

Federal Policy ExamplesFederal Policy Examples

Policy Policy Politics Politics Policy Policy Politics Politics etc. etc.

Multiple biological, socio-cultural, mental, Multiple biological, socio-cultural, mental, physical, economic issues impacting individuals, physical, economic issues impacting individuals, professionals, workplaces, schools, professionals, workplaces, schools, communities, governments etccommunities, governments etc

Domestic & GlobalDomestic & Global

Other- Nursing, medicine, Allied Health SpecificOther- Nursing, medicine, Allied Health Specific

US Senate & US HouseUS Senate & US House

www.thomas.govwww.thomas.gov www.nursingworld.com www.nursingworld.com

Political Strategies To Influence Political Strategies To Influence PolicymakersPolicymakers

Use of mediaUse of mediaTestimonyTestimonyDirect & Indirect contactsDirect & Indirect contactsPACSPACSDrafting Policy Drafting Policy Coalition building Coalition building - Grassroots efforts- Grassroots efforts- Shaping implementation- Shaping implementationOthersOthers

How To’s: Interacting With How To’s: Interacting With Elected OfficialsElected Officials

Face-to-face meetingsFace-to-face meetings

E-mailE-mail

Letter writingLetter writing

Unified ApproachUnified Approach

Do’s and Don’tsDo’s and Don’ts

Quality : Quality : ALLALL Areas of Areas of Public PolicyPublic Policy

Federal & State ResourcesFederal & State Resources

www.delaware.govwww.delaware.gov

Governor Markell 302-744-4101, 1-800-292-9570Governor Markell 302-744-4101, 1-800-292-9570

Lt Governor Denn 302-744-4333Lt Governor Denn 302-744-4333

DE House *302-744-4351 or 302-744-4171DE House *302-744-4351 or 302-744-4171

DE Senate 302-744- 4286 or 302-744- 4048DE Senate 302-744- 4286 or 302-744- 4048County & Local Governments –Visit as neededCounty & Local Governments –Visit as needed

www.thomas.govwww.thomas.gov

US Capitol 1-202-224-3121US Capitol 1-202-224-3121

Know Your Resources & Be Politically Know Your Resources & Be Politically ActiveActive

- Know Associations, Alliances & Know Associations, Alliances & Be OrganizedBe Organized

- National, State & Local OfficialsNational, State & Local Officials- PROACTIVE Policymaking & PROACTIVE Policymaking &

Position StatementsPosition Statements- Role Model to Peers & Policy & Role Model to Peers & Policy &

Public Public AdvocatesAdvocates- OtherOther

Contact InformationContact Information

Senator Bethany Hall-LongSenator Bethany Hall-Long

302-744-4039/4286302-744-4039/4286

[email protected]@state.de.us

““Closing Thoughts”Closing Thoughts”

““The further back we The further back we look, the further ahead look, the further ahead we see”we see” (Churchill)(Churchill)

““It’s always darkest It’s always darkest before the dawn”before the dawn”

““Great opportunities are Great opportunities are disguised as unsolvable disguised as unsolvable problems”problems”