Healthcare Reform Legislation: Magic Elixir or Bitter Pill? Presented by: Katie O. Orrico, Director, AANS/CNS Washington Office January 23, 2010.

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

Organized Coalition Efforts

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 [email protected]

Questions?