National Health Care Reform: The Odds, the Players and the Issues Peter V. Lee, Executive Director for National Health Policy Pacific Business Group on Health Consumer-Purchaser Disclosure Project Policy Briefing January 12, 2009
Mar 21, 2016
National Health Care Reform: The Odds, the Players and the Issues
Peter V. Lee, Executive Director for National Health PolicyPacific Business Group on Health
Consumer-Purchaser Disclosure Project Policy BriefingJanuary 12, 2009
© Consumer-Purchaser Disclosure Project, 2009 2
The Odds – Will “Big Reform” Occur?
• Health care IS a core economic issue • President-elect Obama said so • More than Congressional interest -- we
have thoughtful Congressional leadership.
• Reform interest is bipartisan. • Proposals have low “fright factor” for
existing insureds • Coverage expansion is framed as BOTH
about the “right thing to do” and addressing cost.
• Bigger is often more doable than smaller. • Special interests recognize the need for
reform.
Over ($) 2 trillion reasons say no… but:
© Consumer-Purchaser Disclosure Project, 2009 3
National Reform Opportunities: The Process and the Players
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Health Reform Elements1. Coverage expansion and Financing
– Affordable coverage/Universal access• Expanding public programs (Medicaid, SCHIP, Medicare)• Connector/Exchange
– Subsidies for low-income– Public plan option
• Small business tax credits– Shared Responsibility
• Individual mandate• Employer mandate (play or pay)
– Insurance market reforms• Guaranteed issue• Rating reforms
– Tax code changes (eliminating or modifying tax exclusion for ESI)– Individual out-of-pocket contributions
2. Benefits– Minimum, standard benefit package– Specified in statue or delegated to outside entity?– Value based insurance design– Long term care
© Consumer-Purchaser Disclosure Project, 2009 5
Health Reform Elements3. System Reforms
– Quality improvement• Measurement and Reporting (transparency) • Address disparities• Promote primary care and chronic care management
– Wellness/Prevention– Payment reform
• Promote primary care, collaboration/integration and paying for “Value” – Medical home– Revised RBRVS– Episodes, bundles– Gain-sharing, accountable entities– Payment/non-payment based on quality/outcomes
4. Infrastructure – Oversight: Health Fed/Independent Health Coverage Council– Health Information Technology– Comparative effectiveness research– Workforce– Medical malpractice reform
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The Legislative Process: Clean & Simple Measure introduced into the House
Measure referred to committee
House Committee on Ways and
Means
House Committeeon Energy and
Commerce House passes measure
Measure introduced in the Senate
Measure referred to committeeSenate Health,
Education, Labor and Pension (HELP)
Committee
Senate Committee on
Finance
Legislation may begin in either chamber or proposed by the committee.Similar proposals are often introduced by both chambers
One Chamber agrees to the other’s version
House and Senate exchange amendments and agree
Signs or Vetoes
Or OrConference Committee
Senate approves conference report
Measures must pass both the House and the Senatein identical form before being presented to the President.
House approves conference report
President/Executive BranchAdministers Laws; Adopts Regulations
Legislation presented to the President
Senate passes measure
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The Political Players
Henry WaxmanChair, Committee on Energy
and Commerce
The Obama
All-Stars
Tom Daschle: Sec. HHSDirector, White House Office of Health Reform
Timothy GeithnerTreasury Secretary
Peter OrszagDir. Office Management
and Budget Rahm Emanuel
White House Chief of Staff
Senator KennedyChair, HELP
Pete StarkChair, Ways & Means Comm.,
Subcommittee on Health
Senator GrassleyRanking Min., Sen. Fin.
Senator BaucusChair, Finance Committee
The Senators
The House Reps
Senator HatchRanking Min., Sen. HELP
Nancy PelosiHouse Majority Leader
John Dingell Jr., Chair Emeritus, Committee on Energy and Commerce
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The Obama All-StarsBarak ObamaPosition: Team Owner of the Obama All-Stars Factoid: Spent over $100 million in campaign saying he’d change health care and 77% of Americans said health care was a “decisive concern” in their voteIn his words: “The time has come this year in this new administration to modernize our health care system for the 21st century, to reduce costs for families and businesses, and to finally provide affordable, accessible health care for every single American.” (“The market will work only where it has good information…If you can compare quality and price of an automobile, you should be able to compare quality and price of a heart surgery.” (in 2003 as chair of Illinois Senate Health and Human Services Committee)
Tom DaschlePosition: Team Captain -- Secretary HHS and Director of White House Office on Health Reform Factoid: Co-authored “Critical” (with Jeanne Lambrew), calls for Health FedIn his words: “We have the most expensive health care system in the world, but are not the healthiest nation in the world. Our growing costs are unsustainable, and the plight of the uninsured is unconscionable. Addressing our health care challenges will not only mean healthier and longer lives for millions; it will also make American companies more competitive, address the cause of half of all of our personal bankruptcies and foreclosures, and help pull our economy out of its current tailspin.”
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The Obama All-Stars: The Money GuysPeter OrszagPosition: The Banker -- Director of Office of Management and Budget (“OMB”)Factoid: Former head of Congressional Budget OfficeIn his words:“Two complementary approaches to reducing total health care spending involve generating more information about the relative effectiveness of medical treatments and changing incentives for providers and consumers of health care…. [The] relatively small investment in research focused on the mechanics of restructuring the delivery of and payments for health care to reduce inefficiency [is striking].”
Timothy GeithnerPosition: Treasury Secretary In his words: “[W]e’re seeing a welcome wave of attention in the business community to the broader economic imperative of health care reform. The U.S. system has compelling strengths in the quality of care and the choices available to much of the population. But our system is also remarkable for the magnitude of the costs, the incidence of those costs across the economy, the number of uninsured, and our poor performance on health outcomes even compared with less wealthy economies.”
© Consumer-Purchaser Disclosure Project, 2009 10
The Obama All-Stars: Key PlayersRahm EmanuelPosition: Enforcer -- White House Chief of StaffFactoids: Knows health care, served on Ways & Means Health Subcommittee, brother Ezekiel Emanuel, bioethicist at NIH, authored “Healthcare, Guaranteed”
Additional Key Positions:• Administrator of CMS (oversees Medicare and Medicaid)• Administrator of FDA• Director Centers for Disease Control• Director Agency for Healthcare Research and Quality • Surgeon General• Director National Institutes of Health• Senior Staff: White House Office of Health Reform, HHS, etc
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The SenatorsLeadership & Key
Committees
Senator KennedyChair, HELP
Senator BaucusChair, Finance Committee
Senator HatchRanking Min., Sen.
HELPSenator Grassley
Ranking Min., Sen. Fin.
Senator Harry Reid Majority Leader, 111TH Congress
Senator McConnell Min. Leader, 111TH Congress
© Consumer-Purchaser Disclosure Project, 2009 12
The House of Reps: Leadership & Key Committees
Nancy PelosiHouse Majority Leader
Henry WaxmanChair, Committee on Energy
and Commerce Pete StarkChair, Ways & Means
Subcommittee on Health
John Dingell Jr.Chair Emeritus, Committee on Energy
and Commerce
Joe Barton (R-TX)Ranking Minority, Committee on Energy
and Commerce Dave Lee Camp (R-MI)Ranking Minority, Ways & Means
Subcommittee on Health
John Boehner House Min. Leader
© Consumer-Purchaser Disclosure Project, 2009 13
Legislative Process – The Reality: Chutes and Ladders with Trillions at Play
The Players: Senate House of Reps White House
Chutes or Ladders – those who can move reform forward or back (and their ten year lobbying + federal contributions to Congress):• Clinicians -- $980 million• Hospitals -- $752 million • Pharma -- $1.6 BILLION• Insurers -- $555 million
AND…if we play our cards right: • Labor• Consumers• Employers
Why have we failed to do health care reform: “…the power of the interest groups – doctors, hospitals, insurers, drug companies, researchers, and even patient advocates – that have a direct stake.” Tom Daschle, 2008
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First Rule of Politics: Follow the MoneyFunds Flow 2006: $2,105.5 Billion
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Chute or Ladder: CliniciansMajor Players: AMA, specialty societies, medical colleges, nurses, physical therapists, chiropractorsPro: DEPENDS – differing issues if specialists “versus” primary care; support for primary care generally strong and cross-cuttingConcerns: rapid change to status quoLobbying 2007: $71.8 millionFederal Contributions: $86.6 million
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Chute or Ladder: HospitalsMajor Players: AHA, FHA, PremierPro: Incremental reform; increasing Medicaid paymentsConcerns: Rapid and disruptive changeLobbying 2007: $91.7 millionFederal Contributions: $19.7 million
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Chute or Ladder: Pharma and DevicesMajor Players: PHARMA, AdvaMed, Individual RX companies, specialty developers, generic makersPro: generally “reality based” advocacy – recognize future of lower margins Concerns: importation, Medicare negotiating, comparative effectiveness (especially with cost)Lobbying 2007: $226 millionFederal Contributions: $30.6 million
© Consumer-Purchaser Disclosure Project, 2009 18
Chute or Ladder: Insurers
Major Players: AHIP, BC/BS, individual plansPro: expansion of coverage, maintaining and expanding private plan optionsConcerns: MLR cap, Medicare Advantage payment reform, public plan expansionLobbying 2007: $70 millionFederal Contributions: $31.2 million
© Consumer-Purchaser Disclosure Project, 2009 19
Chutes or Ladders: Other Wild CardsLawyersIT VendorsBanksPharmacies (on-line or old-school)StatesIdeologues…
© Consumer-Purchaser Disclosure Project, 2009 20
Chute or Ladder: LaborMajor Players: AFL-CIO, SEIU, many othersPro: patient-centered reformConcerns: mix of protecting benefits and/or expanding coverage to low income Lobbying 2007: $44 millionFederal Contributions: $31.2 millionBUT…relatively little contributions focused specifically on health care
© Consumer-Purchaser Disclosure Project, 2009 21
Chute or Ladder: Consumer GroupsMajor Players: AARP, Consumers Union, NPWF, disease groups, access/coverage groupsPro: coverage expansion; patient-centered care; “their” condition Concerns: group/issue specific
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Chute or Ladder: Employers
Major Players: US Chamber, BRT, NFIB, individual employers that “step up”
Pro: malpractice reform, increasingly for value and reform (but historically, relatively little Concerns: protecting national consistency (hence, protective of ERISA)Lobbying 2007: $87 million (but tiny on health care)
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Health Reform Elements1. Coverage expansion and Financing
– Affordable coverage/Universal access• Expanding public programs (Medicaid, SCHIP, Medicare)• Connector/Exchange
– Subsidies for low-income– Public plan option
• Small business tax credits– Shared Responsibility
• Individual mandate• Employer mandate (play or pay)
– Insurance market reforms• Guaranteed issue• Rating reforms
– Tax code changes (eliminating or modifying tax exclusion for ESI)– Individual out-of-pocket contributions
2. Benefits– Minimum, standard benefit package– Specified in statue or delegated to outside entity?– Value based insurance design– Long term care
© Consumer-Purchaser Disclosure Project, 2009 24
Health Reform Elements3. System Reforms
– Quality improvement• Measurement and Reporting (transparency) • Address disparities• Promote primary care and chronic care management
– Wellness/Prevention– Payment reform
• Promote primary care, collaboration/integration and paying for “Value” – Medical home– Revised RBRVS– Episodes, bundles– Gain-sharing, accountable entities– Payment/non-payment based on quality/outcomes
4. Infrastructure – Oversight: Health Fed/Independent Health Coverage Council– Health Information Technology– Comparative effectiveness research– Workforce– Medical malpractice reform
© Consumer-Purchaser Disclosure Project, 2009 25
The Consumer-Purchaser Disclosure Project is an initiative that is improving health care quality and affordability by advancing public reporting of provider performance information so it can be used for improvement, consumer choice, and as part of payment reform. The Project is a collaboration of leading national and local employer, consumer, and labor organizations whose shared vision is for Americans to be able to select hospitals, physicians, and treatments based on nationally standardized measures for clinical quality, consumer experience, equity, and efficiency. The Project is funded by the Robert Wood Johnson Foundation along with support from participating organizations.
For more information http://healthcaredisclosure.org/
For the most current information on the Patient Charter http://healthcaredisclosure.org/activities/charter/
Jennifer Eames, MPH Tanya Alteras, MPPAssociate Director Associate DirectorConsumer-Purchaser Disclosure Project Consumer-Purchaser Disclosure [email protected] [email protected] 202-238-4820
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