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Rx for Successful SEIU Strategy
for Health Care
SERVICE EMPLOYEES INTERNATIONAL UNION
November 30, 2007
Chris Jennings, Jennings Policy Strategies, Inc.
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Outline
1) The Return of Health Debate: Issues that Frame
SEIU Priorities
2) Health Care Strategies for
 Cost Containment
 Coverage
 Long-Term Care/Re-Balancing
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The Health Care Debate Today

Health care is now a leading issue for Americans
 Health care is the most important domestic issue to Americans
 One of top priorities overall, second only to the war in Iraq
44%
Iraq
29%
Health Care
13%
Economy
9%
Immigration
Terrorism/Nat'l
Security
0%
Source: Kaiser Family Foundation, March 2007
8%
10%
20%
30%
40%
50%
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Why? Cost…
Costs Drive the Concern and the Debate
1. Cost to Families: Premiums reached an average of $11,480
annually for family coverage in 2006 (87% increase since
2000)
2. Cost to Businesses: Fewer firms offering coverage
(especially small business); CEOs cite health care as
largest cost pressure on corporate America
3. Cost to Government, Now and into Future: Medicare and
Medicaid spending threaten to devour large portions of
budget
4. Cost to Nation: Health care costs to hit $4.0 billion by
2015, or 20% of GDP
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Current System Shifts -- Not Contains -- Costs
Uninsured
 Insured
Government  Businesses
Businesses
 Workers
…and adverse selection gaming
between insurers and patients
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Not All Cost Challenges
Uniformly Harmful to SEIU
74.8 Million
Medicare Beneficiaries
36.4 Million
2005
2035
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Source: KFF, 2005; Census
…Because Biggest Cost Driver are Those
With Chronic Disease Who Need Care



Overall
The 10% of patients that suffer
from chronic disease account for
75% of the nation’s health care
spending
Studies show that virtually ALL
of the spending growth in
Medicare over the last 15 years
resulted from increased
spending on people with
multiple, chronic conditions
25%
75%
Other Treatment
Chronic Care
Medicaid
17%
The number of chronically ill
expected to DOUBLE by 2020
83%
Source: Thorpe K. Health Affairs, 2006; Gillespie, J., et al, February 2003; Johns Hopkins, Partnership for Solutions, 2006
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Budget Deficit Constrains Agenda
Deficit, Dollars in Billions, FY 2000-8
$150
$100
$50
$86 B
$0
($50)
-$278 B*
($100)
($192 B)*
($150)
($200)
2000
Source: CBO, March 21, 2007
* Assumes extension of tax cuts
2008
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Nonetheless, Reform Pressures
Exceed 1993-’94





Greater recognition that health costs are threat
to competitiveness and economic growth
Broader pool of business validators supporting
Traditional stakeholders as well as “strange
bedfellows” embracing comprehensive reform
Emerging consensus that quality/value issues
can bring stakeholders together
Stronger and more bipartisan relationships on
Committees
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Three Priority Issues and Possible
Strategies
1)
Cost containment: Rising costs force need to
be a constructive player
2)
Coverage: Initiatives should be framed to
meet SEIU priorities -- WINNING
3)
Long-Term Care Rebalancing Agenda:
Ensuring that LTC is central component of
reform must be a priority
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Cost Containment Strategy

SEIU needs to inoculate itself from being perceived
solely as a spender

SEIU needs to be associated with politically-viable
modernization initiatives that can achieve savings and
credibility

Failure to do so undermines credibility for opposing
cost-shifting policies that hurt

SEIU particularly well-positioned to support
modernization reforms
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Possible Cost Containment Agenda
1)
Value-purchasing, e.g. P4P
2)
HIT/e-Prescribing
3)
Comparative effectiveness
4)
Chronic care management
5)
Biogenerics and other pharmaceutical cost
containment initiatives
6)
Targeted DSH and HMO overpayments
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Coverage Strategy

Number one priority because:

Helps with organizing and securing affordable care for members

Reduces pressure on compensation negotiations

Creates demand for SEIU-provided services

SEIU needs to continue to make health care
significant part of Presidential and Congressional
2008 debate

Needs to ensure that priority SEIU provisions are
incorporated without excessive micro-management
of policy
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Coverage Strategy

Strong messaging about consequences of inaction
needs to be developed and implemented

Candidates must be put on defense about flawed
policy; champions must not always be defending

Messaging about why this is a sympathetic working
Americans issue must effectively be delivered
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Coverage Policy Strategy

Debate around covering ALL vs. covering SOME must be
won by stressing that policies for incremental, individual
market, high cost-share reforms will harm workforce

Macro debate between extending or rolling back tax cuts
must be won

Policies that promote quality through improved workforce
should be better integrated and promoted

Policies that promote affordability for workers need to be
highlighted

Detailed policy advocacy should be minimized
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Long-Term Care Environment

Long-term care agenda is largely invisible and needs
to resurface

Democrats already being charged as “big spending
tax hikers”

Promotion of unrealistic policies is ticket to
nowhere

Little appetite for costly program add-ons, but
increasing interest in transition policies
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Long-Term Care Policy Strategy

Get long-term care/rebalancing agenda on
table through strategic policy positioning in
2008:

Target committees of jurisdiction to advocate for
potentially achievable policy

Develop and implement integrated financing strategy with
ongoing health reform debate

Lay foundation for strong state advocacy to be financed by
health reform state savings
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Long-Term Care Policy Strategy

Ensure introduction of – and movement on –
bipartisan rebalancing legislation in Finance
Committee

Give states the authority to provide home and
community-based services at same level of
institutional care

Provide grants to expand public authorities and
provider registries

Utilize grassroots and messaging strategy to up-lift
the policy and strategy
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