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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 2009 56 D’s; 44 R’s 58 D’s; 40 R’s; 2 I’s 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% U.S. Senate Uninsured 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 Finance Committee Bill Health, Education, Labor & Pensions (HELP ) Committee Senate Debate & Vote Finance Committee House Bill Education & Labor Committee President’s desk Conference Ways & Means Committee Energy & Commerce Committee Senate Vote House Rules Debate & Vote House Vote Why don’t the AANS and CNS support these healthcare reform measures? Neurosurgery’s Healthcare Reform Principles Principle 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 doctorpatient relationship House Senate Neurosurgery’s Healthcare Reform Principles Principle 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 House Senate Neurosurgery’s Healthcare Reform Principles Principle 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) House Senate 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) Physician Costs up 20% from 2009-2016 $200+ billion 22% Cut Medicare Payments cut 40% from 2010-2016 AMA’s Priority Issues AANS/CNS Actions Organized Coalition Efforts Letters to Congress Letters to AMA and ACS Media Campaigns Operation Patient Access www.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 Effects of Massachusetts Special U.S. Senate Election GAME CHANGER 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 Small Bill Bigger Insurance Pool Insurance Reforms Premium Subsidies Increased Spending Individual/Employer Mandates 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) What A Difference A Week Makes Yesterday Thursday Jan 21 Tuesday 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% 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, Director AANS/C NS Washington Office [email protected] 202-446-2024 Questions?