how the changing political landscape affects health care daniel sisto by 75ig68

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									How the Changing Political
 Landscape Affects Health
          Care

         Daniel Sisto
      President, HANYS
   State
  Budget
  for FY
2009-2010
  Likelihood of
   Large State
 Budget Deficits
   for the Next
  Several Years
 NYS Fiscal Environment - Difficult
Even Before the Mortgage Meltdown
    Tax revenue declining
    Twenty percent of state revenue comes
     from Wall Street
    New York securities industry reported
     $22.8 billion in losses during first half of
     2008 alone
    That was prior to the September crisis on
     Wall Street
 NYS Fiscal Environment - Difficult
Even Before the Mortgage Meltdown

   40,000 finance industry jobs will disappear
    from the September crisis on Wall Street

   At the end of August, Wall Street bonuses
    were projected to decline by 20.5% -- Likely
    to be close to elimination
    NYS Division of Budget
     July 2008 Forecast
   FY 2008-09 potential imbalance of $630
    million
   FY 2009-10 deficit increased from $5.0
    billion to $6.4 billion
   Three-year, cumulative out-year deficit
    increased from $21.5 billion to $26.2
    billion
September 2008 Budget Update

   August budget actions decrease FY 2009-
    10 deficit from $6.4 billion to $5.4 billion
   On September 5, Governor Paterson asks
    all state agencies to draft a zero-growth
    budget
   Potential for Governor to call another
    special legislative session
Election 2008: Democrats May Have the
  Opportunity to Consolidate Power in
                Albany
“Let me tell you what state leaders envision
when they think about health care: they
think of you guys walking around with
billions of dollars in your pocket that they
can tap into.”

                            Jay Gallagher, Gannett Reporter
        Addressing the HANYS 2006 Annual Communication's
                    Conference for Health Care Professionals
            2009 Outlook
   State Budget gap will be very difficult to
    close without tax increases and large
    spending cuts

       Education vs. Health Care

       Hospitals vs. Managed Care

   “When there isn’t enough food, table
    manners deteriorate.”
2009 State Legislative Session

   Other Major Issues
       Health Planning
       CON Reform
       Commissioner’s Public Health Agenda
       Medicaid Fraud and Abuse Initiative
       IT Expectations
Federal
Budget
for FFY
 2009
2008 – “Bush Piles On”
       Budget Proposed Cutting Medicare
        Payments to NYS Hospitals
           $10 Billion Over 5 Years

       Regulations Proposed Cutting NYS
        Medicaid Payment
           $4.8 Billion Over 5 Years

       Placed Physicians at Risk to Protect
        HMOs
2008 Federal Accomplishments
   Congress Ignores Medicare Cuts

   Congress Blocks Regulatory Cuts to
    Medicaid

   Congress Overrides Presidential
    Veto and Defers Physician Payment
    Cut for 18 Months
Pre-Bailout Figures

 Federal Debt 1993:
    $4.49 trillion

 Federal Debt 2007:
     $9 trillion
   Pre-Bailout

Federal Deficit 2009:

    $490 billion
    Democratic Pay-As-You-Go or
       “Paygo” Budget Rules




Congress must offset all new spending
    with budget cuts or revenue
Medicare and Medicaid Spending as a
Share of the Federal Budget, FY 2007

                      Social         Medicare
                     Security          17%
                       21%
                                             Medicaid
                                               7%
                    Defense
                      19%                Other
                                         28%

                          Interest
                             9%

      Total = $2.7 Trillion in FY 2007 Federal Spending

   Source: Congressional Budget Office, Monthly Budget Review, November 6, 2007
Medicare Physician
     Payment:
A $100 billion dollar
     problem
Election 2008: Democrats Will
  Strengthen Their Control of
           Congress
  The influence of
New York Republicans
 in Washington, DC
   will continue to
       diminish
CUMULATIVE NY MEDICARE HOSPITAL RATE
  INCREASES VS. MARKETBASKET COST
             INCREASES
50%
                                                                                                   43.2%
40%



30%



20%                                                                                                15.4%

10%



 0%



-10%
   1997   1998      1999        2000   2001   2002   2003        2004       2005        2006       2007


                 Marketbasket                               Average PPS Rate Increase - New York
NYS Hospitals’ Operating Performance
 Economic slowdowns often
result in increased demand for
 publicly-funded health and
       social services.
 Out-of-pocket costs for
health care consumers will
  continue to increase.
    Managed care and private
    insurance reimbursement
 issues will become even more
  critical in the face of reduced
   government reimbursement
(and health plan consolidation).
Hospitals, HMOs, and Business
    The Tale of the Tape
Physician Workforce Challenges
   Average age of a practicing physician in
    New York State is 52
       23% are age 60 or older
   Shrinking availability of on call ER
    specialty coverage
   Facilities/communities are losing access to
    certain services
     Geographic Shortages
   Substantial decline in physicians per capita
    between 2002 and 2006 in large areas of the
    state
       Overall decline—Western NY, Mohawk Valley
        (11 counties)
       Decline in primary care physicians—Central
        New York, Mohawk Valley, North Country, and
        Western NY (22 counties)


                               Center for Health Workforce Studies
                            School of Public Health, SUNY at Albany
           Specialty Shortages
   The total number of general surgeons declined
    by 12% statewide between 2002 and 2006
       Recent data indicates that fewer medical school
        graduates choosing general surgery

       The total number of general surgeons declined by
        13% in NYC, 33% in the Mohawk Valley, and
        22% in the North Country


                                  Center for Health Workforce Studies
                               School of Public Health, SUNY at Albany
HANYS’ Members Report Growing
 Physician Workforce Shortages
                                                        % Reporting
                               % Reporting            Shortages in 2008
                             Shortages in 2007              Years
                                                       (excludes NYC)
 Primary Care*                               51%                      73%

 General Surgery                             21%                      57%

 Orthopedics                                 18%                      57%

 Urology                                     12%                      44%

 Psychiatry                                  11%                      37%


               *Includes family medicine, internal medicine, and pediatrics
    Doctors Across New York
   Medicaid physician fee enhancements
     75% of Medicare



   Doctors Across New York
     Loan repayment

     Physician practice support

     Ambulatory care training

     Diversity in Medicine/Post-Baccalaureate
      Program
     Workforce Study
U.S. Uninsured in 1993:
       37 million

U.S. Uninsured in 2007:
       46 million
     Approximately 2.5 Million
    Uninsured in New York State
   New York State has a lower rate of uninsured
    than the US
       NY: 13.6% of the population in 2007
       US: 15.3% of the population in 2007

       Massachusetts: 7.9% of the population in 2007

   New York has a higher rate of Medicaid
    coverage than the US
       NY: 18.9% of non-elderly populations in 2006
       US: 13.5%
Republican Presidential Health
          Care Plan
            Tax credits
            Health Savings
             Accounts
            Portability
            Guaranteed access
            De-emphasis on
             employer-based model
Democratic Presidential Health
         Care Plan
            A new national health
             plan available to all
             Americans, including the
             self-employed and small
             businesses, to buy
             affordable health
             coverage that is similar
             to the plan available to
             members of Congress.
     Democratic Presidential
        Health Care Plan
   National Health Insurance
    Exchange
   Required Employer Contributions
   Tax credits to assist small
    business
   Mandatory coverage of children
       Allowing young people up to age 25 to
        continue coverage through their parents'
        plans
       Expansion of Medicaid and SCHIP
The new Governor’s
administration has the
opportunity to ignite
universal coverage
discussions at the state
level, but financing
implications make it
improbable
 National Framework for Change

     Health Coverage for
     All Paid for by All
                                     Focus on Wellness


                   Health for Life;
                 Better Health, Better
                     Health Care
    Best
Information                                Most Efficient
                                          Affordable Care



              Highest Quality Care
                 Better Value
                                                  Care That is
      *Create accountability
                                                  Coordinated
      *Improve quality, safety, and
                                              *Encourage
       efficiency
                                               teamwork
      *Reward excellence
                                              *Give right care at
      *Reduce unnecessary care
                                               right time in right
                                               place
Health Coverage for     Framework for         *Ensure patient
                                               dignity and choice
All Supported by All
*Ensure affordable
                          Improving
 insurance             America’s Health
* Share financial
  responsibility
                                         Access to Information
                                      *Enable health IT
              Focus on Wellness
                                      *Create portable electronic
        *Promote preventive
        services                       health records
        *Reward personal
        participation
        *Reward healthy behaviors
What Does This Mean To You?
   Leverage Relationships
       Community
       Local and Regional Reporters
       Community Affairs Staff
       Opinion Leaders

   Policy and Politics—What Matters the
    Most?
       Affect on your patients
       Provide the human story, the real story
We Need You
 Engaged
Political Participation and Grassroots
       Activism Leads to Results
 Critical Advocacy Tools

 A Unified Base

 Grassroots Power

 Sound Health Policy

 Reliable Data

 The Political Clout of a Strong PAC
How the Changing Political
 Landscape Affects Health
          Care

         Daniel Sisto
      President, HANYS

								
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