"how the changing political landscape affects health care daniel sisto"
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