Jodie_Curtis

Adult Day Services: Effectively Advocating in Washington D.C. & Becoming an Integral Part of Health Reform National Adult Day Service Association Conference San Antonio, TX Jodie Curtis Drinker Biddle & Reath, LLP November 9, 2008 Presidential Results       Obama wins the White House 53%-46% with MO still to be decided 364-163 electoral college votes GW Bush: 51/286,48/271 Clinton:49/379, 43/370 GHW Bush: 53/426 House of Representatives      Democrats pick up seats Was 236-199 Now 255-174, 6 undecided 47++ Blue Dogs 71 Progressive Caucus Senate        Democrats pick up seats Was 51-47-2 57-40-2 MN-AP called Coleman over Franken – 600 votes – recount GA-Chambliss leads Martin but possible runoff AK-Stevens too close to call Unlikely Dems will get to 60 What is Lobbying?      Showing up Educating Persuading Asking Following through Lobbying: The Basics      Strategic relationship-building over an extended period of time  It’s never too early to start Development of policy supported by persuasive arguments and evidence Strategic planning  Importance of understanding the legislative and regulatory calendars Polished execution & “grunt work” Thank supportive Members of Congress What is Federal Government Relations?  Lobbying Congress   Members of the House and key committees Members of the Senate and key committees  Lobbying the Executive Branch   Government agencies (e.g. CMS) White House (i.e. Executive Office of the President) Lobbying 101 in a Nutshell: Turning Ideas into Action Policy Makers Work for You  Washington, DC Legislative staff -- policy focus  District/State caseworkers & outreach staff -- local focus Health Care is Political  Medicaid/Medicare Policy - Medicare Modernization Act and Deficit Reduction Act Implementation   Budget cuts Health care reform Congress: The Basics  House • Senate • 100 • 2 per state • 1/3 every 2 years   435 Pop. based every 2 years 1 Member local district  Key Committees House  Senate • Finance Committee (Medicare/Medicaid) • Health, Education, Labor, and Pensions (HELP) Committee • Appropriations (CMS) • Budget    Ways and Means (Medicare Parts A & B) Energy & Commerce (Medicaid) Appropriations (CMS) Budget “I’m Only a Bill…” Bill introduced (#)  Ref. committee  Ref. subcommittee  Reported out favorably  Full chamber  Repeat in other chamber  Conference Committee  President  Typical Elements of a Government Relations Campaign  Set up meetings with Members of key congressional committees and your company’s state delegations  Develop data/evidence and persuasive rationale for the proposed policy Develop "leave-behind" packets – including issue briefs, talking points, patient access impact analysis, and other advocacy materials for Members and their staff   Enlist support of key Members to help secure a meeting with seniorlevel CMS staff Typical Elements of a Government Relations Campaign  Direct outreach and education with key agency staff and conduct periodic follow-up with congressional offices to keep supporters apprised of status of the effort  Invite Members of Congress and their staff to visit your facilities in their district Conduct outreach to other advocacy groups and seek to enlist their support  Government Relations Myths  Real “lobbying” is done in a smoke-filled backroom Only large companies do it Send in one wellconnected lobbyist and it will all be fine   Putting Advocacy Into Action: Getting Started  Get to know your congressional delegation in Washington by meeting with Members’ staff, ideally before you need something   Introduce your company (provide materials) Do background research on Member prior to meeting (common priorities?) www.house.gov www.senate.gov thomas.loc.gov Getting Started     Find local offices of your Members of Congress and visit them  Invite Member or staff to visit your facility Try to start small with any requests Be respectful and patient  Congressional offices are understaffed for the volume of work they produce, and your priority is just one of many Always follow up with requested information and thank you letters Getting Started  Before engaging in advocacy activities, discuss internally   Possible existing political relationships Need for prioritization and coordination of congressional requests  Democracy is slow – persistence, patience, and a long-term commitment are required Health Care Reform Overall Almost Everyone Agrees About…        Controlling health care costs Providing cost transparency Increasing information about quality of care Promoting use of evidence-based medicine and health information technology (including electronic prescribing) Improving chronic disease management and health promotion/prevention Permitting drug re-importation and generics Supporting expansion and development of health professionals Then the Differences Start Republicans Generally…      Market-based approaches Consumer responsibility Private insurance options Health savings account Use of tax incentives Democrats Generally…    Federal subsidies Expansion of public sector coverage Increased government oversight and regulation Obama Health Plan: Executive Summary        Preserves current employer-based system Creates a “National Health Insurance Exchange” modeled after the Federal Employees Health Benefits Program (private plans compete with public plan) Requires “pay or play” for employers Mandates all children be covered by 2012 Expands eligibility for Medicaid/SCHIP Permits young adults to be covered by parents Promotes health care access and interventions at schools and worksites Positives of the Obama Plan    People can maintain current coverage Near universal coverage Subsidies for those who cannot afford health insurance Pitfalls of the Obama Plan High taxpayer cost, possibly $110 billion per year  Coverage is not universal  “Affordable” premium is subjective  So What Will Really Happen? So What Will Really Happen?  Financial bail-out changes everything  Outcome of the election impacts the national agenda Need bipartisan will and cooperation to make health reform a reality  So What Will Really Happen?    Health care reform will never happen  This was the conventional wisdom about a Medicare prescription drug benefit, but it happened Senator Kennedy’s leadership could be critical to outcome – he is writing his own bill  No one knows more  Polarizing Senator Clinton will play an important role  Where does she throw her support? So What Will Really Happen? Unprecedented “unity” among interest groups regarding the need for reform – Harry & Louise change their tune  Some sort of bipartisanship is a key to success  In 1993-1994, the moderates wanted an individual mandate.     Liberals wanted employer mandate and said “my way or no way.” Conservatives wanted to kill reform. No one wanted to see the moderates succeed. So What Will Really Happen? 2008-2009: The side that finds common ground with the moderates can win.  No health care reform will go forward without discussion of Medicaid and Medicare  ADHC’s Role in Health Care Reform  Should ADHC be part of health care reform?  Absolutely  Will ADHC be part of health care reform?  Unclear ADHC’s Role in Health Care Reform  Challenges     Average policymakers don’t understand what ADHC is or its advantages Not a strong grassroots political voice Not a cadre of Washington lobbyists CMS recent actions ADHC’s Role in Health Care Reform  Opportunities       Saves money – makes this attractive for balancing more expensive components Increasing trend to want to keep people out of institutionalized health care as long as possible Better health outcomes Influential Members of Congress do know about ADHC CMS recent actions Attention starting to focus on chronic care mgmt Opportunities for ADHC     Health care policy will be considered on some level in Congress Everything on the table ADHC has a great “story” No health care reform will go forward without discussion of Medicaid and Medicare    The groundwork has been laid here Medicaid rehabilitation regulation moratorium Medicare Adult Day Health Care Demonstration Project Considerations for ADHC Providers    A large part of HC Reform is controlling cost:  How will providers be a part of the solution for managing costs for those with chronic medical, cognitive, and psych conditions?  Can we show cost savings on the Medicare side? Right now ADHC saves Medicare $$$ with reduced hospitalizations and ER visits but the Medicaid side gets no "credit" for that since they are two different systems. Bridging Medicare and Medicaid is a fundamental issue…  Does the ADHC business model need to change to work with Medicare?  If so, how?  Should health care reform include some new hybrid of Medicare/Medicaid?  Can that be done around the issue of dual-eligible's? How does ADHC position itself as part of the solution? Final Thoughts  Building relationships is key and an investment in the future for adult day services’ position within Medicaid and Medicare reforms New Congress creates new opportunity for our proposal to protect ADHC from a waiver  Contact Information Jodie Curtis Drinker Biddle & Reath jodie.curtis@dbr.com