Noon Conference: Health Reform Update October 2009 www.drsforamerica.org This is an incredibly busy and important time Congress has been mainly driving this process: • Senate has 2 committees with jurisdiction – Health, Education, Labor, Pension (HELP) and Finance each committee working on their own bill • House has 3 committees with jurisdiction – Ways and Means, Education and Labor, Energy and Commerce the three committees have been working together to come out with one bill President Obama has strongly supported the process: • Health Care Forum at the White House in March to bring together all stakeholders • White House Health ―Czar‖: Nancy Anne DeParle The latest from Capitol Hill Senate: • Both the HELP committee and the Finance Committee have completed their bills and successfully voted them out of committee for a full Senate vote • Currently the bills are being merged into one consolidated bill which should be released soon. The latest from Capitol Hill House: • All three committees have voted on HR 3200 ―America’s Affordable Health Choices Act” • The Congressional Budget Office ―scored‖ the bills and they are fully paid for over ten years. • The bill is due for a floor vote in the House in early November Why the rush? Do we need reform this year? Is status quo acceptable? Why reform? High cost • The cost of health care for the average American family is $16,771 • Half of all bankruptcies are related to medical expenses Americans lack Access to Care: • 14,000 Americans lose health insurance coverage everyday Doctors are working within a broken system • Spending more time filling out papers than with their patients • Doctors are undervalued- especially in primary care fields • Doctors work with the threat of mal practice suits • The payment system rewards the number of procedures rather than the quality of care provided The type of reform doctors want: • We want health reform that promotes: – Accessibility – Affordability – Quality • Keep what works • Fix what’s broken • How does this play out in the current health reform legislation….. The Proposed Health Reform Legislation What’s in it for doctors and their patients….. Increased Choice: makes sure people can choose coverage that fits their needs A Health Insurance Exchange • Small businesses and individuals who qualify can enter the health insurance exchange and choose from a range of private and public health insurance options. A public health insurance option • A government run insurance company that can be on option among many for patients Guaranteed coverage and insurance market reforms • limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Essential benefits package – sets a minimum standard for what insurance companies should cover Increased affordability: makes sure people can afford their health care • Limits out-of-pocket spending for health insurance and preventative services • Includes subsidies for the middle class to purchase health insurance • Includes subsidies for small businesses to purchase health insurance for their employees • Eliminates co-payments for preventive services • Expands pharmacy benefits in Medicare to close the ―doughnut hole‖ Increased access: makes sure people have access to a primary care doctor • Enhances the primary care workforce – 5% increase in payments to primary care providers under Medicare and Medicaid. – Provides loan forgiveness for primary care physicians who practice in underserved areas • Increases funding for the National Health Service Corp • Expands Community Health Centers funding Improvements to Medicare: makes Medicare more efficient and effective • SGR Reform: – House – complete reform of SGR ($245 billion expense to fix physician payment –20% of the cost of reform.) – Senate: band-aid for 1 year • Creates pilot for innovative delivery system models such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments. • Creates new payment incentives to decrease preventable hospital readmissions. • Creates new methods for administrative simplification. Improved quality: helps doctors take better, more consistent, more effective care of patients • Invests in comparative effectiveness research • Creates pilots for innovative delivery system models: medical home and accountable care organizations. • Creates community-based programs to deliver prevention and wellness services • Invests in efforts to better identify and address health disparities along racial, ethnic, and regional lines In Summary: Health care reform working for you... 1. Increase choice 2. Increase affordability 3. Increase access 4. Improves Medicare 5. Improves quality Public Plan Options being considered by the House: 1. Linking to Medicare Payment Rates: In the most robust, the public plan would pay hospitals and other providers based on Medicare reimbursement rates, typically lower than private insurance rates. That would allow the public plan to charge lower premiums than private plans, and save the government substantial money in reduced subsidies — more than $100 billion over the next decade. There is a danger that the low payments might push some hospitals, especially in rural areas, into deeper financial trouble. 2. Negotiated reimbursement rates with providers: the plans bargaining power would depend on how many people it enrolled. 3. Hybrid version: start with negotiations with providers to set prices for services, but switch to a Medicare-based formulation if the plan’s premiums rose too rapidly with care taken to mitigate adverse effects on rural areas. Medical Liability Reform • Amendment in the House bill that authorizes state pilot programs for medical liability reforms • As we invest in quality and safety in the health care system –this will foster a safer practice environment for physicians and safer care environment for patients. – Quality improvement initiatives through Medicare – Improved care coordination – Large investment in HIT that will drive decision support tools – Evidence based medicine will help physicians make sound decision about treatment options The hurdles still to come • The full House must vote on and pass their bill • The Senate must merge the HELP and Finance bills….and then the full Senate must vote on that bill • Once both the House and Senate have passed bills of their own – they must ―conference‖ to merge the two versions of the bill into one final bill • Then that final version must be passed again by the House and Senate Thank you for support. For more information, visit: www.drsforamerica.org Doctors for America is a grassroots group of over 15,000 physicians in all fifty states committed to passing meaningful health reform legislation. The group works to convey the ideas and experiences of physicians in order to achieve reform that provides high quality, affordable healthcare for all Americans.