The AMA and Health System Reform

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The AMA and Health System Reform

• J. James Rohack, MDPresidentAmerican Medical
  Association
• South Dakota Medical Association
• October 1, 2009

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A Quick Look at History
1934 FDRs New Deal.
1970s Attempts by Presidents Nixon and Carter,
Sen. Ted Kennedy
1950s Growth of employer-sponsored insurance
1997 SCHIP created
1965 Medicare and Medicaid
1993 Clinton proposal defeated
1940 Trumans public subsidies for the poor
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U.S. Health Care Spending Today
2018 4.4 Trillion
2008 2.4 Trillion
Source National Health Expenditures and Selected
Economic Indicators, Levels and Annual Percent
Change Calendar Years 2003-2018
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National Health ExpendituresBending the Curve
Trillions of 2009 Dollars
Baseline
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• You did not enter this profession to be
  bean-counters and paper-pushers.
• You entered this profession to be healers and
  that's what our health care system should let you
  be.

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We want to make sure that everyone has
affordable quality health insurance.
Americas patients and physicians deserve better
than the status quo.
If Congress is committed, we're committed to
work with them to come up with something that is
going to be right for patients and right for the
physician who cares for them.
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AMA Commitment to Health System Reform

• The AMA is clearly committed to health
  reform this yearthe status quo is
  unacceptable.
• AMA President James Rohack, MD, July 29, 2009

We know at the end of the day, as a practicing
doc, it's the patient and the doctor that need
to make the decision on what is best for that
patient, based on evidence and science.
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Consequences of Being Uninsured

• Fewer preventive, therapeutic and screening
  services
• Sicker when diagnosed
• Poorer health outcomes
• Higher mortality and disability rates
• Lower annual earnings

SOURCE Hadley, Jack. Sicker and Poorer The
Consequences of Being Uninsured A Review of the
Research on the Relationship between Health
Insurance, Medical Care Use, Health, Work, and
Income, Medical Care Research and Review (602),
June 2003.
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South Dakota 85,000 uninsured
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Putting Off Care Because of Cost
Relied on home remedies or OTC drugs instead of
seeing a doctor
Skipped dental care or checkups
Put off / postponed getting health care
Not filled a prescription
Cut pills in half / skipped doses
Had problems getting mental health care
Did ANY of the above
Source Kaiser Family Foundation Health Tracking
Poll (conducted July 7-14, 2009)
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Coverage offered
The Percentage Of US Firms Offering Health
Coverage Has Fallen Significantly Since 2000
Source Kaiser/HRET Survey of Employer-Sponsored
Health Benefits 2000-2005
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Impact of the Rise in Unemployment on Health
Coverage, 2007 to 2009
Decrease in Employer Sponsored Insurance (million)
4.6

National Unemployment Rate Increase since
2007 (from 4.9 in Dec-07 to 9.5 in June-09)
11.3
Note Totals may not sum due to rounding and
other coverage. Source John Holahan and Bowen
Garrett, Rising Unemployment, Medicaid, and the
Uninsured, prepared for the Kaiser Commission on
Medicaid and the Uninsured, January 2009.
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AMA Criteria for Health System Reform

• Protects the patient-physician relationship
• Provides affordable health insurance for all
• Promotes quality, prevention and wellness
• Repeals the Medicare payment system that harms
  seniors' access to care
• Eases medical liability and administrative
  burdens

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Whats Happening in Congress

• In the House
• 3 committees passed legislation
• 50 to 60 additional amendments will be considered
• In the Senate
• Negotiations continue
• Gang of Six on the Finance Committee

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Whats Happening in Congress

• Main options under consideration
• More favorable payment structure for Medicare
  physician payment
• Increased support for prevention and wellness
  services
• Investments in the physician workforce
• An end to insurance coverage denials based on
  pre-existing conditions
• Reduced regulations and administrative burdens
• Increased support for primary care
• Health insurance exchange

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Organizations Supporting Reform

• AMA
• ACS
• ACP
• AAFP
• APA
• AAP
• ISDA
• ASAM

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The Medicare Dilemma
Practice Costs
Medicare Cuts
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Medicare cuts and South Dakota

• South Dakota physicians face a cut of 21.5 in
  2010 and 40 by 2014
• SGR repeal would stop the loss of 40 million in
  2010 for the care of elderly and disabled
  patients
• SGR repeal would prevent cuts of 18,000 on
  average to each physician next year
• SGR repeal would prevent losses of 500 million
  to state physicians over the next five years
• 119,022 Medicare patients and 29,017 TRICARE
  patients in South Dakota will be helped by the
  legislation that averts these cuts

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Access already an issue

• An above-average proportion of Medicare patients
  and a below-average ratio of physicians to
  Medicare beneficiaries
• 27 live in a designated primary care shortage
  area, among the highest in the nation
• 9 report that they could not see a doctor in the
  last 12 months due to cost
• 284 emergency department visits per 1,000
  population
• 26 of the states Medicare beneficiaries live
  below 150 of the federal poverty level
• Reform would bring higher Medicare geographic
  adjustments, which would prevent an additional
  3.3 cut in payment rates for physician Medicare
  services

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AMA Goals for Legislation

• The AMA is committed to achieving health reform
  this year that
• Provides all Americans with affordable,
  high-quality health care
• Reflects the needs of Americas patients and
  physicians
• Includes a permanent fix to the flawed Medicare
  payment system
• Includes a push for liability reform
• Supports primary care, prevention and wellness,
  and Health IT
• Is financially sound

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Public Plan The AMA View

• Physician participation should be voluntary
• Patients should have choice
• Public plan should be subject to same regulations
  as private plans
• Public plan should be self-sustaining

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Public Plan Whats in H.R. 3200

• Voluntary participation
• HHS required to negotiate payment rates
• Physicians and other providers can opt out
• Patients can receive care from the physician of
  their choice
• Physicians can privately contract with patients
• Self-sustaining and independent of the federal
  treasury

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Senate Finance Committee draft

• Creates a national insurance exchange
• Individual mandate to buy insurance, subsidies
  for low income people
• No denying coverage for pre-existing conditions
• Does not repeal the SGR replaces 21.5 cut next
  year with small update
• AMA will work with key senators toward a
  permanent SGR fix and to protect Medicare

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The Presidents Medical Examples

• Tonsillectomies?
• 30K amputations?
• AMA delivered swift, strong reply on both
  occasions
• Misleading and inappropriate, unfairly maligns
  motives of the profession

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U.S. Health Care Today

• 60,000 diagnoses
• 11,000 surgical procedures
• 4,000 drugs

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Obamas Address
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What the President Said

• 3 essential goals for reform
• Make sure the current system is secure and stable
  for those with insurance
• Make coverage affordable and accessible to those
  who need it Reduce unnecessary costs and waste
• Medical liability reform
• Also recognized that medical liability reform is
  needed to bring down the cost of health care
• Obama directed HHS to implement pilot programs to
  ease the liability burden and reduce defensive
  medicine

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Americas Doctors Respond to Obamas Health Care
Speech to Congress
Were pleased President Obama agreed that
defensive medicine drives up unnecessary costs.
AMA President James Rohack, MD
(Fox Business)
As a country, we have to stem rising health care
costs. AMA Immediate Past President Nancy
Nielsen, MD (CNN Larry King Live)
Theres a moral imperative to get health care
reform passed this year. AMA Speaker Jeremy
Lazarus, MD (MSNBC Morning Meeting
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AMA Supports Presidents Focus on Medical
Liability Reform
Dr. Rebecca Patchin, chair of the board of
trustees for the American Medical Assn.,
applauded Obama's call for demonstration projects
on medical liability cases. We are very
encouraged that he has taken this step. Los
Angeles Times, Sept. 10, 2009
Medical liability reform is something weve
mentioned for years is a way to reduce
unnecessary costs as well as streamline
health-care waste we have in our system. AMA
President James Rohack, MD Bloomberg News
Everyday physicians across the country are
forced to consider the broken medical liability
system when making decisions, resulting in
defensive medicine that adds to unnecessary
health costs. We cannot ignore this problem if
health-system reform is going to address the
growing cost of care. AMA President James
Rohack, MD, Modern Healthcare
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• I recognize that it will be hard to reform
  the health care system if doctors feel like
  they are constantly looking over their
  shoulder for fear of lawsuits.

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Liability reform grants

• With AMA urging, Obama administration announced
  25 million in grants for states and health care
  systems to experiment with alternatives to costly
  medical liability lawsuits
• The grants, up to 3 million each for three
  years, include programs in which providers
  acknowledge a mistake, offer an apology and
  restitution, and take corrective action
• A review of liability reform initiatives will be
  completed by December to evaluate future grant
  applications

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What happens now?
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House Status/Timeline

• Tri-committee versions completed
• Energy Commerce 50-60 amendments pending to be
  sent in Sept. as a separate bill
• Leadership, Rules Comm. 3 chairs negotiate
• Bill to full House for debate (likely Sept.)
• Separate vote on a single payer alternative
• Bill to conference committee with Senate

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Senate Status/Timeline

• H.E.L.P. Committee bill approved
• gt 180 amendments still to be inserted
• Finance Committee draft released
• Meld H.E.L.P. and Finance into one bill for
  action by Senate or
• Separate Finance bill to Senate
• If no action by October 15 may consider
  reconciliation process
• Bill to conference committee with House

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The Rubiks Cube Solution

• Scale back scope to resolve financing/cost
  concerns
• Key insurance reforms require universal coverage
• Phase-in approach?

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Road map to White House
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Final Thoughts

• Bill that President hopes to sign has yet to be
  written
• Scope and cost will be scaled back
• Negotiations thru December
• President will sign health reform bill before
  2010 elections
• Current Occupants of Executive Branch will be
  there for another 3 years

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www.hsreform.org