National Health Reform Overview

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National Health Reform Overview Gray Panthers
Annual Forum Austin, Texas August 23, 2009 Anne
Dunkelberg, Assoc. Director, dunkelberg_at_cppp.org
900 Lydia Street - Austin, Texas 78702Phone
[phone] (X102) www.cppp.org www.texasvoi
ceforhealthreform.org
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Texas Voice for Health Reform Principles

• Affordable Access to Good Health Care Must be
  Available for All Americans. It should
• Be affordable for people at all income levels
• Remain available and affordable when family and
  economic circumstances change
• Establish both a responsibility for the public to
  contribute and an assurance of cost containment
  for individuals and families
• Eliminate health costs as the 1 cause of
  bankruptcy in America.
• A Decent Standard of Comprehensive Care Must Be
  Established. It should
• Keep people healthy and treat them when theyre
  ill
• Cover the whole person
• Not be lost or reduced based on pre-existing
  conditions or pregnancy
• These first 2 steps will not happen by accident
  Americans must choose to do this and demand it.
• To be effective, sustainable, equitable, and
  balanced with our other important priorities as a
  nation, national health reform should also
  address safe and high quality care costs and
  cost-effectiveness of health care consumer
  choice and eliminating non-financial barriers to
  care
• Just working on Step 3 will not make Steps 1 or 2
  happen.

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Health Reform Process

• Three bills being drafted Senate Finance Senate
  HELP (Kennedy) House Tri-Committee (EC, WM,
  Ed Labor)
• Finance trimming back cost of 1st draft no bill
  release before August recess, concerns that they
  are cutting back by reducing affordability
  subsidies, protections.
• HELP passed out of committee
• Original goal was to merge the two Senate bills
  before August recess that process cant begin
  until Finance bill is laid out, voted out in
  September
• House bill filed Tuesday July 14. Each of 3
  committees made amendments which must be
  reconciled in September before a full House vote
  can happen.
• Both chambers return from August recess on
  Tuesday 9/8.
• House-Senate compromise process starts as soon as
  Chambers vote their bills.
• If successful, bill could be voted on and signed
  in October, November.
• If no deal reached, large portions of (but not
  all of) reform can/will be passed through Budget
  Reconciliation, but this is less than ideal,
  both politically and from policy standpoint.
• Budget Reconciliation only requires 51 Senate
  votes, but limits what you can do.

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Health Reform Basics

• Key elements BEING CONSIDERED
• If you like what you have now, you can keep it.
• Medicaid expansion (e.g., cover all up to 133
  FPL 14,404 for one 29,327 for 4).
• Reform Private Health Insurance standardize
  benefits, limits on price variation, no denial of
  coverage, no excluding pre-existing conditions.
  Changes focused on individual and small employer
  coverage.
• Create health insurance exchanges where
  participating private options can be compared and
  purchased.
• Will there be a Public or Non-profit plan option?
• Premium assistance up to 300 or 400 of FPL?
  (66,150 to 88,200 for family of 4)
• Out-of-pocket caps, too, to ensure real
  affordability/end (reduce?) medical bankruptcy
• Individual mandate to have coverage but only if
  affordable coverage exists!
• Requirements for employers to contribute, with
  exemptions for smallest employers One idea is a
  requirement to help pay for only employees who
  use Medicaid or get premium assistance (latter
  approach is opposed by advocates for low-income
  Americans).

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Benefits, Costs of Health Reform

• Texas
• About 1 million uninsured Texan adults would get
  Medicaidup to 133 FPL
• about 2.3 million uninsured Texans would get
  premium assistance--above Medicaid and below
  400 of poverty (88,200 for family of 4)
• Under Texas law today, small group insurers
  average high premium is 22,000 a year for a
  single worker.
• CPPP CONSERVATIVELY estimates the Medicaid
  expansion alone will add 3.7 billion a year in
  new federal dollars to the Texas economy (3.3 if
  90 federal share) with a multiplier effect of
  10 to 12 billion a year, and
• could convert Texas from being a donor state
  that sends more to DC in taxes than we get back
  by covering low-income adults in Medicaid.
• even more funding will flow to Texas from premium
  assistance to low-to-moderate income families
• What share will Texas have to pay for required
  Medicaid expansions increased Medicaid provider
  payment rates?
• 100 federally-funded in House proposal EC
  amends to 90 from year 3 onward
• But Senate may push to phase back over time to
  a state-share formula
• Goal is to make the final bill 100 paid for
  (combo of cuts/savings and new revenues) if
  pay-fors are cut, expect to see loss of
  affordability and/or health benefits!
• Long list of provisions would reduce cost,
  improve quality of care, but MORE may be added
  before a bill is passed.

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Policy Some Top Health Reform Concerns

• Will enough be done to really help the middle
  class? (Needed for broad support)
• Will a real affordability cap be created, so no
  one is at risk of medical bankruptcy ever again?
• Every American (not only the poorest) must have
  both affordable premiums, and caps on
  out-of-pocket spending.
• Will insurance reforms be strong enough to help
  all families?
• e.g., Senate Finance proposed allowing top
  premium rates to be 7.5 times the lowest price!
  If you pay 200 a month for the same policy I
  have to pay 1,500 a month for, is that (a)
  affordable or (b) reform?
• Public plan is not more important than affordable
  access for all. Public plan is one tool. Single
  payer is one tool. But Germany, the Netherlands
  and Switzerland all have universal, secure
  coverage with no public option.

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Consumer Voices Some Top Health Reform Concerns

• Supporters of Health Reform are NOT being heard
  loudly in D.C.
• Who is being heard?
• Right-wing opponents of any reform, talk-radio
  disinformation euthanasia, taking hip
  replacements from seniors to pay for teenagers
  abortions.
• Single-payer advocates, who are well-organized!
• Texans should not sit out health reform
• Those who believe real reform is needed should
  tell our elected officials and communicate that
  strong support FIRST, before your special issues
  or concerns.
• OUR POSTIVE MESSAGE MUST BE REPEATED MORE OFTEN
  THAN THEIR NEGATIVE ONE and not just
  corrections to their lies!!

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Consumer Voices The Truth, and the Big Fat Lies

• Medicare
• NO CUTS to Medicare benefits
• Changes to slow the growth rate of Medicare costs
  (shores up Medicares finances)
• Ends subsidies to private health insurance
  companies that cost 14 more than regular
  Medicare
• Phases out Part D donut hole.
• No rationing in Medicare based on age,
  life-expectancy, disability, etc.
• End-of-Life-Care Planning (living wills, advance
  directives)
• NO provisions to encourage euthanasia
• Will let doctors get reimbursed (for first time)
  for discussing end-of-life planning with patients
• Planning is completely voluntary
• Planning cannot presume the withdrawal of
  treatment of encourage hastening of death
• These Provisions may end up removed from reform
  because of the disinformation campaign

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As of 7/7/09
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Major House Committee Amendments

• EC
• Public Option health plan will use rates
  negotiated by Secretary of HHS (not Medicare
  rates) also will meet all insurance regs that
  commercial plans are held to.
• No one is mandated to enroll in, or provide care
  in, the public option plan.
• Doubled the payroll size from 250,000 to
  500,000 for non-insuring employers exempted from
  pay-or-play assessments reduced assessment for
  non-insuring employers between 550K and 750K.
• After two years of 100 percent federal funding of
  Medicaid, states would have to pick up 10 percent
  of the cost (filed version tri-committee bill had
  100 percent federal funding indefinitely)
• Reducing slightly premium subsidies and
  out-of-pocket cost caps for Americans from
  150-400 percent of the federal poverty level
  (FPL), but the subsidies will be increased if
  certain savings on medications, administration,
  and limits to premium increases actually
  materialize.
• Energy Commerce amendment prohibits the use of
  Comparative Effectiveness research to delay,
  deny, or ration care or to make coverage
  decisions in Medicaresquarely addressing one of
  the most egregious outright lies being circulated
  about the bill.
• End-of-life counseling cant promote suicide,
  cant assume withdrawal of treatment and both
  en-of-life counseling AND advance directives are
  voluntary.

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Major House Committee Amendments

• EC, contd
• No discrimination for/against providers related
  to willingness/unwillingness to provide
  abortions no required inclusion of TAB in
  essential benefits, no public subsidy of TAB
  beyond Hyde Amendment.
• Accountable care pilots in Medicaid (bundled
  payments, medical homes), models to be expanded
  to system if proven
• EL
• Hardship exemptions for employers demonstrating
  high job loss risk
• Allow states to waiver federal ERISA law if
  they chose to establish state single-payer
  system.
• Benefits for children must be comprehensive
  EPSDT package used in Medicaid
• WM
• IOM study of geographical health cost variations,
  to recommend ways to reduce variation, promote
  high-quality care.
• Other notable committee amendments helpfully laid
  out in the side-by-side at www.kff.org

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Get Involved with Texas Voice for Health Reform

• Join our email list Weekly update
• Web site Fact Sheets, MythBusters, News and
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• Health reform Photo project!
• Have a group representative participate in weekly
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• Communicate with your elected representatives
  using the tools in our online Citizen Advocacy
  Center calls, letters Congress and newspapers,
  op-eds needed!
• Educate your community, congregation, friends and
  family
• Contribute to our Story Bank project

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