Health Care Reform

Health Care Reform PowerPoint PPT Presentation


Harry and Louise have returned, d j vu. Dem Option #1, Pass the Senate Bill in the House ... would have scuttled the savings if they had been proposed in piecemeal fashion. ...

Download Presentation

Health Care Reform

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


The Health Reform Train Wreck: What Went Wrong and What Might They Do About It? 2

Slide 3:Health Care Reform

Health Care Death Panel Health Care Insurance Reform Health Care Mandatory Euthanasia Health Care” “the Sky is REALLY Falling” Revisioning Socialized Health Care

Bringing out the long knives, Harry and Louise have returned, déjà vu Dem Option #1, Pass the Senate Bill in the House With No Changes Risks Public Perception Given What the Media Will Characterize as a Change in Public Sentiment Regarding Health Reform Delays in Implementing Key Changes, Fueling “Tea Party” Discontent GOPers Running in November on Negative “Tea Party” Public Mood Fueled by Right-Wing Dominated Media Rewards Passage of the Legislation Giving Dems an Opportunity to Run in November as the “Party That Can!” Fueled by Left-Wing Media Early Returns Highlight Prospects for Real Improvement in U.S. Health Care System Reduction in the Numbers of Uninsured Positively Impacts Providers Health Insurers Benefit From Mandates Without Controls Dem Option #2, Use “Reconciliation” to Pass a Bill With Only 51 Senate Votes Risks Public Perception That Dems Have Somehow Violated the “Rules” and Cheated Private Health Insurers Go Postal After Being Hit by New Controls and Taxes; “Harry and Louise” Return Reconciliation requires that the bill be broken up into several pieces and depending on how the piece is drafted, may not apply, i.e., insurance reforms. (see #2, above) Rewards Early Returns Highlight Prospects for Real Improvement in U.S. Health Care System Reduction in the Numbers of Uninsured Positively Impacts Most Providers Economy Shows Signs of Recovery and Public Perceives a Democratic

Slide 8:Dem Option #3, Hard Ball

Break it up into bite size chunks and drag Republicans kicking and screaming into an up or down vote on things like these: 1. Pre existing conditions 2. Life time caps 3. Anti-trust exemptions 4. Foreign imports on drugs 5. Administrative costs vs. medical payouts 6. TORT reform 7. Option to buy into Medicare at a lower age 8. Fees to companies who push their employees on Medicaid rather than offer legitimate benefits

Slide 9:Dem Option #4, Drop the Whole Thing; 1994 Déjà Vu

U.S. Health Care System Continues on Its Merry Way: Number of Uninsured Grows to 66 Million by 2012, as States Restrict Medicaid and S-CHIP Dramatically Virtually Eliminating Safety Net; 80+ Million by 2016 Medicare Is Insolvent by 2015 Health Care Insurance Costs Continue Annual Double Digit Increases Health Care is 20%+ of the Nation’s GDP by 2018 U.S. Becomes a Banana Republic to the Growing Economies of the “BIC” Nations: Brazil, India and China

Obama wanted to create a National Health Insurance Exchange, a quasi-public/private sector initiative to monitor private insurance companies in offering the coverage. His plan was actually built on the Utah Health Exchange, a model promoted by George W. Bush’s last Secretary of Health and Human Services, former Utah Governor Mike Leavitt (another good Republican idea co-opted by a Democrat). In essence, Obama's plan would have retained the private insurance system but with greater potential controls

Slide 10:Obama’s “Original” Pre-Congress, Pre-Lobbyist Proposal

Slide 11: The “Public Plan” Controversy

So what happened to that plan? How did we get to the current situation? In order to “light a fire” under the private insurance industry… Obama originally said a “public plan” competing fairly with the private sector was necessary… oops.

Slide 12:“Fair Competition”

The two programs would then compete on a level playing field and, according to the John Edwards model upon which the plan is devised, a winner would be determined down the road. If private health care insurance is as good as he claims to be, it will prevail; if not, the people will choose so … … needless to say, this compromise scared the living daylights out of the private health insurance industry and they began pulling out all the stops to defeat it!

Slide 13:“Public Plan” Fire Storm

Immediately, both the liberal and conservative media and blogospheres spun into action: The liberal commentators were appalled... it wasn’t “progressive” enough. There was no “single-payer;” there weren’t enough controls over the private insurance industry. It didn’t cover everyone. The right wing went postal: death panels, killing granny, faceless bureaucrats controlling every personal decision, socialized medicine, “British healthcare!”

Slide 14:“Public Plan” Fire Storm

Funded extensively by hard right sources and the private insurance industry, “tea partiers” stormed public hearings on the proposal and drowned out all attempts at reasoned discussion or debate. Misrepresentations and outright lies and distortions about what was being proposed were taken as the gospel truth. The public option concept began to wither. And then the tea-partiers lit fire…

Slide 15:A Fickle Congress…

A dozen or so “blue dog” Senate and House Democrats joined with lock-step Republicans… to essentially kill the “public plan” option, at least in the Senate. Will Rogers, the famous 1930’s political pundit and humorist was once quoted as saying, “I don’t belong to any organized political party, I’m a Democrat!” Unlike Republicans who have developed far stronger party discipline, Democrats, trying to maintain their “bigger tent,” have never been as successful in herding their Congressional cats.

Slide 16:Thursday, February 25, 2010 …the Health Care Summit

The Summiteers Convene

Slide 17:Thursday, February 25, 2010 …the Health Care Summit

Cut Taxes! Republicans Offer Their Plan...

Slide 18:Thursday, February 25, 2010 …the Health Care Summit

For the wonderful bills they have passed… NOT! Democrats Congratulate Each Other…

Slide 19:Thursday, February 25, 2010 …the Health Care Summit

Offers his version… FINALLY! President Obama …

Slide 20:House v. Senate: Individual Mandate

Includes mandate. Penalty: Tax equal to 2.5% of adjusted gross income over certain thresholds ($9,350 for individuals, $18,700 for couples). Exemptions: American Indians, people with religious objections and people who can show financial hardship. Includes mandate. Penalty: Tax equal to 2.5% of adjusted gross income over certain thresholds ($9,350 for individuals, $18,700 for couples). Exemptions: American Indians, people with religious objections and people who can show financial hardship. House Bill Senate Bill

Individual Mandate The Obama Alternative… President Obama’s plan has an individual mandate. All Americans should have insurance: Penalty: A gradually increasing tax equal to 0.5% in 2012, to 1% in 2014, to 2% in 2015 and to 2.5% by 2016, of adjusted gross income over certain poverty-level thresholds (currently $9,350 for individuals, $18,700 for couples). Exemptions: American Indians, people with religious objections and people who can show financial hardship.

Slide 22:House v. Senate: Employer Contribution

Require employers with annual payrolls of $500,000 or more to offer coverage to employees or pay a federal tax. Penalty: Up to 8% of wages in payroll taxes. Employers with payrolls of $500,000 to $750,000 would pay 2% to 6% of wages, and those with payrolls above $750,000 would pay the full 8%. Employers would contribute at least 72.5% of the premium cost for individuals and 65% for families for the lowest cost plan that meets the minimum benefit requirements set by the government. Would not require employers to offer coverage, but if an employer with more than 50 employees does not offer coverage and if any worker qualifies for a federal subsidy, the employer would have to pay a penalty. Penalty: Typically $750 for each employee at the firm. House Bill Senate Bill

Employer Contribution The Obama Alternative… President Obama’s plan has a version of the Senate employer non-mandate, mandate. Companies employing more than 50 workers would have to: Penalty: $2,000 per full-time employee, or $750 per employee whose incomes make them eligible for a tax credit; Starting in 2014, limits “waiting periods” for employer coverage to 90 days, with payments up to $600 per non-covered worker during the waiting period.

Slide 24:House v. Senate: Insurance Exchange

Creates a national insurance exchange. States could operate their own exchanges, with federal approval. Open to people who do not have qualifying coverage through an employer or public program. Open to employers with 25 or fewer employees in the 1st year, 50 or fewer in the 2nd year and 100 or fewer in the 3rd year. Later the exchange could be expanded to larger employers, “with the goal of allowing all employers access.” A temporary program would provide coverage to “those who have been uninsured for several months or denied a policy because of pre-existing conditions.” States would form their own exchanges. Several states could join together to form a regional exchange. Open to people who do not have qualifying coverage through an employer or public program. Open to employers with 50 or fewer employees, but states could allow employers with up to 100 workers to participate. Starting in 2017, states could also allow larger businesses to participate. House Bill Senate Bill

Insurance Exchange The Obama Alternative… Administered by a state government agency or non-profit organization; Individuals and small businesses (<100) could purchase insurance via Exchange; Starting in 2017, states could open the Exchange to larger employers; States could have more than one Exchange but each would have to serve a defined geographical area; Federal funding will be available until 2015 to help states establish Exchanges.

Slide 26:House v. Senate: Public Plan

Public plan would negotiate payment rates with doctors and hospitals (rather than using Medicare rates). The government would allocate $2 billion in start-up money but beneficiary premiums would have to cover the full cost of the plan. The government would also provide loans to start nonprofit insurance cooperatives. Public plan would negotiate rates with doctors and hospitals. A state could refuse to participate in the public plan by adopting a law to opt out. House Bill Senate Bill

Public Plan The Obama Alternative… "Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying-Medicare rates...or controlled by the secretary of health and human services. 'We have an agreement with the White House that I'm very confident will be seen all the way through conference', one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter...Industry lobbyists say they are not worried [about a public option.] 'We trust the White House,' Mr. Kahn said.” New York Times, August 22, 2009 In other words, Obama, despite rhetoric to the contrary, has always had the public plan concept “off the table,” albeit, the “official” explanation as to why Obama’s new version has no public plan, as put forth by Obama’s press secretary Robert Gibbs is "We have seen obviously that though there are some that are supportive of this, there isn't enough political support in a majority to get this through."

Slide 28:House v. Senate: Family Subsidies

Available to people with incomes up to 400 percent of the federal poverty level ($88,200 for a family of four). Available to people with incomes up to 400 percent of the federal poverty level. House Bill Senate Bill

Family Subsidies The Obama Alternative… President Obama addresses overall premium costs via tax credits to low and middle income families to purchase insurance: And second to limit “out-of-pocket” expenses , again based on a sliding scale of family incomes:

Slide 30:House v. Senate: Employer Subsidies

Employers with 25 or fewer workers and average wages of $40,000 or less would qualify for tax credits. The amount, up to 50% of premium costs, phases out as firm size and average wages increase. The credit would not be allowed for employees earning more than $80,000 a year. From 2013 to 2015, the federal government would cover 80% of the cost of a retiree’s medical claims of more than $15,000, with a cap at $90,000 — at which point the employer’s plan would pay the rest. Employers with 25 or fewer workers and average wages of $40,000 or less would qualify for tax credits. The amount, up to 50% of premium costs, phases out as firm size and average wages increase. The federal government would cover 80% of the cost of a retiree’s medical claims of more than $15,000 through 2013, with a cap at $90,000 — at which point the employer’s plan would pay the rest. House Bill Senate Bill

Employer Subsidies The Obama Alternative… Obama adopts the Senate-passed version in it’s entirety: Employers with 25 or fewer workers and average wages of $40,000 or less would qualify for tax credits. The amount, up to 50% of premium costs, phases out as firm size and average wages increase. The federal government would cover 80% of the cost of a retiree’s medical claims of more than $15,000 through 2013, with a cap at $90,000 — at which point the employer’s plan would pay the rest.

Slide 32:House v. Senate: Defined Benefits

The basic plan would cover 70% of the cost of the benefits. Consumers would pay the remainder, in deductibles, co-payments and other charges. The exchange would offer three other benefit plans, covering up to 95% of costs. The basic plan would cover 60% of the cost of the benefits. The exchanges would offer three other benefit plans, covering 70% to 90% of costs. (The CBO says that policies bought in the individual insurance market now averages 55% to 60%.) House Bill Senate Bill

Defined Benefits The Obama Alternative… – Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010); – Silver plan provides the essential health benefits, covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limits; – Gold plan provides the essential health benefits, covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limits; – Platinum plan provides the essential health benefits, covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limits; Creates four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets: Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market.

Slide 34:House v. Senate: Insurance Reform

Premiums for people over 45 cannot be more than double the premium for young adults. The legislation would strip health insurance companies of their antitrust exemption. It would outlaw price fixing, bid rigging and “market allocations” by companies that sell health insurance or medical malpractice insurance. Premiums for people over 50 cannot be more than triple the premium for young adults. The legislation would not strip health insurance companies of their longstanding exemption from federal antitrust laws House Bill Senate Bill

Insurance Reforms The Obama Alternative… President Obama proposes broad-based health insurance reforms, including: -- Guaranteed coverage to all regardless of pre-existing conditions with a limit of 150% on rates based on condition, age, but not gender -- “Rate Review” via a new government agency: a Health Insurance Rate Review Authority, providing oversight of continuing State-level regulation of health insurance, helping states to “… determine how rate review will be enforced,” at the federal level. -- Prohibits plans from making post-service coverage rescissions; -- Require states to have stronger appeal processes to address insurance company insurance denials; -- Require States to conduct annual rate reviews; -- Starting in 2014, prohibits annual and lifetime limits to insurance coverage, bans pre-existing condition exclusions, and prohibits discrimination in favor of “highly compensated” individuals; Starting in 2018, requires plans to cover proven preventive services with no additional cost-sharing

Slide 36:House v. Senate: Cost and Coverage

About $1.052 trillion. Expected to reduce deficits by $109 billion. 36 million people would gain coverage, leaving 18 million uninsured. About $849 billion. Expected to reduce projected federal budget deficits by $127 billion. 31 million people would gain coverage, leaving 23 million uninsured. House Bill Senate Bill

Costs and Coverage The Obama Alternative… The CBO has not yet “scored” the Obama plan. The White House claims it will cost $950 Billion, cover 38 million uninsured Americans and reduce the federal deficit by $150 billion over the next 10 years

Slide 38:House v. Senate: Illegal Immigrants

Could buy insurance from the exchanges, but could not get federal subsidies to help pay the costs Could not buy insurance from the exchanges, even if they were able to pay the full cost themselves, without federal subsidies House Bill Senate Bill

Illegal Immigrants The Obama Alternative… Undocumented immigrants can not buy insurance from the exchanges, even if they were able to pay the full cost themselves, without federal subsidies. Obama adopts the Senate version:

Slide 40:House v. Senate: S-CHIP

The program would no longer exist. Children with family incomes up to 150% of the poverty level ($33,075 for a family of four) would receive coverage through Medicaid. Families with higher incomes that are still eligible for subsidies could buy coverage through the exchange. Children now enrolled in the Children’s Health Insurance Program would continue to receive coverage through the program. Beginning in 2014, states would receive higher federal reimbursement for the program’s beneficiaries, increasing from an average of 70%to 93%. House Bill Senate Bill

Children’s Health Care The Obama Alternative… Requires states to maintain current income levels for eligibility Children now enrolled in the Children’s Health Insurance Program would continue to receive coverage through the program. Beginning in 2014, states would receive higher federal reimbursement for the program’s beneficiaries, increasing from an average of 70%to 93%. Obama accepts the Senate version:

Slide 42:House v. Senate: Paying For It

A 5.4% surtax on high-income people — couples with adjusted gross incomes of more than $1 million a year and individuals over $500,000. Expected to raise $460 billion from 2011 to 2019. . A 40% excise tax on “Cadillac health plans” — employer-sponsored group health plans with premiums over $8,500 for individual and $23,000 for family coverage. Expected to raise $149 billion from 2013 to 2019. House Bill Senate Bill

Paying for It The Obama Alternative… Increase the threshold for the itemized tax deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income; Increase the Medicare Part A tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and impose a 2.9% assessment on unearned income for higher income taxpayers. Funds from the additional tax on earned income will be credited to the Part A Trust Fund and funds from the new tax on unearned income will be credited to the Part B (Supplementary Medical Insurance) Trust Fund. (Effective January 1, 2013) Impose an excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage, indexed to the CPU. The threshold amounts may be adjusted upwards if health care costs rise unexpectedly quickly prior to implementation. Paying for It The Obama Alternative… Obama would impose new fees and taxes on segments of the health care sector: – $2.3 billion annual fee on the pharmaceutical manufacturing sector, increasing by $10 billion over 10 years (effective 2011); – Fees on the health insurance sector totaling $67 billion over 10 years. [Exemptions granted for non-profit plans that receive more than 80% of their income from government programs targeting low income or elderly populations, or people with disabilities, and voluntary employees’ beneficiary associations (VEBAs) not established by employers (effective 2014)]; – Excise tax on the medical device manufacturing sector to raise $20 billion over 10 years (effective 2013). Bye-Bye Billy, We hardly knew ya’

Slide 45:House v. Senate: Paying For It By “Squeezing” Medicare

Squeeze $404 billion out of the projected growth in Medicare and other federal programs over 10 years, including $117 billion from cutting Medicare Advantage plans… the 14% more Medicare pays for coverage under private plans than it does for traditional Medicare. Squeeze $436 billion out of the projected growth in Medicare and other federal programs over 10 years, including $118 billion in cuts to federal subsidies for privately offered Medicare Advantage plans. House Bill Senate Bill

Paying for It: Obama’s Alternative Medicare Squeeze… Restructure payments to Medicare Advantage plans by creating a set of benchmark payments for MA plans at different percentages of Medicare fee-for-service (FFS) rates, by area, phased in over an unspecified period, taking into account relative payments to fee-for-service costs in an area. Provide bonuses for quality and enrollee satisfaction, and lower plan rebates for “low-quality” plans. Achieve additional savings by further adjusting payments to plans for coding practices related to the health status of enrollees. Bush Signing Medicare Modernization Act, December 8, 2003 LBJ Signing Original Medicare Act, July 30, 1965 Reduce annual market basket updates for inpatient hospital, home health, skilled nursing facility, hospice and other Medicare providers, and adjust for productivity. (Effective dates vary) Freeze the threshold for income-related Medicare Part B premiums for 2011 through 2019, and reduce the Medicare Part D premium subsidy for those with incomes above $85,000/individual and $170,000/ couple. (Effective January 1, 2011) Establish an Independent Payment Advisory Board comprised of 15 members to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. Paying for It: Obama’s Alternative Medicare Squeeze… Outside, the gathering verged on a street brawl. The opposing forces lined up like screaming armies on either side of the street, about 1,000 people a side. Diane Campbell of Kingston, N.H., held a sign with Mr. Obama's face superimposed on a Nazi storm trooper, a sign, she said, that was made by her chronically ill mother. Her mother's hereditary autoimmune disease is treated with expensive transfusions of gamma globulin, paid for by Medicare. Her sister, Louise, was born with no arms and one leg, and is also covered by Medicare, the government-run, health-insurance program for the elderly and disabled. Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increase payments based on the percent of the population uninsured and the amount of uncompensated care provided. (Effective FY 2015) Eliminate the Medicare Improvement Fund. (Effective upon enactment) Allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program. To qualify as an ACO, organizations must agree to be accountable for the overall care of their Medicare beneficiaries, have adequate participation of primary care physicians, Define processes to promote evidence-based medicine, report on quality and costs, and coordinate care. (Shared savings program established 1/1/2012) Paying for It: Obama’s Alternative Medicare Squeeze… Create an Innovation Center within the Centers for Medicare and Medicaid Services to test, evaluate, and expand in Medicare, Medicaid, and S-CHIP different payment structures and methodologies to reduce program expenditures while maintaining or improving quality of care. Payment reform models that improve quality and reduce the rate of cost growth could be expanded throughout the Medicare, Medicaid, and CHIP programs. (Effective 1/1/2011) Reduce Medicare payments that would otherwise be made to hospitals by specified percentages to account for excess (preventable) hospital readmissions. (Effective 10/1/2012) Reduce Medicare payments to certain hospitals for hospital-acquired conditions by 1% {Effective FY 2015) Paying for It: Obama’s Alternative Medicare Squeeze… Provide a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 and eventually eliminate the Medicare Part D coverage gap by phasing down the coinsurance to the standard 25% by 2020 (Effective 1/1/2010); Provide a 50% discount on brand-name prescriptions filled in the Medicare Part D coverage gap for enrollees, other than those who receive low-income subsidies and those with incomes above $85,000/individual and $170,000/couple (Effective 7/1/2010); Make Part D cost-sharing for full-benefit dual eligible beneficiaries receiving home and community-based care services equal to the cost-sharing for those who receive institutional care (Effective no earlier than 1/1/2012); The Obama Alternative… Medicare Part D Obama wants to make changes in the Medicare Part D Rx program: Conspicuously Missing: Any provision about regulating or negotiating Rx prices. Billy Tauzin, Billy Tauzin where have you gone? Increase the Medicaid drug rebate percentage for brand name drugs to 23.1 (except the rebate for clotting factors and drugs approved exclusively for pediatric use increases to 17.1%); Increase the Medicaid rebate for noninnovator, multiple source drugs to 13% of average manufacturer price; Extend the drug rebate to Medicaid managed care plans. (Effective 1/1/2010) Reduce a state’s Medicaid DSH allotment by 50% or 25% for low DSH states (and by lesser percentages for states meeting certain criteria) once the state’s uninsured rate decreases by at least 45%. DSH allotments will be further reduced, not to fall below 50% of the total allotment in 2012 if states’ uninsured rates continue to decrease. Exempt any portion of the DSH allotment used to expand Medicaid eligibility through a section 1115 waiver. (Effective 10/1/2011) Prohibit federal payments to states for Medicaid services related to health care acquired conditions. (Effective 7/1/2011) Paying for It: Squeezing Medicaid Too… Obama: The H&%# With the SGR… at Least as Far as The Docs are Concerned Beginning April 2013, require the Medicare Chief Actuary to project whether Medicare per capita spending exceeds the average of CPI-U and CPI-M, based on a five year period ending that year. If so, beginning January 15, 2014, the Board will submit recommendations to achieve reductions in Medicare spending. Beginning January 2018, the target is modified such that the board submits recommendations if Medicare per capita spending exceeds GDP per capita plus one percent. The Board will submit proposals to the President and Congress for immediate consideration. The Board is prohibited from submitting proposals that would ration care, increase revenues or change benefits, eligibility or Medicare beneficiary cost sharing (including Parts A and B premiums), or would result in a change in the beneficiary premium percentage or low-income subsidies under Part D. Hospitals and hospices (through 2019) and clinical labs (for one year) will not be subject to cost reductions proposed by the Board. The Board must also submit recommendations every other year to slow the growth in national health expenditures while preserving quality of care by January 1, 2015.

Slide 53:House v. Senate: Paying For It

A 5 percent tax on elective cosmetic medical procedures. The tax would be paid by patients, but collected by doctors and clinics and forwarded to the government. Senate Bill Increase in the Medicare payroll tax rate — from 1.45 to 1.95 percent for workers with incomes of more than $250,000 a year. Expected to raise about $54 billion from 2010 to 2019.

The Obama Alternative… High Income Tax Increases Increase the Medicare Part A tax rate on wages by 0.9% (from 1.45% to 2.35%) on earnings over $200,000 for individual taxpayers and $250,000 for married couples filing jointly and impose a 2.9% assessment on unearned income for higher-income taxpayers. Funds from the additional tax on earned income will be credited to the Part A Trust Fund and funds from the new tax on unearned income will be credited to the Part B (Supplementary Medical Insurance) Trust Fund. (Effective January 1, 2013) Impose an excise tax on insurers of employer-sponsored health plans with aggregate values that exceed $10,200 for individual coverage and $27,500 for family coverage (these threshold values will be indexed to the consumer price index for urban consumers (CPI-U) plus one percentage point). The Obama Alternative… Limit the amount of contributions to a flexible spending account for medical expenses to $2,500 per year increased annually by the cost of living adjustment. (Effective January 1, 2011) Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes; waive the increase for individuals age 65 and older for tax years 2013 through 2016. (Effective January 1, 2013)

Slide 56:Lobbyist Full-Employment Act of 2009

K Street to rake in healthcare cash; 'Lobbyist Full-Employment Act' By Jeffrey Young - 10/22/09 06:00 AM ET K Street looks like a winner if healthcare reform reaches President Barack Obama’s desk. Even though more than one lobbyist described healthcare reform as once-in-a-generation legislation, lobbyists speaking on background predicted a busy 2010 and beyond.

Slide 57:Anti-Reform Chart, “What ObamaCare Would Look Like

Pro-Reform Chart, “What Medical Care Looks Like Today

Slide 59:Health Rationing … er, I mean “Comparative Effectiveness”

Trust me on this, I’m a lawyer… just like his somewhat successful at reaching across the aisle Democratic predecessor in the presidency, Bill Clinton, Barack Obama will not hesitate to “steal” a good Republican ideal and turn it to good (political) use. Republicans (without a single Democratic vote) passed the “Medicare Modernization Act of 2003.” Buried in that 717-page law were provisions for CMS to begin the process of determining the “comparative effectiveness” of various health care services. The current health care plans simply build on that initial step… but oops, that’s where “killing granny” became an issue. Let’s Kill Granny! Health Care Rationing

Slide 61:“Outcomes Research” and (gasp) Health Care “Rationing”

The GOP-passed 2003 Medicare Modernization Act (better known for establishing the Part D drug program) had lots of buried secrets, not the least of which was new funding for AHRQ and a plan to begin several demonstration projects with a goal of better identifying… theJeanneScottletter “the appropriate use of best practice guidelines by providers and services by beneficiaries” The “reduced scientific uncertainty” in the delivery of care through the examination of variations in the utilization and *allocation of services, and outcomes measurement and research” achieving the “*efficient allocation of resources” “the financial effects on the health care marketplace of altering the incentives for care delivery and changing the *allocation of resources” HIPAA facilitates the collection of data and thus the ability of planners and payers to ration health care intelligently. (* Trust me on this, I’m a lawyer, “allocation of resources” = “rationing”)

Slide 62:Election 2008: the Winners and Losers

The little agency that could. Buried in the backwater reaches of the U.S. Public Health Service is the Agency for Healthcare Research and Quality (AHRQ), charged with developing the future “cookbook of health care.” CM2 has already embarked on an effort to define many of the elements of effective health care, that is what works and what doesn’t, using much of the work product of AHRQ. “In the future, we will only pay for what works and not for what doesn’t work.” President George W. Bush, September 17, 2006 Future of US Health Care: “Rationing” … by any other name

Slide 63:How Efficient Allocation of Resources (i.e., “Rationing”) Would Work

Collect all-population, all-patient, all-payer data (including care processes, clinical outcomes, patient experiences, and costs while enabling benchmarking and monitoring of changes) Assess health outcomes (e.g., percent diabetes under control; cancer survival rates) Post web comparison of insurance choices, costs and benefits, experiences; include share of premium for administrative/overhead/profit (complete national transparency with capacity for state or geographic analysis and benchmarks and designed so states could add, build with more detailed data where available) And someday… start paying only for what works and not for what doesn’t

Slide 64: Future of US Health Care

Both President Obama and Senator John McCain promised that they would address the issues of better managing chronic health care disease and thereby reducing the costs. Wow, that’s a mouthful! It remains to be seen if anything meaningful can be delivered on these promises, but an awful lot is at stake. Obama said he could reduce the cost of an average family’s health insurance by $2,500 annually. A big chunk of that projected savings came from savings from disease management. Medical Managers, Disease Management, Evidence-Based Medicine and Preventive Health Care Richard Simmons to be named personal health secretary to the nation, helping all Americans to better health through preventive health care, exercise and diet

Slide 65:Future of US Health Care: Big PhRMA

Pharmaceutical Manufacturers Both John McCain and Barack Obama called for major new regulations and controls over the Rx Manufacturing industry During the Republican primary campaign, John McCain once referred to the pharmaceutical industry as “the bad guys.” and he called for new limits on patent reformulations, drug reimportation and generic mandates Oops, he said all the same things as Barack Obama The Rx industry is in a state of panic!

Democrats May Make Dramatic Changes in the Medicare and Medicaid Rx Program

Slide 67:Democrats Will Try to Pass a Law to Directly Negotiate the Price of Drugs Under Part D

The 2003 Medicare Modernization Act, which gave us the Medicare Drug Part D, was passed without a single Democratic vote. Democrats opposed the provision saying that prohibited the government from negotiating directly on the price of drugs. In 2007, when the Democrats took over-control of the 110th Congress, the first bill passed by the House would have allowed for Rx price negotiation. The bill failed in the Senate where the Democrats had only a marginal majority and the GOP threatened a filibuster. Now with at least 58 votes in the Senate, the prospects for passage have increased dramatically, albeit the filibuster threat has already been made by the GOP.

Slide 69:Congress and the Drug Industry

The Rx manufacturing industry has enjoyed a “robust” 14 years with either a GOP Congress and/or a GOP president in charge with almost 80% of their political contributions going to the GOP -- but now facing a new era, they have upped their contributions to Democrats, and will expect a return on their investment

Slide 70:Paying For It, How?

Slide 72:$634 Billion for Health Care

Slide 73:Greedy Seniors React to Losing Medicare Advantage

Slide 74:Losing Half His Funds, Obama Considers Other Options

Nearly 164 million people, or 62% of the nation's non-elderly population, receive health insurance through work, according to a joint congressional committee on taxation. Money spent on insurance provided by employers is excluded from an employee's taxable income. If the exemption was lifted entirely, it could have raised about $226 billion in 2008, the joint committee reports.*[note] Well. No, that’s not going to happen… or can it? Lawmakers, both Democratic and Republican, may set an income limit so the exemption would not apply to high-paid employees. Also being discussed are proposals to create a penny-per-ounce federal tax on soft drinks, which the Center on Budget and Policy Priorities estimates could raise $10 billion a year, and raising taxes on alcohol and cigarettes. *[note] Republicans included this tax in their alternative health reform plan released May 22.

Slide 75:Passing It? Exactly How Do We Do That?

Slide 76:Budget Reconciliation

THE BUDGET RECONCILIATION PROCESS "The 1981 reconciliation bill, which encompassed legislative language from thirteen different committees in response to savings instructions mandated by the Senate, produced a legislative result that would have been impossible to achieve if each committee had reported an individual bill on subject matter solely within its own jurisdiction. By using a procedure that permitted packaging of the savings, Congress was able to consider President Reagan’s economic program as a whole, resistant to the type of special interest pressures that would have scuttled the savings if they had been proposed in piecemeal fashion." - Senator Howard H. Baker, Jr., then Senate Majority Leader (Winter, 1983) While Republicans in Congress are now calling “foul!” over Democrats considering use of the Budget Reconciliation process, it was the GOP that first implemented the process during the Reagan years when they controlled the Senate but not the House. And during the G.W. Bush years, GOPers used the process to stifle any Democratic opposition to pass several major pieces of legislation, including: he 2001 Bush Tax Cuts [HR 1836, 3/26/01] – The 2003 Bush Tax Cuts [HR 2, 3/23/03] – the 2003 Medicare Modernization Act – Tax Increase Prevention and Reconciliation Act of 2005 [HR 4297, 5/11/06] – The Deficit Reduction Act of 2005 [H. Con Res. 95, 12/21/05]

Slide 77:Budget Reconciliation… A History

Personal Responsibility and Work Opportunity Act (1996) R Balanced Budget Act of 1997 R Taxpayer Relief Act of 1997 R Economic Growth and Tax Relief Reconciliation Act of 2001 R Jobs and Growth Tax Relief Reconciliation Act of 2003 R Medicare Modernization Act of 2003 R Deficit Reduction Act of 2005 R Tax Increase Prevention and Reconciliation Act of 2005 R College Cost Reduction and Access Act of 2007 R Omnibus Reconciliation Act of 1980 D Omnibus Budget Reconciliation Act of 1981 R Omnibus Budget Reconciliation Act of 1982 R Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) R Omnibus Reconciliation Act of 1983 R Consolidated Omnibus Budget Reconciliation Act of 1985 R Omnibus Budget Reconciliation Act of 1986 R Omnibus Budget Reconciliation Act of 1987 R Omnibus Budget Reconciliation Act of 1989 D Omnibus Budget Reconciliation Act of 1990 D Omnibus Budget Reconciliation Act of 1993 D But something changed in 1996…???

Slide 78:Future of US Health Care: More Winners and Losers

Winners: Food Safety: The Food and Drug Administration, bedeviled by a salmonella outbreak and tainted medicine from China, is likely to monitor imports and fresh produce more closely under an Obama administration. Only a fraction of imported food is inspected now. Foreign drug manufacturing plants can go years without an FDA visit. Democrats had considered fees on industry to pay for more FDA inspectors, but could not persuade the Bush administration to go along. They expect Obama to be receptive. Winner: Ted Kennedy, any final Universal Health Care law will bear his name Losers: Halliburton, Blackwater and other war profiteers… some of whom may go to jail Loser: Osama Bin Laden. Now that raising the terror fear factor is no longer a political wedge tool, maybe we will actually try to catch him

Slide 79:Web Site for You to Follow

http://www.healthreform.gov/ For more information contact Jeanne Scott: [email protected] www.health-politics.com

Jeanne’s Heart… … Before Jeanne’s Heart… …After w/Annuloplasty Ring (serial #1885155, size M 38mm, model 4400)

Slide 82:Jeanne’s Rules for Frequent Passengers

5. If you must work on your flight, you will experience turbulence as soon as you touch pen to paper. 1. No flight ever leaves on time unless you are running late and need the delay to make the flight 2. If you are running late for a flight, it will depart from the farthest gate within the terminal. 3. If you arrive very early for a flight, it inevitably will be delayed. 4. Flights never leave from Gate #1 at any terminal in the world.

Slide 83:Jeanne’s Rules for Frequent Passengers

10. The less carry-on luggage space available on an aircraft, the more carry-on luggage passengers will bring aboard. 6. If you are assigned a middle seat, you can determine who has the seats on the aisle and the window while you are still in the boarding area. Just look for the two largest passengers. 7. Only passengers seated in window seats ever have to get up to go to the lavatory. 8. The crying baby on board your flight is always seated next to you. 9. The best-looking man on your flight is never seated next to you.

Slide 84:Health Care Industry Lobbying

Source: Center for Responsive Politics, www.opensecrets.com

  • Login