State & Federal Deficits, Health Reform:
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State & Federal Deficits, Health Reform: Cuts & Change…The Only Two Certainties Heidi L. Gartland, VP Government Relations November 17, 2011. October 7, 2011. February 4, 2011. January 24, 2011. University Hospitals. Federal Deficit Reduction Health Reform State Update 2012 Elections.

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October 7 2011

State & Federal Deficits, Health Reform:

Cuts & Change…The Only Two Certainties

Heidi L. Gartland, VP Government Relations November 17, 2011

October 7, 2011

February 4, 2011

January 24, 2011

University Hospitals

University Hospitals


October 7 2011

  • Federal Deficit Reduction

  • Health Reform

  • State Update

  • 2012 Elections

October 7, 2011

February 4, 2011

University Hospitals

University Hospitals


Federal deficit reduction

Federal: Deficit Reduction

Nov. 16 2011

University Hospitals Rainbow Babies and Children’s Hospital

4


Federal deficit budget control act stage i

Federal Deficit: Budget Control Act- Stage I

Immediate budget reduction of $917 billion

No cuts in Medicare, Medicaid, Social Security

No new revenues

University Hospitals

University Hospitals


Federal deficit budget control act stage ii

Federal Deficit: Budget Control Act- Stage II

  • Creation of special bipartisan congressional committee

  • $1.5 trillion in deficit reductions by 11.23.11

  • Guaranteed up or down vote by 12.23.11

  • Enforcement process…debt limit extended another $1.5 trillion thru 2012 if:

    • Resolution of committee adopted, or

    • Balance budget amendment adopted, or

    • Automatic across the board cuts/sequester of $1.2 trillion

University Hospitals

University Hospitals


Federal deficit the super committee

Federal Deficit: The Super Committee

House

Senate

Dave Camp (R-MI)

Jeb Hensarling (R-TX)

Fred Upton (R-MI

Xavier Becerra (D-CA)

James Clyburn (D-SC)

Chris Van Hollen (D-MD)

University Hospitals

Max Bacus (D-MT)

Patti Murray (D-WA)

John Kerry (D-MA)

Jon Kyl (R-AZ)

Rob Portman (R-OH)

Pat Toomey (R-PA)

University Hospitals

9


Federal deficit super committee observations

Federal Deficit: Super Committee--Observations

All appointees loyal to their leadership

No members in Gang of Six

No senators up for re-election

Every House member has safe seat

Focus on entitlements vs. appropriations

Every GOP member took the “pledge”

University Hospitals

University Hospitals

10


Federal deficit super committee success or failure

Federal Deficit: Super Committee—Success or Failure

  • Impact on the markets of the Super Committee making a deal?

  • Is failure (sequestration) preferable?

    • AARP

    • Anti-tax lobby

    • Health sectors-hospitals, physicians, Pharma

    • Social service advocates

    • Defense

University Hospitals

University Hospitals

11


Federal deficit super committee options

Federal Deficit: Super Committee Options

Medicaid

Medicare

Blending FMAP rates ($14.9 billion)

Provider tax reduction ($26.3 billion)

University Hospitals

Graduate medical education cuts ($15 billion)

Bad debt cuts ($15-30 billion)

Coding offset ($5 billion)

Rural cuts ($14 billion)

Post acute ($15 billion)

Expand Independent advisory board

University Hospitals

12


Federal deficit super committee

Federal Deficit: Super Committee

Medicare options:

  • Increase retirement age ($125 billion)

  • Means testing ($38 billion)

  • Reform and increase co-payments part A & B ($110 billion)

  • Medigap restrictions ($53 billion)

  • Home health co-payments ($40 billion)

  • SNF co-payments ($50 billion)

University Hospitals

University Hospitals

13


Federal deficit budget control act sequester impact of 1 2 trillion

Federal Deficit: Budget Control Act- Sequester Impact of $1.2 trillion

Sources of Cuts

Impact of Cuts

  • New revenues

  • Defense

  • Total non defense

  • Medicare*

  • Medicaid exempt

  • Net interest savings

    *Medicare 2% across the board, no cuts to benefits

$0

$492 billion

$492 billion

$123 billion ($43B hosp.)

$0

$216 billion

University Hospitalsl

14


Opening bids last week

Opening Bids: Last Week

University Hospitals

15


New gop offer

New GOP Offer

Total package $1.2 trillion

“Revenues: ($300)-$600 billion

Spending cuts: $700 billion

Medicaid $50 billion vs $185 billion (previously)

University Hospitals

16


Current status

Current Status: ???

Medicaid: $50 billion cut

Provider tax 6% to 4.5% beginning 2015-3 year phase in

Medicare: Rep. vs Dem.

$75 B vs $225 B provider cut

$200B vs $100 B beneficiary cut

University Hospitals

17


October 7 2011

  • Federal Deficit Reduction

  • Health Reform

  • State Update

  • 2012 Elections

October 7, 2011

February 4, 2011

University Hospitals

University Hospitals


Health reform affordable care act

Health Reform: Affordable Care Act

U.S. Supreme Court accepts to hear the case

US Supreme Court decision by June 2012

Challenged in several federal courts and courts of appeal

Court’s ruling one of the most important issues 2012 campaign?

University Hospitals


Health reform implementation vs dismantling

Health Reform: Implementation vs. Dismantling

20

University Hospitals

University Hospitals


Health reform regs

Health Reform: Regs

  • Movement away from fee- for-service…toward ‘integration”

  • Emphasis on value vs. volume

  • Emphasis on quality vs. quantity

  • Accountable care organizations

  • Bundling

  • Medical homes

  • Health benefits exchange

  • Value-based purchasing

  • Comparative effectiveness

  • Medical loss ratio

  • CMS Center for Innovation

University Hospitals

University Hospitals


Health reform ohio impact

Health Reform: Ohio Impact

University Hospitals

University Hospitals


October 7 2011

Positioning for reform

  • Achieve solid hospital-physician (clinical) alignment

  • Measure, report and deliversuperior outcomes

  • Attain a favorable cost position

  • Strategic alliances

University Hospitals

University Hospitals


October 7 2011

  • Federal Deficit Reduction

  • Health Reform

  • State Update

  • 2012 Elections

October 7, 2011

February 4, 2011

University Hospitals

University Hospitals


State update legislation regulations

State Update: Legislation/Regulations

General Assembly & Governor

  • Various health related bills

  • Medicaid policy changes

  • JobsOhio

  • Workers Comp reform

  • Tax reform

  • Capital Bill

University Hospitals


Ohio medicaid high cost cases

Ohio Medicaid: High Cost Cases

University Hospitals

University Hospitals


October 7 2011

University Hospitals

University Hospitals


Hospital franchise fee

Hospital Franchise Fee

University Hospitals

University Hospitals


October 7 2011

  • Federal Deficit Reduction

  • Health Reform

  • State Update

  • 2012 Elections

October 7, 2011

February 4, 2011

University Hospitals

University Hospitals


Congressional redistricting

Congressional Redistricting

Federal law requires each census

Ohio will lose 2 seats in the U.S. House of Representatives.

Ohio’s congressional delegation from 18 to 16 seats.

University Hospitals


Current congressional map

Current Congressional Map

University Hospitals


October 7 2011

University Hospitals


Congressional redistricting overview ne ohio impact

Congressional Redistricting Overview: NE Ohio Impact

  • Cleveland-Akron substantially altered.

    • 11th District (Fudge) will now include Akron

  • New 3rd District in Columbus.

    • New district will likely elect a Democrat

    • Reps. Stivers’ & Tiberi’s districts strengthened

  • Loss of one district in Central – SE

    • Reps. Austria & Turner will likely compete for new 10th District

  • Republican districts strengthened

  • University Hospitals


    Congressional redistricting ne ohio impact

    Congressional Redistricting: NE Ohio Impact

    Democratic #’s likely decrease from 5 seats to 3 seats.

    Republican # likely increase from 1 seat to 4 or 5 seats.

    Rep. Sutton’s & Renacci’s district.

    Rep. Kucinich & Rep. Kaptur for the new 9th District.

    University Hospitals


    Federal update 2012 calendar

    Federal Update: 2012 Calendar

    • Electoral and presidential politics

    • Mar. 6, 2012 – Ohio Primary

    • Nov. 6, 2012 – Election Day

    • Presidential Politics:

      • Tough economyand high unemployment

      • Pres. Obama is upside down on his approval -disapproval numbers

      • Republican primaries

    University Hospitals


    Federal update elections 2012

    Federal Update: Elections 2012

    • U.S. Senate:

      • Nationally, 33 seats in play in 2012

      • 23 D / 8 R

      • Only 8 of the 33 seats are open races

    • U.S. House of Representatives:

      • 242 R / 192 D (1 Vacant)

      • All 435 seats up for reelection

      • 218 Seats needed to gain majority in House

    • Growing anti-incumbent sentiment

    • Very unpredictable election season

    University Hospitals


    October 7 2011

    View from Washington

    Contact:

    Heidi L. Gartland

    Vice President, Government Relations

    University Hospitals

    (216)844-3985 (work)

    (216)403-4050 (cell)

    [email protected]

    University Hospitals

    University Hospitals


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