Alliance for Health Reform Briefing for Reporters

1. Alliance for Health Reform Briefing for Reporters July 1, 2009 Dean A. Rosen, Partner

2. Where Things Stand, And Where They’re Heading • Health Reform Goals • Reform Drivers • Key players • Administration • Congress • Stakeholders • Reform timing and process • Health reform focus areas • Opportunities for progress • Remaining challenges and party positioning

3. Four Federal Health Care Goals for 2009

4. What’s Driving Reform?

5. National Health Expenditures Actual Projected Health Spending Will Nearly Double Over the Next Decade, Rising to Over 20 Percent of GDP by 2018 Dollars in trillions Source: Centers for Medicare & Medicaid Services, Office of the Actuary, January 2009.

6. Three in four dollars spent on health care in the U.S. are for patients with one or more chronic conditions Total U.S. health spending in 2006 = $2.1 trillion Health care costs for patients with one or more chronic diseases =~$1.58 trillion Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available a http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007.

7. Number of Uninsured Continues to Climb * Number of uninsured nonelderly. The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 2000 through 2004, and 2004 though 2007. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2008 ASEC Supplements to the CPS.

8. The Obama Administration

9. The Obama Administration:Key Health and Economic Players Budget & Economic Team Budget Budget Health Care Team Orszag Emanuel NEC Key White House Advisors Treasury Summers COS Senior Advisor DPC HHS HHS/ OHR WH OHR Geithner Emanuel Axelrod Barnes Sebelius DeParle Lambrew

10. The 111th Congress

11. Democrats Have Large Congressional Majorities, Including 60 In Senate Senate: 60-40 Democratic Majority House: 257-178 Democratic Majority

12. Senate and Health Committee Leaders Leadership HELP Budget Finance Chairman Minority Leader Majority Leader Ranking Member Chairman Ranking Member Chairman Ranking Member Reid (D-NV) Kennedy (D-MA) Baucus (D-MT) Conrad (D-ND) Gregg (R-NH) McConnell (R-KY) Enzi (R-WY) Grassley (R-IA)

13. House and Health Committee Leaders Budget Energy and Commerce Leadership Education and Labor Ways and Means Chairman Chairman Chairman Ranking Member Ranking Member Ranking Member Speaker Minority Leader Ranking Member Chairman Waxman (D-CA) Barton (R-TX) Pelosi (D-CA) Boehner (R-OH) Spratt (D-SC) Ryan (R-WI) Health Subcomm. Chair Stark (D-CA) Camp (R-MI) Rangel (D-NY) Miller (D-CA) Kline (R-MN)

14. Stakeholders Shaping, Not Stopping, Health Reform Policy This Time Around

15. Building Blocks of Democrats’ Health Reform Strategy Speedy timetable Congressional Committees cooperating closely Congress drafting legislation Lessons learned from 1993-94 Bipartisan consensus Engaging stakeholders White House support

16. GOP Positioning On Health Reform Budget Hawks/Fiscal Conservatives Reformers, with very different reform visions Undecided Moderates, willing to compromise

17. GOP Positioning On Health Reform Budget Hawks/Fiscal Conservatives Fault Lines • Individual mandate • Employer mandate • Medicare buy-in • Medicaid expansions • Government-funded comparative effectiveness research • Government-run public plan option • Overall cost • Tax increases Reformers, with very different reform visions Undecided Moderates, willing to compromise

18. Critical Factors That Will Shape Outcome Budget Reconciliation Budget Neutrality

19. Senate Health Reform Timeline June September May April July October November HELP and Finance Bipartisan Working Groups Finance Committee Options Papers ConferenceCommitteeAgreement Committee Markups ? Finance Committee Roundtables Begin Senate Floor Consideration ?

20. House Health Reform Timeline June September May April July October November HearingsContinue Legislative Plan Release Committee Hearings ConferenceCommitteeAgreement Committee Markups July Floor Consideration

21. Reform Focus Areas Health System Reforms Expanded Coverage Financing • he • Quality/pay-for- performance • Public reporting • Primary care incentives • Workforce improvement • Medical home • Medicare doctor payment • Bundled payments • Reduce readmissions • Accountable care organizations • Medicare Advantage payment reforms • Comparative Effectiveness • Health information technology • Health insurance exchange • Benefit design • Rating reforms • Small business tax credit • Market reforms • Mandates • Public plan option • Public program expansion • Medicaid reforms, including expansion to 100% FPL • Home and community based services • Long-term care • Health disparities • Prevention • Health care tax exclusion • Other sources of tax revenue • Multinational corporations • Alcohol • Sugary drinks • Additional health system savings • Medicaid rebate • Part D prescription drug cost-savings

22. Prevention & Wellness Health Reform: Opportunities for Common Ground Expanding Coverage System Reform and Quality Improvement Fraud & Abuse

23. Health Reform: Major Challenges Financing Government-Run Public Plan Medicaid Expansion

24. Most Important Economic Issues Source: NBC/Wall Street Journal Survey http://s.wsj.net/public/resources/documents/WSJ-NBC_Poll090617.pdf

25. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

26. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

27. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

28. Alliance for Health Reform Briefing for Reporters July 1, 2009 Dean A. Rosen, Partner