AMGA Town Hall Webinar Health Care Reform Update

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AMGA Town Hall WebinarHealth Care
Reform Update
November 18, 2009 American Medical Group
Association Public Policy Staff
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Inside the Capitol

• Health Care Reform Efforts
• Reported Legislation
• House Bill
• Senate Finance
• Senate HELP
• Still to Come
• Consolidated Senate Bill
• Senate Passage
• House and Senate Conference
• White House Victory Lap
• Possibilities for Success
• Obstacles
• Q A

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House Bill

• Public Plan
• Negotiated Rates
• Exchange
• Employer Mandate
• Individual Mandate
• Medicaid Expansion
• SRG ReliefStripped
• But New Separate SGR Bill
• Separate ACO Bucket
• Insurance Reform
• ACO Provision
• Medical Home Provision

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House Bill, Cont

• Pay Fors
• Medicare Cuts
• Wealthy Surtax
• Public Plan Savings
• Cost - 900 Billion?
• Passed, 220 ayes to 215
• noes, passed by 2 votes,
• 1 Republican vote.

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SGR Legislation

• House SGR Bill, H.R. 3961
• Separate from Reform Bill
• _at_ 200 billion over 10 Years
• Democrats Not Whipping Bill
• Senate SGR Bill
• 47 yeas to 53 nays
• Stabenow Bill Would have Frozen Physician Payment
  for 10 Years
• Would have added 247 Billion to the Deficit Over
  10 Years
• Health Care Reform Bill Will Now Likely Include a
  1-2 Year Patch

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Senate Melded Bill

• Still Being Drafted by Senator Reid
• Public Option with State Opt-OutOr, Opt In,
  Triggers, CO-Ops, all on the Table to Get 60
• Insurance Reform
• Pre-Existing Clause
• Guaranteed coverage
• Age Rating
• Mandates
• Individual
• Employer
• ACOs

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Senate Melded Bill

• Pay Fors
• Excise tax on Cadillac plans over
  8,000/individual plan, 21,000/family plan, 55
  or over and high risk professionals are
  9,850/individuals, 26,000/family plans
• Industry Fees
• Super MedPAC
• Fee on Device, Payors, Branded Drugs
• Provider Cuts
• MA, Hospitals, SNF, HHA, Pharma,
• DME, Rehab, others
• Cost South of 900 billion

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Next Steps

• Consolidated Senate Bill
• Reid Combining
• HELP Finance Bills
• Senate Floor Vote
• House and Senate Conference
• White House Signature
• Final Votes Pushed to 2010?

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Chances for Success

• Obama, Obama, Obama
• Large Democratic Majorities
• Still Majority Public Support for Something
• Lots of and Grassroots Commitment
• Reconciliation
• Senator Kennedys Passing
• Morality

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Obstacles

• Cost, Cost, Cost
• CBO Bombshell/Bills Do Not Contain Costs/Increase
  Deficit
• CBO Bombshell No. 29 Trillion deficit by
  20191.6 Trillion in 2010. Thats Trillionwith
  a T!
• Economy/Unemployment
• Foreign Affairs

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Policy Obstacles

• Public Plan?
• Mandates
• Individual
• Employer
• Medicaid Expansion Governors Opposed
• Medical Malpractice CBO Report
• Insurance Reforms Increased Premiums

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Policy Obstacles

• Financing
• Wealthy Surtax
• Tax on High Priced Plans
• Medicare Payroll Tax
• Fraud and Abuse
• MA Cuts
• Provider Cuts
• Industry Excise Tax
• Immigration
• Abortion Coverage

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Political Obstacles-House

• Politics
• Blue Dogs/New Dems v. Progressives/Pro-Life/Pro-Ch
  oice/Hispanic Caucus
• Freshman/Sophomore Dems
• 2nd Tough Vote
• What the Heck Happened in New Jersey and
  Virginia?
• Town Halls Ouch /Members Remember
• Industry SupportLosing ItGaining It
• Do We Want to Own This?

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Political Obstacles-Senate

• HELP-Finance Consolidation
• Problems - Similar to House Moderates/Liberals
• 2010 Elections
• Need 60 votes
• Lieberman/Moderates in Play.

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Political Obstacles House/Senate

• House/Senate Conference
• All These Issues Will Have to Be Addressed and
  much harder, Agreed to.

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Questions and Answers

• Q A
• Thank you!

Chairman Baucus Speaks to AMGA members