The Status of Health ReformThe Status of Health Reform

Melanie HobbsDirector, Public Policy and Government Relations

St.Vincent Health

Tory Callaghan CastorVice President, Government Relations

Clarian Health Partners

UpdatedDecember 14, 2009

• The White House

• House “Tri-Committee”

• House Speaker Nancy Pelosi• Ways and Means (Rep Charles Rangel – D., NY)• Energy and Commerce (Rep Henry Waxman – D., CA) • Education and Labor (Rep George Miller – D., CA)

• Senate

• Senate Majority Leader Harry Reid• Health, Education, Labor and Pensions (HELP Committee) – (Sens. Dodd & Harkin – D., Ct, IA)• Finance Committee - (Sen Max Baucus – D., Mont)• Ben Nelson• Olympia Snowe• Joe Lieberman

• Blue Dog Democrats • The Congressional Budget Office

• Industry Trade Groups

Important PlayersImportant Players

COMMITTEES

FLOORCONSIDERATIO

N

House-SenateConference Committee

HOUSE

Energy & Commerce

Ways & Means

Education& Labor

PassedJuly 31

PassedJuly 16

PassedJuly 17

SENATE

Finance HELP

PassedJuly 16

Two bills to be combined into one

Regular Order

Reconciliation

Full Senate vote on bill(simple majority to pass)

Unlimited floor debate

Filibuster

Cloture (60 votes)

Limited floor debate

Limits on non-budget-related

provisions

Passed October

13

Three bills combined into one

October 29

HOUSE VOTEPassed 220-215

Limited floor debate – One Day

Two Amendments Considered;One Adopted

November 7

Next Steps: Senate ActionNext Steps: Senate Action

Two bills combined into one

November 18

What the White House WantsWhat the White House Wants

 House Bill (HR3962)

“Affordable Health Care for America Act”Passed: November 7, 2009 (220-215)

Senate Bill (HR3590)“Patient Protection and Affordable Care Act”

Currently Being Debated on the Senate Floor

Cost $1.2 Trillion over 10 Years $849 Billion over 10 Years

Coverage36 Million 

(Currently, the House bill covers 96% of those legally residing and 94% of those residing in the country.) 

31 Million (Currently, the Senate bill covers 94% of those legally residing 

and 92% of those residing in the country.) 

Government-RunInsurance

Public Option(negotiated rates with “corridors”)

Public Option with Opt-Out Provision (Current)(Federal Employee  Health Benefits-type model with Medicare buy-in and public option trigger---being scored by CBO.)

Individual Mandate Yes. Individuals must purchase insurance or pay a penalty of 2.5% of income. 

Yes. Individuals must purchase insurance or pay a penalty. Those obligated to buy coverage who fail to do so would pay a fine starting at $95 in 2014 and rising to $750.

Employer Mandate

Yes. Employers must pay 65% of family premiums or pay a penalty based on payroll. Small businesses with less than $500,000 on payroll are exempt. Payrolls up to $750,000 have a reduced contribution.

No, the bill would not require employers to offer health insurance. However, medium and large employers who do not offer coverage would have to reimburse the government for each full-time employee receiving a health-care affordability tax credit.

Revenue Raisers

The original proposal imposed a surcharge on families with incomes above $350,000 and individuals with incomes above $280,000. House leaders are considering limiting the surtax to singles who earn more than $500,000 and families who earn more than $1 million.

Fees on insurance companies, drug makers, medical device manufactures.  Medicare payroll tax would increase to 1.95% on income of more than $200k/yr for individuals; $250k/yr for couples.  New 5% tax on elective cosmetic surgery.  Tax on “Cadillac plans” ($8,500 annually for individuals and $23,000 for families). 

Insurance Reforms No denial of coverage based on pre-existing conditions.  No higher premiums based on gender/age. (2013)

No denial of coverage based on pre-existing conditions.  No higher premiums based on gender/age/family size. Children up to age 26 can stay on parents insurance.  No lifetime limits on coverage. (2014)

Medicaid Expansion Yes. Expanded to 150% FPL. Yes. Expanded to 133% FPL.

Insurance Subsidies Yes. Available to households earning up to400% FPL.

Yes. Available to households earning up to400% FPL.

The Goal

Tactics

Prerequisite

Delivery System ReformDelivery System Reform

Public OpinionPublic Opinion

The Role of Physical TherapistsThe Role of Physical Therapists

APTA-Supported Policy Principles for Health Care Reform:

• Systematic health care reform that provides:• Guarantee Issue• Guarantee Renewal• Guarantee Choice

• Ensure that rehabilitation services, provided by licensed health care professionals, are an essential element of a standard benefits package in any proposal to reform the insurance delivery system.

• Enact insurance reforms that:• Eliminate arbitrary limits on annual or lifetime benefits;• Prohibit cost shifting by increased co-payments, deductibles, and/or premiums;

and• Ensure non-discrimination on benefits or providers.

• Reform Medicare payment policies:• Permanently repeal the Sustainable Growth Rate (SGR) formula• Permanently repeal arbitrary outpatient therapy caps on services; and• Eliminate certification of the plan of care for patients to access outpatient physical

therapy services.

The Role of Physical TherapistsThe Role of Physical TherapistsAPTA-Supported Policy Principles for Health Care Reform:

• Ensure that policies regarding bundling payments meet the following criteria:

• Bundled payments should not be implemented without evaluation of its feasibility as a payment model for post-acute care services.

• Patient safeguards should be established to ensure patient choice and access to the full range and continuum of post-acute and outpatient care.

• Post-acute care should be defined as Part A services within the first 30 days post discharge from an acute care hospital stay delivered by inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and/or long-term acute care hospitals.

• Enhance initiatives to develop an adequate health care workforce.

• Enable physical therapists to participate in current initiatives, such as the NHSC.• Expand federal funding for clinical education, fellowships, and faculty development

in physical therapy.

• Reduce unnecessary regulatory burdens on physical therapists to enhance efficiency and effectiveness in delivering health care to their patients at the right time and place.

QuestionsQuestions