1 Perspectives on Health Care Reform Health Care in the New Administration February 2009

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Perspectives on Health Perspectives on Health Care Reform Care Reform Health Care in the New AdministrationHealth Care in the New AdministrationFebruary 2009February 2009

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This Presentation This Presentation IncludesIncludes Major details of the Obama PlanMajor details of the Obama Plan Major Concerns Major Concerns Congressional healthcare proposalsCongressional healthcare proposals Analysis of the political landscapeAnalysis of the political landscape Health Care in the StimulusHealth Care in the Stimulus Who heads up health reform?Who heads up health reform? Possible AlternativesPossible Alternatives Recent and Future response activitiesRecent and Future response activities

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Obama Plan DetailsObama Plan Details

Key Points:Key Points: Accountability: All providers will be Accountability: All providers will be

expected to exhibit a higher form of expected to exhibit a higher form of accountabilityaccountability

Evidence based treatments: Evidence based treatments: Reimbursement will be fast-tracked Reimbursement will be fast-tracked through the quality lensthrough the quality lens

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Obama Plan DetailsObama Plan Details

Reduction of 26+ million of uninsured Reduction of 26+ million of uninsured from current 49 million when fully from current 49 million when fully implemented implemented (Estimates by Lewin (Estimates by Lewin Group)Group)

Net federal spending increase of $1.17 Net federal spending increase of $1.17 trillion over 2010-2019 timeframe trillion over 2010-2019 timeframe (Lewin estimates, assumes plan is (Lewin estimates, assumes plan is implemented 2010)implemented 2010)

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Plan DetailsPlan Details

Plan builds on current Employer Based Plan builds on current Employer Based Insurance (EBI) systemInsurance (EBI) system

Medium and large employers “play or Medium and large employers “play or pay” pay” (Provide coverage that meets a (Provide coverage that meets a specified federal standard, or pay a specified federal standard, or pay a new payroll tax)new payroll tax)

Actual stated requirement is for firms Actual stated requirement is for firms to provide a “meaningful” contribution to provide a “meaningful” contribution for the above coverage, but what for the above coverage, but what constitutes “meaningful” is not definedconstitutes “meaningful” is not defined

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Plan Details Cont’dPlan Details Cont’d

Definition of “medium and large” Definition of “medium and large” businesses not precisely clear – perhaps businesses not precisely clear – perhaps a business with 25 or more employees a business with 25 or more employees would be considered medium-sizedwould be considered medium-sized

A new tax credit for “small employers” A new tax credit for “small employers” that offer coverage that offer coverage (Up to 50% of (Up to 50% of premiums paid…?)premiums paid…?)

States can continue to “experiment” – States can continue to “experiment” – but any state plans must meet a federal but any state plans must meet a federal standardstandard

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Mandate that parents provide coverage Mandate that parents provide coverage for their children for their children (Enforcement (Enforcement mechanism not specified)mechanism not specified)

Expands Medicare and SCHIP Expands Medicare and SCHIP (Eligibility (Eligibility not clear, State Government cost portion not clear, State Government cost portion not clear)not clear)

Subsidies for those whose incomes are Subsidies for those whose incomes are too high to qualify for Medicaid, but too too high to qualify for Medicaid, but too low to afford private insurance on their low to afford private insurance on their ownown

Insurers must accept all, regardless of Insurers must accept all, regardless of health status health status (Guaranteed Issue)(Guaranteed Issue)

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Insurers prohibited from setting Insurers prohibited from setting premiums based on health statuspremiums based on health status

Coverage to be “portable”Coverage to be “portable” Establishes a new Establishes a new nationalnational “public “public

plan” available to those without plan” available to those without employer coverage, the self-employed, employer coverage, the self-employed, and small business employeesand small business employees

Benefit structure not specified Benefit structure not specified (Some (Some observers believe it will be equivalent observers believe it will be equivalent to the FEHBP Blue Cross/Blue Shield to the FEHBP Blue Cross/Blue Shield “standard” option)“standard” option)

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Establishes a “national exchange” Establishes a “national exchange” through which consumers access the through which consumers access the new “national plan” or a selection of new “national plan” or a selection of competitive private plans meeting the competitive private plans meeting the minimum requirements of the “national minimum requirements of the “national plan” plan” (plus information, options, etc.)(plus information, options, etc.)

““National Exchange” is intended as a National Exchange” is intended as a key mechanism intended to spur key mechanism intended to spur competition and lower costs to competition and lower costs to consumersconsumers

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Other Plan DetailsOther Plan Details

Establishes a new independent “institute” to Establishes a new independent “institute” to “guide reviews and research” on “guide reviews and research” on comparative comparative effectiveness effectiveness (addressed in stimulus)(addressed in stimulus)

Seeks to “accelerate” efforts to develop and Seeks to “accelerate” efforts to develop and disseminate “best practices” and align disseminate “best practices” and align reimbursement to the provisioning of high reimbursement to the provisioning of high quality care (May be included in above) quality care (May be included in above)

New requirements for hospitals and providers New requirements for hospitals and providers to collect and report cost and quality data, to collect and report cost and quality data, including data on preventable medical errorsincluding data on preventable medical errors

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Health Plans required to disclose the Health Plans required to disclose the percentage of premiums that actually goes percentage of premiums that actually goes to paying for patient careto paying for patient care

Some revisions to anti-trust statutes “to Some revisions to anti-trust statutes “to prevent insurance plans from overcharging prevent insurance plans from overcharging providers for medical malpractice costs”providers for medical malpractice costs”

Eliminate insurance plan subsidies for Eliminate insurance plan subsidies for Medicare Advantage plansMedicare Advantage plans

Increased focus on prevention and wellness Increased focus on prevention and wellness (chronic diseases account for 75% of all (chronic diseases account for 75% of all health care dollars spent)health care dollars spent)

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New requirements that plans New requirements that plans participating in the new “public plan,” participating in the new “public plan,” Medicare or FEHBP utilize proven disease Medicare or FEHBP utilize proven disease management programsmanagement programs

$50 billion $50 billion (over five years)(over five years) in federal in federal funding to advance health IT and funding to advance health IT and standards (addressed in stimulus)standards (addressed in stimulus)

Young adults (up to age 25) can continue Young adults (up to age 25) can continue to access coverage through their parentsto access coverage through their parents

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Major ConcernsMajor Concerns

To many, the Obama plan seemed “simple” To many, the Obama plan seemed “simple” in concept during the campaign, but a close in concept during the campaign, but a close look reveals that it is complex and includes look reveals that it is complex and includes controversial and political elements controversial and political elements (our (our opinion)opinion)

Much of the detail remains missing – and Much of the detail remains missing – and usually “the devil is in the details”usually “the devil is in the details”

True scope and level of controversy probably True scope and level of controversy probably can’t be fully measured until his proposal is can’t be fully measured until his proposal is turned into precise legislative languageturned into precise legislative language

It is clear that providers will be subjected to a It is clear that providers will be subjected to a range of new expectations range of new expectations (quality and cost (quality and cost reporting, etc.)reporting, etc.)

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Major ConcernsMajor Concerns

The extent to which the new national The extent to which the new national plan or federal standard does or does not plan or federal standard does or does not specifically cover chiropractic care (will it specifically cover chiropractic care (will it be spelled out in a minimum plan?)be spelled out in a minimum plan?)

As it lacks much detail, Obama’s plan As it lacks much detail, Obama’s plan must be considered a “work in progress”must be considered a “work in progress”

As a practical matter the Obama plan As a practical matter the Obama plan (regardless of much detail is eventually (regardless of much detail is eventually fleshed out)fleshed out) can only be considered a can only be considered a “starting point” for congressional debate“starting point” for congressional debate

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Congressional Congressional ProposalsProposals BaucusBaucus WydenWyden ConyersConyers KennedyKennedy

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Congressional Congressional Proposals Baucus Plan Proposals Baucus Plan OverviewOverview 89 page plan released November 12, 200889 page plan released November 12, 2008 ““Devil is in the details” – Devil is in the details” – (i.e. no legislative (i.e. no legislative

language, plan is in prose form)language, plan is in prose form) Plan is potentially important because 1) Plan is potentially important because 1)

Baucus is Chair of Senate Finance; 2) Baucus is Chair of Senate Finance; 2) Baucus is not considered a “far left” Baucus is not considered a “far left” Member of CongressMember of Congress

Baucus plan is one of many expected to be Baucus plan is one of many expected to be introduced in the next Congressintroduced in the next Congress

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Congressional Congressional Proposals Baucus Plan Proposals Baucus Plan OverviewOverview Baucus would create a national “Health Baucus would create a national “Health

Insurance Exchange” through which Insurance Exchange” through which insurance could be obtained, along with insurance could be obtained, along with comparative data regarding benefits, comparative data regarding benefits, costs, etc. costs, etc. (This appears similar to (This appears similar to Obama)Obama)

Also creates a new national plan Also creates a new national plan “similar to Medicare” “similar to Medicare” (Similar feature (Similar feature also in Obama, but Obama plan also in Obama, but Obama plan suggests the national plan would be suggests the national plan would be more similar to FEHBP)more similar to FEHBP)

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Congressional Congressional Proposals Baucus Plan Proposals Baucus Plan OverviewOverview IMPORTANT: Baucus would create a new IMPORTANT: Baucus would create a new

“Independent Health Coverage Council” “Independent Health Coverage Council” that would make major decisions and fill that would make major decisions and fill in much of the detail of his planin much of the detail of his plan

Council would define such basics as what Council would define such basics as what is meant by “coverage” and is meant by “coverage” and “affordability” – and would define what is “affordability” – and would define what is to be included in the new national to be included in the new national “public” plan“public” plan

Council would be comprised of Council would be comprised of presidential appointees, with advice and presidential appointees, with advice and consent of the Senateconsent of the Senate

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Congressional Congressional Proposals Baucus Plan Proposals Baucus Plan OverviewOverview Again, like Obama Again, like Obama (and other plans that (and other plans that

will be introduced)will be introduced) it is hard to imagine it is hard to imagine that the legislative language form of that the legislative language form of any substantive proposal will be any any substantive proposal will be any thing but complex. Complexity in some thing but complex. Complexity in some respects is likely to equate with respects is likely to equate with “controversy” – as groups begin to “controversy” – as groups begin to focus on the “devil in the details” as the focus on the “devil in the details” as the reform issue unfolds.reform issue unfolds.

CAUTION: We believe virtually all major CAUTION: We believe virtually all major proposals will create some new proposals will create some new nationally available plan or mechanism nationally available plan or mechanism that may preempt state lawsthat may preempt state laws

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Congressional Proposals Congressional Proposals Wyden Overview, S. 391Wyden Overview, S. 391 Interesting blend of R’s (Bennett, Specter, L. Interesting blend of R’s (Bennett, Specter, L.

Graham) and D’s (Cantwell, Stabenow, Graham) and D’s (Cantwell, Stabenow, Landrieu) behind the billLandrieu) behind the bill

Universal coverage - Under the proposal, all citizens are enrolled in a basic minimum benefits package within the Healthy Americans Private Insurance System (HAPI)

Any enhanced coverage is purchased separately by direct payment by the individual to the insurer (or direct payment to a newly created “Health Help Agency” (HHA)

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Congressional Congressional Proposals Proposals Wyden Overview, S. Wyden Overview, S. 391391 A HAPI plan is required to provide at least a

minimum benefits package benchmarked to the actuarial value of the Federal Employees Health Benefits (FEHB) Program standard benefit option BlueCross/Blue Shield plan

Universal coverage is partially enforced through the requirement that payment for the lowest-cost premium is part of an individual’s tax liability, and withholding tables are adjusted to reflect this liability, except that certain low-income individuals are eligible for premium assistance.

Source: CBO

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Congressional Congressional Proposals Proposals Conyers Overview, HR Conyers Overview, HR 676676 Single-Payer system, currently has 59 Single-Payer system, currently has 59

CosponsorsCosponsors Single-Payer not holding any currency in the Single-Payer not holding any currency in the

AdministrationAdministration Under Conyers, doctors have private practices, Under Conyers, doctors have private practices,

hospitals may be owned by nonprofits or by hospitals may be owned by nonprofits or by government. government.

Chiropractic listed as a “covered benefit”Chiropractic listed as a “covered benefit” Reimbursement would be set by fee structures Reimbursement would be set by fee structures

negotiated with health care providers; “tnegotiated with health care providers; “the Program shall negotiate a simplified fee schedule that is fair and optimal…”

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Congressional Congressional Proposals Proposals Kennedy OverviewKennedy Overview Ailing chair of Senate HELP committee Ailing chair of Senate HELP committee

looking at health reform as a last contribution looking at health reform as a last contribution of an almost 50 year Senate tenureof an almost 50 year Senate tenure

Negotiations have been secretive; however Negotiations have been secretive; however latest intel is that focus of the plan may latest intel is that focus of the plan may compose of a mandate on individuals to have compose of a mandate on individuals to have coveragecoverage

Several workgroups chaired by chiropractic Several workgroups chaired by chiropractic champions: Harkin (prevention); Mikulski champions: Harkin (prevention); Mikulski (quality); Bingaman (private insurance)(quality); Bingaman (private insurance)

All have pledged support for chiropractic in All have pledged support for chiropractic in meetings (2009)meetings (2009)

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Our AnalysisOur Analysis

Current economic crisis could easily Current economic crisis could easily cause Obama to delay efforts to advance cause Obama to delay efforts to advance his health planhis health plan

HHS void may impede any early HHS void may impede any early momentummomentum

The mandate on medium and large The mandate on medium and large businesses businesses (and individuals to provide (and individuals to provide coverage for their children)coverage for their children) may prove to may prove to be controversial and potential major be controversial and potential major obstacles to enactmentobstacles to enactment

Savings attributed to the plan may Savings attributed to the plan may eventually be judged to have been eventually be judged to have been overestimated – likewise, costs may be overestimated – likewise, costs may be judged to have been low-balled judged to have been low-balled

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Obama Administration could easily Obama Administration could easily decide to send an “outline” of the decide to send an “outline” of the proposed plan to Congress and not proposed plan to Congress and not specific legislative languagespecific legislative language

Lack of specifics will continue as a Lack of specifics will continue as a problem if the above takes placeproblem if the above takes place

Congress Congress (under pressure from various (under pressure from various special interests)special interests) will modify the plan, will modify the plan, perhaps in major waysperhaps in major ways

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Specific inclusion of chiropractic Specific inclusion of chiropractic services in the new minimum benefits services in the new minimum benefits package remains package remains (at this time)(at this time) an an unlikely prospect – because chiropractic unlikely prospect – because chiropractic care won’t be seen as “essential”care won’t be seen as “essential”

A great deal of work remains to be done A great deal of work remains to be done in order to change the above perception in order to change the above perception and to create the political impetus to and to create the political impetus to “deliver” for the chiropractic profession “deliver” for the chiropractic profession – and there is no guarantee of victory– and there is no guarantee of victory

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StimulusStimulus

Health Information Technology Health Information Technology – Provides $19 billion to accelerate Provides $19 billion to accelerate

adoption of HIT systems by doctors and adoption of HIT systems by doctors and hospitals, to “modernize the health hospitals, to “modernize the health care system, save billions of dollars, care system, save billions of dollars, reduce medical errors and improve reduce medical errors and improve quality.”quality.”

– ACA-led coalition fought for non- ACA-led coalition fought for non- MD/DO inclusion.MD/DO inclusion.

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StimulusStimulus

MedicaidMedicaid– Provides $87 billion over the next two Provides $87 billion over the next two

years in additional federal matching years in additional federal matching funds to help states maintain their funds to help states maintain their Medicaid programs.Medicaid programs.

– Helps states avoid cutting eligibility for Helps states avoid cutting eligibility for Medicaid and scaling back the health Medicaid and scaling back the health care services covered.care services covered.

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StimulusStimulus

Prevention & Comparative Effectiveness Prevention & Comparative Effectiveness ResearchResearch– Provides $1 billion for a new Prevention Provides $1 billion for a new Prevention

and Wellness Fund. and Wellness Fund. – Provides $1.1 billion for comparative Provides $1.1 billion for comparative

effectiveness research, to help patients effectiveness research, to help patients and doctors determine the and doctors determine the effectiveness of different treatments. effectiveness of different treatments.

– ACA will be working to guarantee ACA will be working to guarantee chiropractic inclusion in these two chiropractic inclusion in these two initiatives.initiatives.

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Myths and Facts on Myths and Facts on the Stimulusthe Stimulus

Myth:Myth: One new bureaucracy, the National Coordinator One new bureaucracy, the National Coordinator of Health Information Technology, will monitor of Health Information Technology, will monitor treatments to make sure doctors are doing what the treatments to make sure doctors are doing what the federal government deems appropriate and cost federal government deems appropriate and cost effective.effective.

Fact: Fact: It is true that the bill creates a National It is true that the bill creates a National Coordinator of Health Information Technology. Coordinator of Health Information Technology. However, there is not one piece of language that However, there is not one piece of language that authorizes, empowers or even so much as addresses authorizes, empowers or even so much as addresses the Coordinator’s role as being one that will monitor the Coordinator’s role as being one that will monitor treatments to ensure that a health provider is “treatments to ensure that a health provider is “doing doing what the federal government deems appropriate and what the federal government deems appropriate and cost effectivecost effective.” The section speaks solely to the .” The section speaks solely to the development of an EHR system and how it can be most development of an EHR system and how it can be most effectively used to share patient and clinical effectively used to share patient and clinical information to improve the information to improve the qualityquality of medical care. of medical care.

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Myths and Facts on Myths and Facts on the Stimulusthe Stimulus Myth:Myth: The goal of the Federal Coordinating The goal of the Federal Coordinating

Council for Comparative Effectiveness Research Council for Comparative Effectiveness Research is to slow the development and use of new is to slow the development and use of new treatments and technologies because they treatments and technologies because they are driving up costs. are driving up costs.

Fact:Fact: The goal of the Council is to create (from The goal of the Council is to create (from the bill) “opportunities to assure optimum the bill) “opportunities to assure optimum coordination of comparative effectiveness and coordination of comparative effectiveness and related health services research conducted or related health services research conducted or supported by relevant Federal departments and supported by relevant Federal departments and agencies, with the goal of reducing duplicative agencies, with the goal of reducing duplicative efforts and encouraging coordinated and efforts and encouraging coordinated and complementary use of resources.”complementary use of resources.”

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After Daschle…After Daschle…

Early February withdrawal of former Sen. Tom Early February withdrawal of former Sen. Tom Daschle leaves White House scrambling for Daschle leaves White House scrambling for successorsuccessor

According to many sources, Daschle was the According to many sources, Daschle was the “only choice” to head HHS and become newly “only choice” to head HHS and become newly created “Health Czar” at the White Housecreated “Health Czar” at the White House

Daschle decision a serious blow to chiropractic Daschle decision a serious blow to chiropractic given his track record in the Senategiven his track record in the Senate

Does the health care reform momentum Does the health care reform momentum suffer?suffer?

Sen. Ted Kennedy’s health status may also Sen. Ted Kennedy’s health status may also slow action in the Senate slow action in the Senate

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Possible AlternativesPossible Alternatives

If the economy collapses into a If the economy collapses into a depression, then an effort to advance depression, then an effort to advance a government run single-payer system a government run single-payer system will gain traction will gain traction (We think this (We think this scenario is unlikely)scenario is unlikely)

As noted previously, economic issues As noted previously, economic issues could force Obama to delay or scale could force Obama to delay or scale back his health reform plan back his health reform plan (A very (A very real possibility we think)real possibility we think)

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Rather than full scale reform, a series of Rather than full scale reform, a series of smaller legislative steps are takensmaller legislative steps are taken

With reference to the above, we With reference to the above, we consider the following likely: consider the following likely: 1.) Medicaid expansion (in stimulus)1.) Medicaid expansion (in stimulus)2.) S-CHIP expansion (passed earlier 2.) S-CHIP expansion (passed earlier this year, 11 million now covered, up this year, 11 million now covered, up from 7m)from 7m)3.) Elimination of Medicare Advantage 3.) Elimination of Medicare Advantage subsidies (component of several plans; subsidies (component of several plans; Stark)Stark)

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4.) Initiatives to fund/promote Health IT 4.) Initiatives to fund/promote Health IT (in stimulus)(in stimulus)

5.) Additional measures to try and link 5.) Additional measures to try and link reimbursement to quality and reporting reimbursement to quality and reporting (on going through regulatory efforts and (on going through regulatory efforts and PQRI)PQRI)

6.) Some small business relief measure 6.) Some small business relief measure that would preempt state laws (unlikely that would preempt state laws (unlikely return of Enzi given majorities in both return of Enzi given majorities in both chambers)chambers)

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Recent Response Recent Response ActivityActivity Creating patient advocacy network key to Creating patient advocacy network key to

winning chiropractic inclusion in reform; winning chiropractic inclusion in reform; expansion in Medicareexpansion in Medicare

ACA Leadership Approves Plan to Involve Patients ACA Leadership Approves Plan to Involve Patients in Coming ‘Perfect Storm’ of Federal Initiativesin Coming ‘Perfect Storm’ of Federal Initiatives– In October, the ACA Board of Governors approved a In October, the ACA Board of Governors approved a

plan based on a multi-layered strategy that will plan based on a multi-layered strategy that will ultimately create a patients’ advocacy network, the ultimately create a patients’ advocacy network, the primary component being the development of primary component being the development of ChiroVoice.orgChiroVoice.org, a website devoted to patients and , a website devoted to patients and supporters supporters

– ChiroVoice.orgChiroVoice.org will help rally public support for will help rally public support for chiropractic coverage in federal initiatives that will be chiropractic coverage in federal initiatives that will be considered by Congress and the new Administrationconsidered by Congress and the new Administration

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Recent Response Recent Response ActivityActivity ACA-inspired Summit process ACA-inspired Summit process

continues with 4continues with 4thth national meeting national meeting (January 2009)(January 2009)

Summit maintains high emphasis on Summit maintains high emphasis on ensuring “common” messages to ensuring “common” messages to Capitol Hill and coordination of Capitol Hill and coordination of grassroots activitiesgrassroots activities

Interim conference call coordination Interim conference call coordination and subcommittee work continuesand subcommittee work continues

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Recent Response Recent Response ActivityActivityRegarding Medicare:Regarding Medicare: ACA Medicare “Webinar” available on ACA website ACA Medicare “Webinar” available on ACA website

(Seeks reduction in claims errors)(Seeks reduction in claims errors) ACA heavily involved in CMS Physicians’ Quality ACA heavily involved in CMS Physicians’ Quality

Reporting Initiative (PQRI); through ACA efforts, DCs Reporting Initiative (PQRI); through ACA efforts, DCs eligible to report and receive bonus payment for eligible to report and receive bonus payment for reporting quality measuresreporting quality measures

ACA working with researchers to further investigate ACA working with researchers to further investigate effects of demo project in various areas, including effects of demo project in various areas, including beneficiary accessbeneficiary access

On going: On going: – Coordinating CCACCoordinating CCAC– Issuing regulatory alerts to professionIssuing regulatory alerts to profession– Monitoring SGR reimbursement policiesMonitoring SGR reimbursement policies

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Recent Response Recent Response ActivityActivity ACA continues to help steer activities of ACA continues to help steer activities of

PARCA coalition of non-MD provider groups in PARCA coalition of non-MD provider groups in anticipation of national reform battle. Seeks anticipation of national reform battle. Seeks agreement on common issues such as “anti-agreement on common issues such as “anti-discrimination” provisions and discrimination” provisions and patient/provider protectionspatient/provider protections

ACA reached out to national campaigns and ACA reached out to national campaigns and secured chiropractic support letters from secured chiropractic support letters from most candidates (Three from Obama)most candidates (Three from Obama)

ACA present at ACA-PAC sponsored major ACA present at ACA-PAC sponsored major fundraising events for candidates in fundraising events for candidates in Washington and around the country ($300K+ Washington and around the country ($300K+ to candidates in 2007-08; 93% success rate)to candidates in 2007-08; 93% success rate)

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Future ResponseFuture Response

ACA will work with the Summit participants ACA will work with the Summit participants to promote a “National Mobilization to promote a “National Mobilization Campaign” to members and non-members Campaign” to members and non-members

Major goal: Educate the profession/patients Major goal: Educate the profession/patients as to the true dimension of the threats as to the true dimension of the threats posed by the “Perfect Storm” and to instill posed by the “Perfect Storm” and to instill sense of urgency sense of urgency toto support efforts by support efforts by the ACA and Summit allies to address the the ACA and Summit allies to address the situationsituation

ACA profession-wide publications will ACA profession-wide publications will continue to educate the profession with continue to educate the profession with regular updates for the foreseeable futureregular updates for the foreseeable future

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Future ResponseFuture Response

ACA to place a major priority on ACA to place a major priority on growing patient database (growing patient database (2009 and 2009 and beyond)beyond) so that it can be used as a so that it can be used as a permanent grassroots resource to help permanent grassroots resource to help “level the playing field” “level the playing field” in terms of in terms of competing with other more well-competing with other more well-funded interest groups funded interest groups (insurance (insurance industry, competitor providers, etc.)industry, competitor providers, etc.)

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Questions?Questions?

Contact info:Contact info:

ACA Department of Government ACA Department of Government RelationsRelations

703-812-0224703-812-0224

[email protected]@acatoday.org

Documents

1 Perspectives on Health Care Reform Health Care in the New Administration February 2009