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Health Care Reform 2009Health Care Reform 2009
Where We Are…Where We Are…
Where We Are Heading…Where We Are Heading…
Current SituationCurrent Situation
47 Million Uninsured Americans47 Million Uninsured Americans 25 Million Underinsured 25 Million Underinsured Health Spending Accounts for 17% of Gross Health Spending Accounts for 17% of Gross
Domestic Product (GDP)Domestic Product (GDP) Health Care Spending Continues to RiseHealth Care Spending Continues to Rise Current Inefficiencies Current Inefficiencies Denials Based on Pre-Existing ConditionsDenials Based on Pre-Existing Conditions Restraints on Access to OTRestraints on Access to OT
President ObamaPresident Obama
Major Component of the Presidents Campaign PlatformMajor Component of the Presidents Campaign PlatformTop domestic policy priorityTop domestic policy priority
““I am not the first President to take up this cause, but I am determined I am not the first President to take up this cause, but I am determined to be the last.”to be the last.”
-- President Barack Obama, September 9, 2009-- President Barack Obama, September 9, 2009
““I suffer no illusions that this will be an easy process. It will be I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year."not wait another year."
– – President Barack Obama, February 24, 2009 President Barack Obama, February 24, 2009
House Minority Leader:
Representative John Boehner (R-OH) “Despite our differences on some
important health care-related issues, we are convinced there are areas offering potential for common ground on health care reform among Republicans and Democrats.”
CongressCongress
5 Committees of Jurisdiction 5 Committees of Jurisdiction
– SenateSenate Health Education Labor and Pensions (H.E.L.P)Health Education Labor and Pensions (H.E.L.P) FinanceFinance
– House “Tri-Committees”House “Tri-Committees” Education and LaborEducation and Labor Energy and CommerceEnergy and Commerce Ways and MeansWays and Means
House of RepresentativesHouse of Representatives
House Tri-Committee Bill:House Tri-Committee Bill:
– America’s Affordable Health Choices Act (H.R. 3200)America’s Affordable Health Choices Act (H.R. 3200)
Single bill drafted by House Leadership and Committee ChairsSingle bill drafted by House Leadership and Committee Chairs Amended separately in each CommitteeAmended separately in each Committee
The 3 versions of the bill must be merged before being The 3 versions of the bill must be merged before being brought to the floor for passage.brought to the floor for passage.
SenateSenate
H.E.L.P. CommitteeH.E.L.P. Committee – Passed legislation on July 15, 2009 on a party Passed legislation on July 15, 2009 on a party
line voteline vote– Passing of Senator Edward Kennedy (D-MA)Passing of Senator Edward Kennedy (D-MA)– Senator Tom Harkin (D-IA): New ChairmanSenator Tom Harkin (D-IA): New Chairman
SenateSenate
Finance Committee Passed Bill Oct. 13Finance Committee Passed Bill Oct. 13– ““Gang of Six” worked together for monthsGang of Six” worked together for months
Bipartisan group of Finance Committee MembersBipartisan group of Finance Committee Members – Democrats: Chairman Max Baucus (D-MT), Kent Conrad (D-Democrats: Chairman Max Baucus (D-MT), Kent Conrad (D-
ND), Jeff Bingaman (D-NM)ND), Jeff Bingaman (D-NM)– Republicans: Ranking Member Charles Grassley (R-IA), Republicans: Ranking Member Charles Grassley (R-IA),
Olympia Snowe (R-ME), Mike Enzi (R-WY)Olympia Snowe (R-ME), Mike Enzi (R-WY)
– Only Republican vote: Olympia SnoweOnly Republican vote: Olympia Snowe $829B cost—lowest of all bills$829B cost—lowest of all bills Summary: www.finance.govSummary: www.finance.gov
Senate Finance America’s Health Futures Act
Less expensive than House proposals Provides insurance subsidies for some Allows establishment of insurance co-ops
Medicare cuts: SNFs, HH
AOTA Victories in Finance Bill
Expected to specifically include rehabilitation services
Two-year cap exception extension Study allowed on direct access to all
outpatient services—includes occupational therapy, not just physical therapy
Harmful orthotics/prosthetics provision defeated
Home health flexibility for OT pending– May be floor amendment
Key Healthcare Reform IssuesKey Healthcare Reform Issues
Benefits Insurance Reforms Who is Covered? Financing Medicare Reforms
Benefits
Minimum Benefits Package– Actuarial Values Based on % of Current Plans
Tiered Plans Ranging from Platinum to Bronze
Required Benefits Categories– Hospital Services, Physician Services, Outpatient,
Mental Health, Rehabilitation and Habilitation Services*
Establishment of Advisory Commission– Commission to Advise the Secretary Regarding
Essential Benefits that would be Specific After Passage
Insurance Reforms Elimination of denials based on pre-existing conditions
Portability of health insurance when changing jobs
Establishment of a central health insurance exchange regulated federally and operating across state lines
Proposed Public Option to Compete with Private Insurance Products within the Exchange*
Increased emphasis on prevention and wellness
Caps on annual out-of-pocket expenses as well as prohibiting life-time and annual limits on benefits
Who is Covered?
Individual mandate for purchasing coverage– Subsidies for lower income citizens
Employer mandated contributions– Small business exemptions– Enforced through tax penalties
Expands Medicaid and maintains Medicare
Does not provide coverage for illegal aliens*
Financing
Medicare Provider Cuts ($313b) Health Industry Taxation
– Insurance and Pharmaceutical Companies– Hospitals
Health Care Surcharge– High Income Individuals– Extensive Benefit Plans Exceeding $8000/year
Taxation of Alcohol and Tobacco products
MEDICARE PROPOSALS
Pros… Physician Fee Schedule Update Extension of the Therapy Cap Exceptions Process Part D Assistance RX Improvements Incentives for Prevention and Wellness
And Cons… Proposed Provider Cuts ($313b)
– SNF’s– HH Agencies
Post-Acute Care Bundling Pilot
Opponent ConcernsOpponent Concerns
Increased costs for health coverage for the Increased costs for health coverage for the currently insuredcurrently insured
Unwillingness of health professionals to Unwillingness of health professionals to participate in the public option or in the exchangeparticipate in the public option or in the exchange
Public Option potential first step to a government Public Option potential first step to a government run single payer system run single payer system
Reduced access to care in Medicare because of Reduced access to care in Medicare because of reimbursement cutsreimbursement cuts
Increased health care workforce shortagesIncreased health care workforce shortages Market forces not allowed to workMarket forces not allowed to work Savings not equal to increased costsSavings not equal to increased costs
House Republican Alternative/Part 1
Expand federal block grants for state high-risk pools, no caps
Create association/small business health plans, individual membership associations
Allow purchase of insurance across state lines Enact comprehensive medical liability reform Expand and improve Health Savings Accounts Allow employer to offer a “defined
contribution” for health plans Require citizenship verification for Medicaid
beneficiaries
House Republican Alternative/Part 2
Allow employers to offer discounts for healthy behavior through wellness/prevention programs
Allow private insurance vouchers for Medicaid and SCHIP
Expand funding for Fraud and Abuse control Prohibit comparative effectiveness research used to
ration or deny care Provide tax incentives to purchase long-term care
insurance Prohibit insurance companies from rescinding a policy
unless there was proof of fraud
Argument vs. DebateArgument vs. Debate
Words of Caution:Words of Caution:
– Be careful of rhetoric versus realityBe careful of rhetoric versus reality
– Visit AOTA’s Health Care Reform Hub Visit AOTA’s Health Care Reform Hub for detailed arguments from both sides for detailed arguments from both sides of the debate.of the debate.
AOTA Position on Health Care ReformAOTA Position on Health Care Reform
AOTA is Non-PartisanAOTA is Non-Partisan AOTA has AOTA has notnot taken a position in taken a position in
support or opposition of any of the support or opposition of any of the current proposalscurrent proposals
AOTA AOTA hashas taken positions on particular taken positions on particular provisions in the various proposals (e.g. provisions in the various proposals (e.g. Autism coverage, workforce issues, Autism coverage, workforce issues, extension of the therapy capsextension of the therapy caps))
Occupational Therapy in Health Care ReformOccupational Therapy in Health Care Reform
Minimum Benefits PackageMinimum Benefits Package– Rehabilitation and HabilitationRehabilitation and Habilitation– Hospital and Outpatient ServicesHospital and Outpatient Services
Expanded Potential for Occupational Therapy in Expanded Potential for Occupational Therapy in Telehealth and in the Use of Health Information Telehealth and in the Use of Health Information TechnologyTechnology
Medicare Payment ChangesMedicare Payment Changes– Therapy Cap: 2 Year ExtensionTherapy Cap: 2 Year Extension– OT as a Home Health Initiating ServiceOT as a Home Health Initiating Service
Workforce Definitions, Expansions of programsWorkforce Definitions, Expansions of programs
AOTA Position on Health Care ReformAOTA Position on Health Care Reform
There is a need for reform in the There is a need for reform in the American health care system to address American health care system to address problems including coverage for the problems including coverage for the uninsured, access to care, quality, cost uninsured, access to care, quality, cost growth and workforce shortages.growth and workforce shortages.
A national debate and discussion about A national debate and discussion about
health care is needed.health care is needed.
Occupational Therapy: Part of the Health Care Solution
AOTA promoting evidence-based rationale for OT involvement in:– Care coordination– Chronic care management– Prevention– Primary care coordination– Medical home systems
See fact sheet at Health Care Reform Hub www.aota.org Legislative Action Center
AOTA Reform PrinciplesAOTA Reform Principles ( (Representative Assembly 2008)Representative Assembly 2008)
Health care must have a proactive, prevention focus. Health care must have a proactive, prevention focus.
Health care must address the whole person across the Health care must address the whole person across the lifespan and across needs for acute and chronic care.lifespan and across needs for acute and chronic care.
Mental health and substance abuse parity must be Mental health and substance abuse parity must be
included for all.included for all. The provision of health care services should be The provision of health care services should be
integrated across facilities, communities, and settings, integrated across facilities, communities, and settings, including services where people live, work and including services where people live, work and participate in society.participate in society.
Access to quality, affordable care for all should be the Access to quality, affordable care for all should be the
goal of reform. goal of reform.
AOTA Principles Continued…AOTA Principles Continued…
Ensuring access to supportive services for people with Ensuring access to supportive services for people with disabilities or chronic conditions is essential.disabilities or chronic conditions is essential.
Investments are needed in our health care education Investments are needed in our health care education system to ensure availability of qualified occupational system to ensure availability of qualified occupational therapy practitioners to meet growing needs.therapy practitioners to meet growing needs.
Occupational therapy should be covered to provide Occupational therapy should be covered to provide
preventive services, rehabilitation and habilitation in all preventive services, rehabilitation and habilitation in all settings.settings.
Use of health information technology must be Use of health information technology must be maximized to improve the efficiency and effectiveness maximized to improve the efficiency and effectiveness of care. of care.
What’s NextWhat’s Next INTENSE Legislative Activity: INTENSE Legislative Activity:
– Bills in House, Senate melded for each chamberBills in House, Senate melded for each chamber– Votes on the floor of each—November?Votes on the floor of each—November?– Conference to iron out differencesConference to iron out differences
Senate may not vote until NovemberSenate may not vote until November
House expected to wait for Senate actionHouse expected to wait for Senate action
House will include broader approach on public option or related House will include broader approach on public option or related alternativesalternatives
President Obama has asked Congress to have a bill to him by President Obama has asked Congress to have a bill to him by mid-October: he will wait probably until Decembermid-October: he will wait probably until December
ADVOCACYADVOCACY
With the Health Care Reform Debate Heading With the Health Care Reform Debate Heading Around the Final Turn…..Around the Final Turn…..
Now is the time to advocate for the protection and Now is the time to advocate for the protection and advancement of OT: for your clients, for your advancement of OT: for your clients, for your profession and for yourselves.profession and for yourselves.
Utilize the Tools Available on AOTA’s Utilize the Tools Available on AOTA’s Legislative Action Center to Keep up to Date Legislative Action Center to Keep up to Date and Take Actionand Take Action! 24/7!! 24/7!