Children s Hospital Association of Texas An Association for the Advancement of Children s Healthcare in Texas

Transcription

1 Children s Hospital Association of Texas An Association for the Advancement of Children s Healthcare in Texas CHAT Nursing Conference, November 6, 2010, Austin, Texas Ed Berger, VP, Advocacy & Government Relations, Seton Family of Hospitals Kathy Eckstein, Director of Public Policy, CHAT

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3 CHAT s Mission Advocate the development of an effective, comprehensive, high quality and appropriately funded children s health care delivery system in Texas.

4 What We ll Cover Today Federal healthcare reform and its impact on pediatric health delivery CHAT s legislative priorities for the 82 nd Texas Legislative session Importance of hands on legislative advocacy by providers and care givers

5 The once and future debate about health reform Brace yourselves for a whole lotta ugly comin' at you from a never ending parade of stupid. Motor mouth Maybelle, Hairspray (2007)

6 What Reform is... Mostly about insurance, both public and private Expanded coverage Increased access New restrictions on insurance companies Changes to Medicare, Medicaid Some cost control reduces federal deficit by $143B to 2019, according to CBO Effective dates Some things were retroactive to January 2010 Some don t take effect until 2019

7 What Reform is not No consensus With 535 egos, there are at least 750 different opinions on how to do anything Many Republican ideas included but no R s supported Democrats and Republicans disagree among themselves Not entirely different system No fully public option (e.g., Medicare for all ) favored by some Not a totally free market favored by others

8 We know change is coming

9 And things won t be the same in Kansas (or Texas) any more

10 High Altitude Overview of Kansas, Texas, and rest of the Nation Much of reform deals with Medicare, Medicaid reimbursement and programs That s where Congress can have biggest cost impact Medicaid is vehicle for biggest expansion of coverage to uninsured Private insurance often takes its lead from govt. programs As Medicare begins to bundle payments, look for that trend in Medicaid and private market as well Significant changes in private market, too Annual and lifetime limits, preexisting conditions gone or will be eliminated Incentives and mandates for businesses and individuals to offer, carry coverage

11 Insurance Reforms that Impact Kids Provides up to 35% tax credit to small businesses (max 25 employees, $50K avg. wage) that offer insurance January 2010 Prohibits pre existing condition limit in covering children, allows adult children up to age 26 on parents policy (many plans renewing after ) Bans policy rescissions, lifetime limits, imposes restrictions on annual limits (many plans renewing after ) Establishes interim high risk pool for uninsured (July 2010)

12 Insurance Reforms that Impact Kids (cont.) Preventive care, screenings, immunizations must be provided without cost sharing (plans after ) State based insurance exchanges for individual, small business plans ( ) CHIP kids can get coverage through comparable plans on exchanges Mandate (with penalties) for individuals to have and keep insurance, and for businesses to offer insurance (some exceptions to both) Insurance reforms (no preexisting, no annual or lifetime limits) depend on mandate to keep costs down Minimum required benefit package will include mental health coverage

13 Medicaid/CHIP Reforms that Impact Kids Requires states to maintain existing Medicaid & CHIP eligibility, methodologies, and procedures Raises Medicaid eligibility to 133% of Federal Poverty Level, FPL, or $14,400 for single individual (1 1 14) Texas caps kids over 6 at 100% for Medicaid Adult coverage in Texas is limited to pregnant moms at 185%, disabled adults at 78% and parents at 14% FPL Federal government pays for 100% of expansion cost , then declines to 90% of expansion cost by 2019 Authorizes CHIP to 2015 (up to 200% FPL in Texas) Kids up to 133% will move to Medicaid in 2014

14 Medicaid/CHIP Reforms that Impact Kids (cont.) Some 500,000 kids are eligible but not enrolled in either program; large share of Texas projected reform costs relates to this population to be covered without extra federal dollars Reform increases Medicaid payments for primary care provided by primary care physicians in 2013 and 2014 Hospitals, with HHS guidance, able to determine presumptive eligibility for Medicaid temp coverage while final eligibility determined ( ) Gradual reductions in DSH payments as number of uninsured decline

15 Workforce Changes that Impact Kids Workforce Expands health profession loan repayment programs Establishes National Health Care Workforce Commission to recommend alignment of health workforce resources Increases training support for primary care, nursing and public health workforce Redistributes unused residency slots 75% of redistributed slots must be for general surgery or primary care (current cap 100,000 nationally, Texas unlikely to meet resident to population ratio criteria)

16 Quality/Delivery System Changes that Impact Kids Quality Payment reductions to hospitals with higher thanexpected readmission rates for specific conditions Medicare now, Medicaid possibly later NO Medicaid payment for care associated with hospitalacquired conditions ( ) Allows Medicare providers to create Accountable Care Organizations (ACOs) to share in cost savings achieved through care coordination, quality initiatives; creates 5 year ACO pilot for pediatric providers in Medicaid (1 1 12)

17 Quality/Delivery System Changes that Impact Kids Delivery System Establishes Patient Centered Outcomes Research Institute to conduct comparative effectiveness research Creates Medicaid bundled payment demos in 8 states Creates Innovation Center within CMS to test, evaluate payment structures and methodologies, enhance quality, coordination and efficiency

18 Coverage Among the Nonelderly Pre and Post Health Reform 50 million uninsured 2010 uninsured % 10% 15% Medicaid/ CHIP Employer Nongroup and other Uninsured 56% 56% Exchanges 23 million 9% 8% 9% 18% n=267 million n=282 million Note: Nongroup and other includes Medicare Source: CBO scoring of combined effects of HR 3590 and HR 4872 in letter to Speaker Pelosi, March 20, 2010.

19 The Great and Powerful Oz may have matters well in hand, but does anyone else?

20 It will require some assembly

21 And it is already resulting in lots of Draft regulations, Proposed regulations, and Final Regulations

22 Our Assessment Is it perfect? Far from it. Congress, no matter which party is in control, rarely gets anything right the first time Many well intended provisions not well thought out some are clunky There will be bumps and hiccups along the way Significant challenge for providers, consumers, businesses and government: manage, control costs Implementation will be an interesting journey Is it better than doing nothing? Yes. Much easier to fix something than nothing for things that don t work well, or those unintended consequences, we will have a target

23 Our Assessment (cont.) Repeal? Lots of talk, but unlikely; some changes now in effect House may have votes, but Senate not likely to agree Presidential veto Replace? Republican Agenda for America health care section includes things already in reform law How to keep popular things (insurance reform) and pay for them (individual mandate) Starve the beast! Reform is authorized, but it is not all funded; gridlock in Washington may mean no money to implement certain items

24 Reform s Impact on Texas Texas Health & Human Services Commission estimates state cost for Medicaid & CHIP at $9.2B from , incl. $76B in federal funds Comptroller estimates federal health insurance subsidies over the 10 years will bring in $44 billion and credits for small employers will total $2 billion No wrong door /streamlined eligibility for insurance subsidies, as well as Medicaid and CHIP, will be a challenge State agencies preparing for changes, some legislation will be required Implementation may hit budget roadblocks and/or political opposition

25 What the Session will be About Election results who s running the show Redistricting the most important issue for way too many Immigration someone to blame Budget no new taxes and spending cuts Budget smoke and mirrors and revenue enhancers Budget Rainy Day fund and there s still a BIG gap Budget special session(s)?

26 Texas Fiscal Issues Revenue outlook not pretty Sales taxes running FAR below projections New franchise tax not generating as much revenue as expected Property values (and taxes) are declining Federal stimulus dollars must be replaced, not likely to see any more coming State leadership committed to no new taxes

27 Texas Fiscal Issues (cont.) Budget shortfall even uglier Could be $4B gap in current budget to backfill when Legislature arrives in January Gap in budget needed to maintain current services in could be as high as $25B Rainy Day Fund (if used) could provide up to $9B Agencies required to submit proposals for 10% reductions in

28 Texas Fiscal Issues (cont.) Health & Human Services To maintain current programs and address caseload and cost increases in , agencies need $7.7B more than budgeted in $1.4B needed to maintain Medicaid and CHIP cost trends $102 million to continue eligibility system improvements in Medicaid and CHIP Medicaid maintenance of effort requirements limit options for controlling costs

29 Texas Fiscal Issues (cont.) Health & Human Services (cont.) Options for 10% budget reduction total over $500 million include but are not limited to: Fewer children with special health care needs served Decreased funds for immunizations, primary care, mental health and dental care Less money to hospitals for trauma care Deeper cuts to Medicaid reimbursement anticipated

30 CHAT s 82 nd Legislative Priorities Keep kids healthy Smoke free environments, tobacco prevention Support for obesity prevention programs Grants to school districts and community programs Health education as a requirement for high school graduation Policies to encourage physical activity Immunizations

31 CHAT s 82 nd Legislative Priorities (cont.) Covering kids Sustain and continue to improve CHIP and Medicaid eligibility systems Continue to serve Children with Special Health Care Needs

32 CHAT s 82 nd Legislative Priorities (cont.) Build a high quality pediatric program Maintain Medicaid hospital reimbursement With large percentage of Medicaid patients, children s hospitals cannot shoulder rate reductions Maintain Medicaid physician reimbursement Additional cuts will further jeopardize access to care Medical Child Abuse Resources and Education System Protect funding for MEDCARES to improve identification, diagnosis and treatment of child abuse

33 CHAT s 82 nd Legislative Priorities (cont.) Build a high quality pediatric program (cont.) Trauma Care Maintain and improve funding for uncompensated care at designated trauma facilities Invest in Graduate Medical Education Maintain and improve funding for GME to improve access to care

34 The Importance of being Involved As a state representative and a former registered nurse, I can say that letting your elected representatives know what you think about healthrelated issues is both important and credible. Elected officials look to experts to help us craft legislation in the health arena that is good for patients, makes sense for providers, and is sound public policy for Texas. Please help us by being involved. Thank you for what you do. Rep. Donna Howard, District 48, Texas House of Representatives

35 How You Can be Involved Follow issues through your professional organizations and work place nurses day at capitol Get to know your elected reps through public meetings, visits to office Use your personal relationships who do you know who knows officials, key staff, etc? Let your elected reps know how you feel about important issues

36 How You Can be Involved (cont.) Please keep your hospital GR person informed of any contacts you make or receive: Ed Berger, Austin, Shane Casady, Corpus Christi, Regina Montoya, Dallas, Bob Feather, Fort Worth, Rosie McStay or Rebekah Schroeder, Houston, or Gwen Stafford, Lubbock, Vicki Perkins, San Antonio,

37 How You Can be Involved (cont.) Who represents me web site Action alert systems (CHAT, TNA, TPS, others) CHATvocacy User friendly action system, 820+ subscribers, 20,000+ s since 2003 Sign up at

38 Resources CHAT web site: Kathy Eckstein: Kaiser Family Foundation Health Reform web site: Your hospital s Government Relations person(s)

39 Final Thought: NON SEQUITUR BY WILEY

40 Final Thought: NON SEQUITUR BY WILEY

41 Final Thought: NON SEQUITUR BY WILEY

42 Questions?