Federal Advocacy Update: Health Care and the Deficit Reduction Debate

Transcription

1 G R E A T E R N E W Y O R K H O S P I T A L ASSOCIATION Federal Advocacy Update: Health Care and the Deficit Reduction Debate Jon Cooper November 10, 2011

2 2 Presentation Outline Federal Health Reform: The Affordable Care Act Raising the Debt Ceiling & Reducing the Deficit: The Budget Control Act of 2011 Additional Deficit Reduction: The Supercommittee GNYHA Actions What Happens Next?

3 3 The Affordable Care Act (ACA) Federal Health Reform G R E A T E R N E W Y O R K H O S P I T A L ASSOCIATION

4 4 The Affordable Care Act Was Signed Into Law In March 2010 Level 1; font size is 24 Level 2; font size is 20 Level 3; font size is 18 Level 4; font size is 16 Level 5; font size is 16 Level 6; font size is 16 Level 7; font size is 16 Level 8; font size is 16

5 5 Key Elements Coverage Expansion Delivery System Reform Financing

6 6 Coverage Expansion The most significant Federal benefit expansion since Medicare and Medicaid were enacted in 1965 Aims to provide health insurance to 32 million uninsured legal residents

7 7 Financing: Equally Split Between Revenue Increases And Spending Cuts Taxes & Fees Medicare & Medicaid Cuts $597 Billion $597 Billion Source: GNYHA analysis of CBO scoring.

8 8 $597 Billion in Medicare & Medicaid Cuts $157 Billion From Hospitals

9 9 Will The ACA Be Repealed? Depends on 2012 election & the Supreme Court All Republican presidential candidates have vowed to repeal the coverage expansions Unclear what the Supreme Court will decide but likely focused on the individual mandate and not overturning the entire law Regardless, the cuts to hospitals and other providers will remain!

10 10 Federal Deficit Reduction The Budget Control Act 2011: Raised the federal debt ceiling, decreased deficit, and created the Supercommittee G R E A T E R N E W Y O R K H O S P I T A L ASSOCIATION

11 11 Deficit Reduction: Overview August 2011: Congress enacts & the President signs into law the Budget Control Act (BCA) of 2011 BCA provides for a total debt ceiling increase of $2.1 - $2.4 trillion $917 billion in immediate deficit reduction savings Sets ten-year caps on discretionary spending Includes funding for the NIH, CDC, SAMHSA No immediate cuts to Medicare and Medicaid Significant threat of Medicare and Medicaid cuts in the future Joint Select Committee on Deficit Reduction ( Supercommittee ) OR Sequestration

12 12 Deficit Reduction: The Supercommittee BCA created the Supercommittee 12-member bipartisan committee charged with devising a package to reduce the deficit by at least $1.2 trillion over ten years A majority of the Supercommittee must approve a proposal, which would have protected and privileged status in both chambers The proposal could include anything, including Medicare and Medicaid cuts, and revenues

13 13 Supercommittee Timeline September 8: Supercommittee held its first meeting November 23: Deadline for Supercommittee to vote on proposals October 14: Deadline for committees to forward their recommendations to Supercommittee December 23: Deadline for House and Senate to vote on proposals 13

14 14 Supercommittee Members Sen Patty Murray (D-WA) Co-Chair Rep Jeb Hensarling (R-TX) Co-Chair Sen Max Baucus (D-MT) Sen John Kerry (D-MA) Sen Pat Toomey (R-PA) Sen Jon Kyl (R-AZ) Sen Rob Portman (R-OH ) Rep James Clyburn (D-SC) Rep Xavier Becerra (D-CA) Rep Chris Van Hollen (D-MD) Rep Dave Camp (R-MI) Rep Fred Upton (R-MI) 14

15 15 What Happens If They Fail? Sequestration If the Supercommittee does not agree on recommendations, or Congress fails to enact recommendations, sequestration would be triggered and $1.2 trillion in across-the-board spending cuts occur Cuts equally divided between defense and non-defense programs Medicaid, Social Security, veteran s benefits, and low-income programs would be exempt Medicare cuts to providers would be allowed, but would be limited (capped) to 2% of the cost of the Medicare program $123 billion over the next 10 years Cuts would take place on January 2, 2013

16 16 President Obama: Supercommittee Deficit Reduction Plan President Obama proposed his own deficit reduction plan Reduces the Federal deficit by $3 trillion over 10 years $1.5 trillion in tax reform proposals $1 trillion in savings from the troop drawdown $580 billion in cuts to mandatory programs $248 billion from Medicare (GME, Bad Debt, IPAB, Post Acute) $50 billion from Medicaid (Provider taxes, FMAP reductions)

17 17 Supercommittee Proposals Exchanged Democratic offer - Senator Baucus (D-MT) $3 trillion in deficit reduction over 10 years Significant cuts: Medicare: $400 billion, ½ from beneficiaries, ½ from providers Medicaid: $75-$100 billion No details $1.3 trillion in new revenues Rejected by GOP

18 18 Supercommittee Proposals Exchanged GOP counteroffer $2.2 trillion in deficit reduction over 10 years $500 billion in Medicare cuts, combination of beneficiary and provider cuts $185 billion in Medicaid cuts No details Revenues ($640 billion) primarily from assumption that economy will grow if debt is reduced and tax reform is enacted Rejected by Democrats

19 19 GNYHA Concerns GNYHA is extremely concerned The Supercommittee is considering significant Medicare and Medicaid reductions to hospitals Have waged an all out local and national campaign to stop these cuts

20 20 GNYHA s Plan to Lobby the Supercommittee Supercommittee Constituents Public Campaigns NYS Delegation Direct Lobbying White House Contacts

21 21 Supercommittee Constituents Texas Hospitals Senator Patty Murray (D-WA) Representative Jeb Hensarling (R-TX) U. Washington Boston Teaching Hospitals Senators Max Baucus (D-MT); John Kerry (D-MA) James Clyburn (D-SC); Xavier Becerra (D- CA); Chris Van Hollen (D-MD) PA Teaching Hospitals Pat Toomey (R-PA); Jon Kyl (R-AZ); Rob Portman (R-OH) Representatives Dave Camp (R-MI); Fred Upton (R-MI) Banner OH State Johns Hopkins UCLA, Cedars Sinai MI Teaching Hospitals

22 22 NYS Delegation Bipartisan letter sent from entire NY House Congressional delegation to the Supercommittee Letter sent from Senator Gillibrand to the Supercommittee

23 23 White House Contacts

24 24 Direct Advocacy

25 25 Public Campaigns

26 26 What Happens Next? Potential outcome changes by the day Great deal of pressure to produce a proposal Sequestration (defense cuts) Potential downgrade Political blame Either way, ongoing federal reimbursement pressure on hospitals