How the Changing Political Landscape Affects Health Care

1. How the Changing Political Landscape Affects Health Care Daniel Sisto President, HANYS

3. State Budget for FY 2009-2010 Likelihood of Large State Budget Deficits for the Next Several Years

4. NYS Fiscal Environment - Difficult Even Before the Mortgage Meltdown • Tax revenue declining • Twenty percent of state revenue comes from Wall Street • New York securities industry reported $22.8 billion in losses during first half of 2008 alone • That was prior to the September crisis on Wall Street

5. NYS Fiscal Environment - Difficult Even Before the Mortgage Meltdown • 40,000 finance industry jobs will disappear from the September crisis on Wall Street • At the end of August, Wall Street bonuses were projected to decline by 20.5% -- Likely to be close to elimination

6. NYS Division of Budget July 2008 Forecast • FY 2008-09 potential imbalance of $630 million • FY 2009-10 deficit increased from $5.0 billion to $6.4 billion • Three-year, cumulative out-year deficit increased from $21.5 billion to $26.2 billion

7. September 2008 Budget Update • August budget actions decrease FY 2009-10 deficit from $6.4 billion to $5.4 billion • On September 5, Governor Paterson asks all state agencies to draft a zero-growth budget • Potential for Governor to call another special legislative session

9. Election 2008: Democrats May Have the Opportunity to Consolidate Power in Albany

10.   “Let me tell you what state leaders envision when they think about health care: they think of you guys walking around with billions of dollars in your pocket that they can tap into.” Jay Gallagher, Gannett Reporter Addressing the HANYS 2006 Annual Communication's Conference for Health Care Professionals

11. 2009 Outlook • State Budget gap will be very difficult to close without tax increases and large spending cuts • Education vs. Health Care • Hospitals vs. Managed Care • “When there isn’t enough food, table manners deteriorate.”

12. 2009 State Legislative Session • Other Major Issues • Health Planning • CON Reform • Commissioner’s Public Health Agenda • Medicaid Fraud and Abuse Initiative • IT Expectations

14. Federal Budget for FFY 2009

15. 2008 – “Bush Piles On” • Budget Proposed Cutting Medicare Payments to NYS Hospitals • $10 Billion Over 5 Years • Regulations Proposed Cutting NYS Medicaid Payment • $4.8 Billion Over 5 Years • Placed Physicians at Risk to Protect HMOs

16. 2008 Federal Accomplishments • Congress Ignores Medicare Cuts • Congress Blocks Regulatory Cuts to Medicaid • Congress Overrides Presidential Veto and Defers Physician Payment Cut for 18 Months

17. Pre-Bailout Figures Federal Debt 1993:$4.49 trillionFederal Debt 2007:$9 trillion

18. Pre-Bailout Federal Deficit 2009: $490 billion

19. Democratic Pay-As-You-Go or “Paygo” Budget Rules Congress must offset all new spending with budget cuts or revenue

20. Medicare and Medicaid Spending as a Share of the Federal Budget, FY 2007 Total = $2.7 Trillion in FY 2007 Federal SpendingSource: Congressional Budget Office, Monthly Budget Review, November 6, 2007

21. Medicare Physician Payment: A $100 billion dollar problem

22. Election 2008: Democrats Will Strengthen Their Control of Congress

23. The influence of New York Republicans in Washington, DC will continue to diminish

24. CUMULATIVE NY MEDICARE HOSPITAL RATE INCREASES VS. MARKETBASKET COST INCREASES

25. NYS Hospitals’ Operating Performance

26. Economic slowdowns often result in increased demand for publicly-funded health and social services.

27. Out-of-pocket costs for health care consumers will continue to increase.

28. Managed care and private insurance reimbursement issues will become even more critical in the face of reduced government reimbursement (and health plan consolidation).

29. Hospitals, HMOs, and BusinessThe Tale of the Tape

31. Average age of a practicing physician in New York State is 52 23% are age 60 or older Shrinking availability of on call ER specialty coverage Facilities/communities are losing access to certain services Physician Workforce Challenges

32. Substantial decline in physicians per capita between 2002 and 2006 in large areas of the state Overall decline—Western NY, Mohawk Valley (11 counties) Decline in primary care physicians—Central New York, Mohawk Valley, North Country, and Western NY (22 counties) Geographic Shortages Center for Health Workforce StudiesSchool of Public Health, SUNY at Albany

33. The total number of general surgeons declined by 12% statewide between 2002 and 2006 Recent data indicates that fewer medical school graduates choosing general surgery The total number of general surgeons declined by 13% in NYC, 33% in the Mohawk Valley, and 22% in the North Country Specialty Shortages Center for Health Workforce StudiesSchool of Public Health, SUNY at Albany

34. HANYS’ Members Report Growing Physician Workforce Shortages *Includes family medicine, internal medicine, and pediatrics

35. Doctors Across New York • Medicaid physician fee enhancements • 75% of Medicare • Doctors Across New York • Loan repayment • Physician practice support • Ambulatory care training • Diversity in Medicine/Post-Baccalaureate Program • Workforce Study

36. U.S. Uninsured in 1993:37 million U.S. Uninsured in 2007: 46 million

37. Approximately 2.5 Million Uninsured in New York State • New York State has a lower rate of uninsured than the US • NY: 13.6% of the population in 2007 • US: 15.3% of the population in 2007 • Massachusetts: 7.9% of the population in 2007 • New York has a higher rate of Medicaid coverage than the US • NY: 18.9% of non-elderly populations in 2006 • US: 13.5%

38. Republican Presidential Health Care Plan • Tax credits • Health Savings Accounts • Portability • Guaranteed access • De-emphasis on employer-based model

39. Democratic Presidential Health Care Plan • A new national health plan available to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress.

40. Democratic Presidential Health Care Plan • National Health Insurance Exchange • Required Employer Contributions • Tax credits to assist small business • Mandatory coverage of children • Allowing young people up to age 25 to continue coverage through their parents' plans • Expansion of Medicaid and SCHIP

41. The new Governor’s administration has the opportunity to ignite universal coverage discussions at the state level, but financing implications make it improbable

42. National Framework for Change Health Coverage for All Paid for by All Focus on Wellness Health for Life; Better Health, Better Health Care Best Information Most Efficient Affordable Care Highest Quality Care

43. Better Value • Create accountability • Improve quality, safety, and efficiency • Reward excellence • Reduce unnecessary care • Care That is Coordinated • Encourage teamwork • Give right care at right time in right place • Ensure patient dignity and choice Framework for Improving America’s Health • Health Coverage for All Supported by All • Ensure affordable insurance • Share financial responsibility • Access to Information • Enable health IT • Create portable electronic health records • Focus on Wellness • Promote preventive services • Reward personal participation • Reward healthy behaviors

44. What Does This Mean To You? • Leverage Relationships • Community • Local and Regional Reporters • Community Affairs Staff • Opinion Leaders • Policy and Politics—What Matters the Most? • Affect on your patients • Provide the human story, the real story

45. We Need You Engaged

46. Political Participation and Grassroots Activism Leads to Results

47. Critical Advocacy Tools • A Unified Base • Grassroots Power • Sound Health Policy • Reliable Data • The Political Clout of a Strong PAC

48. How the Changing Political Landscape Affects Health Care Daniel Sisto President, HANYS