Will the care be there? What’s at Stake in this Election

1. Will the care be there? What’s at Stake in this Election [Hospital Logo] Summer 2012

2. Our Hospital… Serving our community… • # of patients treated • # of employees • Key services: • Emergency department • Birthing center • Cardiac services • Cancer center

3. …and preparing for our future 1990 U.S. population 248.7 million 2030 U.S. population 351.0 million 2010 U.S. population 308.7 million 2050 U.S. population: 403.7 million Source: U.S. Census Bureau

4. More patients with chronic diseases Prevalence of Common Chronic Diseases, 2001 and 2010 Source: Centers for Disease Control and Prevention, 2011

5. Hospitals are continually asked to do more with less

6. Forces Increasing Costs • Labor • Life-saving technology • Older, sicker patients • Redundant regulation • Liability insurance • Information technology • Emergency readiness

7. Distribution of Iowa Hospitals Revenue by Payer 2002 2011

8. Distribution of Iowa Hospitals Revenue 2002 2011

9. Trends in Percentage Increase in Iowa Hospitals Net Patient Revenues & Total Expenses2002-2011

10. Iowa Hospitals Uncompensated Care (in Millions)2001-2010

11. Trends in Iowa Hospitals Total Employment2002-2011

12. Forces Decreasing Revenue • Government underpayment • Private payer pressure • Rising number of uninsured individuals

13. Despite challenges, hospitals remain ready to care 24/7

14. Hospitals are improving care by: Investing in effective and efficient health care delivery Investing in improved safety & quality Investing in health information technology

15. ***Hospital Examples*** • Insert local examples of what your hospital is doing to improve value and quality.

16. But can that level of care remain? ? ? state budget cuts growing need for care federal budget

17. Election 2012 • Both houses of Congress are unlikely to consider legislation to overhaul Medicare or Medicaid until a new Congress – and possibly a new president – are seated in 2013. • But Congress is expected to return to Washington after the election to consider major deficit reduction legislation during a “lame-duck” session.

18. Federal Deficit • Congress continues to dedicate significant time and energy focusing on long-term budgeting. • U.S. Debt hitting record levels. • Members have very different approaches in how to handle. • Increase Taxes? • Cut Spending? • Both? • None? Percent of GDP August 2011: 98% Source: CBO “Alternative Fiscal Scenario” constructed from the August 2010 Budget and Economic Outlook, additionally assuming that troops in Iraq and Afghanistan are reduced to 30,000 by 2013.

19. Deficit Reduction Options As congressional leaders and the administration have debated deficit reduction, several “plans” and proposals have emerged. These include: • President Obama’s budget proposals • House Budget Chairman Paul Ryan’s budget proposal • The Congressional Budget Office’s report on options for reducing the Federal deficit • The National Commission on Fiscal Responsibility and Reform (Simpson-Bowles) • The Debt Reduction Task Force (Rivlin-Domenici) • The “Gang of 6” US senators that developed a bipartisan plan to reduce the deficit • House Majority Leader Eric Cantor’s list of spending reductions

20. What’s At Stake for Hospitals • The Lame-Duck Congress will need to consider: Bottom Line: The Potential for Billions In Cuts to Hospital Funding

21. What’s At Stake …threaten access to care. • Longer wait times for emergency room care. • Fewer doctors, nurses and other caregivers. • Less patient access to the latest and most effective treatments and technologies. • The potential for fewer specialty services particularly in rural areas compromising the delivery of community-based health care. • Increased charity care and bad debt. • Reduced financial capacity for continued investments in community-based programs and services provided by hospitals. Additional cuts to Medicare and Medicaid would: …threaten Iowa’s economy. • Hospitals are major employers and provide care for millions of individuals across the state. Iowa hospitals provide nearly 70,000 jobs that pay more than $3.8 billion in salaries and benefits. Hospitals are the ninth largest non-agricultural employer in Iowa. • There is an economic multiplier effect that is compromised when hospitals experience cuts that impact other sectors of the economy, including other non-health care businesses that interact with hospitals. In Iowa some 136,000 jobs are tied to Iowa hospitals, creating an overall impact valued at nearly $6.2 billion to Iowa's economy. • Hospitals provide a variety of community benefits and services that total $1.5 billion. These services provide critical financial and health care benefits to communities all across Iowa.

22. “No-Cut” Alternatives The following alternatives could be discussed and thoughtfully considered in any deficit reduction debate: • Modernizing cost sharing for Medicare and Medicaid • Increasing the eligibility age for Medicare • Increasing the FICA tax to support Medicare Part A spending • Implementing enhanced comparative effectiveness research and programs • Improving programs to improve care at the end of life

23. “No-Cut” Alternatives • Developing programs to coordinate care for individuals eligible for both Medicare and Medicaid • Applying Medicare reforms in the ACA (such as accountable care organizations, medical homes, bundling) to Medicaid • Increasing use of generic drugs and biologicals • Modernizing the Medicaid long-term care benefit • Taxing ‘Cadillac’ health plans • Taxing junk foods and sugary drinks

24. “No-Cut” Alternatives These types of reforms can be used to reduce spending, improve quality, better coordinate care, enhance personal responsibility, and modernize Medicare, Medicaid and the entire health care system.

25. What You Can Do: • Candidates need to know that we care…and we vote. • We care and we vote because we are concerned about whether the care will be there for the patients we serve. • The time is now to work together toward long-term solutions that will set these programs on a path toward future sustainability. • Our patients, communities and Iowa’s economy and quality of life depend on us, and the care we provide, to be there…today and tomorrow.

26. What You Can Do: • Encourage hospital staff to get involved and register to vote. • Encourage hospital staff to register into IHA VoterVoice to prepare for fall advocacy efforts • Attend candidate forums • Share: • What are your challenges? • What is your hospital doing to increase value? • What public policy changes are needed…and what should be avoided? • Attend Advocacy Days in D.C. (Sep. 11, Nov. 29, Dec. 11) • Vote November 6 • Prepare for and Respond to IHA Action Alerts Post-Election

27. We Care We Vote: Iowa Action Center: www.ihaonline.org/election Find your polling place, voting information and other advocacy resources “Like” IHA on Facebook: www.facebook.com/iowahospital Posting on health care policy and hospital news across Iowa and the nation. Follow IHA on Twitter: www.twitter.com/iowahospital Up-to-the minute details on happenings at the Iowa Legislature, as well as breaking news and other important advocacy information. (@iowahospital) IHA Policy Blog blog.iowahospital.orgStay apprised of breaking news and other policy issues on the IHA Policy Blog. The blog details issues related to health care and hospital policy and provides readers an opportunity to comment on stories and share information with IHA.