Health Care Reform Victory: Labor's Leadership Triumph

1. Health Care Reform Victory! Labor Leads the Way

2. Winning a 60 Year Fight! “There's so many people who we have to thank. And as I look around the room, we've got leaders of labor who helped to make this happen.” President Obama, March 23rd, 2010

3. We Made It Happen! • Lobby Phone Calls & Meetings • Rallies & Sit-ins • Most of all your Leadership! Stanislaus & Tuolumne Counties CLC – Cardoza’s Office, CA USW Sit-in – Altmire’s Office, PA SW & S Central CLCs – Rahall’s Office, WV

4. Sunday, March 21, On Capitol Hill The Hill: “AFL-CIO chief presses wavering Dems, takes victory lap on health bill” By Walter Alarkon - 03/21/10 TPM: Trumka: AFL Will Look Closely At Lynch's Health Care Vote When It's Time To Make Endorsements By Brian Beutler 3/21/10

5. Follow Up Actions • Phone Program: robo & patch-throughs to leaders & activists • Thank You to Members of Congress who voted right • Strategy to deal with those who voted wrong and “split” voters (Senate bill/reconciliation) • Recruit State Attorneys General to oppose court challenge

6. Last Lap in the Senate • 51 Votes Needed to win • 20 Hours of Debate, then… • Dozens of amendments in rapid-fire order – a “Vote-o-Rama” OUR MESSAGE TO SENATORS “A NO on amendments is a YES on health care - and we will have your back."

7. Immediate Senate Action Needed! • Call All Democratic Senators: oppose ALL amendments, no matter how popular, and we’ll have your back with voters

8. “The Patient Protection and Affordable Care Act” • Not Radical Change… • Maintains current structure – employment-based coverage supplemented by Medicare for the elderly, Medicaid for the poor and S-CHIP for kids • But Big Change… • Aims to control costs system-wide, cover 95% of population (adding 32 million), end medical errors • With phased implementation to get it right… • Over four years for most changes • Eight years before excise tax kicks in

9. What The Act Provides • Consumer Protections • More Affordable Care & Better Care • Coverage for 95% of population • Cost Containment • Progressive Financing • Deficit reduction

10. Consumer Protections • 2010 • Pre-existing Conditions: Outlaws denials or higher rates due to pre-existing conditions -- for children right away and everyone by 2014 • Guaranteed Issue/Renewal of Insurance: insurers must sell insurance to and renew insurance for, anyone • Bans “Rescissions”: Prohibits insurers from dropping coverage for people who get sick

11. Consumer Protections • 2010 • Ends Lifetime Limits on Benefits • Regulates Annual Limits from 2010-2013, abolishes them in 2014 • Ends gender discrimination in insurance rates • Young adults: allowed to stay on parents’ plans up to age 26 • Improves Pay for Docs to Increase Supply • Increase payments for primary care physicians • Boosts Medicaid payment rates for physicians to Medicare levels

12. Affordable Care • 2010 • Small Businesses: Tax credits of 35%, going to 50% in 2014 • Shrinks Medicare Drug “Doughnut Hole”: phase out “doughnut hole”, starting with 50% reduction in brand-name drug prices and $250 rebate • Early Retiree Subsidies: New program pays 80% of plan costs over $15,000 (up to $90,000) for retirees 55-64 • Subsidized High Risk Pool: For people with pre-existing conditions (until denial or higher rates for pre-existing conditions are banned in 2014)

13. Affordable Care • 2011 • Free Check-Ups & Screenings: No charge for preventive care in Medicare and new private plans (applies to all plans over time) • Insurance Rebates: Refunds money spent on advertising, profits, executive salaries or admin expenses over 20% (15% in large groups) • Community Health Centers: $11 billion to fund new community health centers/ expansion of existing ones

14. Affordable Care • 2014 • Establish Insurance Exchanges: standardized benefit options, simplified administration. Open to individuals and companies with up to 100 workers (100+ worker after 2017, as state option) Cap Family Costs for Coverage: no more than $11,900 • Subsidies: For family incomes up to 400% of the federal poverty line ($88,000 in 2010) • Medicaid Expansion (100% Federal Funding): Open to all non-elderly with incomes up to 133% of federal poverty line

15. Cost Containment • Automate Data Systems: • Large grants to hospitals and physician offices to automate records • Standardize IT operating rules and requires electronic storage and transmission of data (2012-2016) • Cut Medicare Rate Hikes For Hospitals & Other Facilities: setting pattern for private payers • Comparative Effectiveness Data: basis for varying payment depending on quality • Payment Reform: Base payments on quality of service, not just quantity

16. Cost Containment • Independent Payment Commission: takes decisions out of the hands of Congress (and industry lobbyists!) • Annual Cost Containment Recommendations for Medicare and private sector • Innovation Center: Center to develop and implement new models of care and payment • Waste, Fraud & Abuse:much more aggressive program to attack fraud • Reduces Costly Medical Errors: requires reduction in preventable re-hospitalization and hospital-acquired infections • Quality Improvement: • National strategy to improve quality • Increased quality measurement and reporting

17. $ 490 Billion in Progressive Financing Medicare taxes for high-income earners Tax on health-insurance providers Penalties on employers who don’t provide health insurance Tax on pharmaceutical manufacturers/importers Tax on medical-device manufacturers/importers Penalties on persons who don’t buy health insurance Excise tax on tanning services $210 billion $60 billion $52 billion $27 billion $20 billion $17 billion $2.6 billion Sources: Joint Committee on Taxation; House Ways and Means Committee (Republican staff)

18. Progressive Financing “The bill that President Obama signed On Tuesday was the federal gov’t’s biggest attack on income inequality since inequality began rising more than three decades ago.” New York Times March 24, 2010

19. Deficit Reduction • Fully Paid For: Expansions and new programs won’t add to the federal deficit • Large Deficit Reduction: Cuts federal deficit by $143 billion in first ten years and $1.2 trillion in second ten year period • Strengthens Medicare Finances: adds nine years to Medicare solvency

20. Employer Threats on Top of Republican Lies • Already, there are widespread reports of employer threats about the impact of health reform • Premiums will go up • Existing plans closed and people have to go into the insurance exchanges (that don’t begin for four years! • Cut benefits because of excise tax (in 2018!) • Raise premiums because of excise tax • End retiree coverage