Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing

1. “New Frontiers: A Call to Policy Action for Health Reform”May 13, 2011For: Delaware Association for Healthcare Quality (DAHQ). Bethany Hall-Long, PhD, RNC, FAAN DE State Senator, District 10 Professor, School of Nursing University of Delaware

3. Overview • Introduction • Driving Forces & Legislative/Regulatory Structures, Health Policy & Politics Highlights • Legislative & Regulatory Processes • State: Example Bills, Regs., Policy Proposals • Review of Health Professionals Role in the Political Process • Summary, Call to Action, & Q & A

4. Objectives • List 3-4 relevant health care quality issues, legislation &/or regulations at the state and national levels • Discuss the legislative and public policy processes in Delaware • Describe the role of health professionals in the political process and relevant political strategies.

5. Questions? • When you hear the words “Health Care Reform” what one word comes to mind? • When you hear the word “Health Quality” what word comes to mind? • When you hear the word “Politics” what comes to mind?

6. Local, State, National & International Policy Forces • Fiscal Constraints (16% GDP Health Care) • Health Professions Resources/Shortages • Technology & Informatics Gaps/Demands • Ethics (i.e., HIPPA, DNR Orders)

7. Local, State, National & International Policy Forces (Continued) • Surge in Chronic Disease & Aging • Bio-Terrorism, War & Global Disaster Risks • Scope of Practice, Malpractice • Other 4th Branch of Government: Media

8. Uninsured in DE • Over the past few years uninsured in DE has risen from 9.9% to 11.2% • Approximately 101,000 are without insurance at any given time- (this is a 2008 estimate) • Approximately 28% or 28,000 are eligible for public benefit through Medicaid (21,000 or CHIP 7,000)

9. Who are the uninsured? • 23% - under the age of 19 • 54% - male • 69% - white • 59% - own or are buying their home • 21%- live alone • 80% - are above the poverty line • 34%- with household income over %50,000 • 59% - are working adults • 9% - are self-employed • 21% - are non citizens

10. Health System Actors & Government Actors: • Consumers • Providers • Employers • Government • Insurers • Interest Groups • Other • FUNCTIONS: • Funding • Regulations • Service • Delivery • Research & Development • Other

11. Central Driving Policy Issues • Quality • Access • Cost

12. Costs • Health Care Costs • $6.5 billion was spent on personal health care ($7,485 per person) in DE in 2008 – highest point in 10 years. • Average rate of increase is 5% per year. • Largest share of spending is on: • Hospital care at 39% • Physicians at 25.4% • Prescription drugs at 14.8%

13. Health Policy: • Course of action or inaction by the government regarding the public’s health and welfare • Impact on the Nursing Profession?

14. Legislative Process: Application of Evidenced Based Practice Bill to Law • Idea, Drafted Legislation, Assigned a # (HB,SB..), Introduced, Assigned to Committee, Hearings (mark-up), Voted on - Other Chamber (Same Process), Vote…

15. Executive Branch Role • To Executive Branch: law or veto • Current Obama Administration’s Health Care Reform Act • **Regulation, if Override as needed passed. (see **Federal Registry) • Know State Regulations

16. Audience Questions/Comments • List 2-4 key public policy or political issues for quality measures in health care • List 2-4 Pressing Public Policy issues (federal or state) • Identify 2-4 clinical problems you feel must be addressed to improve patient care, outcomes costs etc..

17. Obama Reform (PL111-148): Purpose • Expand Coverage and access to care • 32 million uninsured will be covered (estimated 18,000 -25,000 additional Delawareans) • New Insurance Exchange with Premium Sharing Subsidies, and Cost Sharing Caps • Large Expansion of Medicaid Eligibility • Significant Insurance Market Reforms • Emphasis on Prevention • Bending the Cost Curve over time

18. Expanding Coverage • Coverage for Dependents (IRS Definition) (6 months – September 23, 2010): • Must provide coverage to a beneficiary’s dependent child until the child turns 26 • Child does not have to live at home • Temporary High Risk Pool (90 days- July 2010- to 2014) • Citizens with pre-existing conditions who were uninsured 6 months prior to applying for coverage in the pool • $5 billion provided • Pool operated by HHS or states • Delaware participates in HHS Pool – Premiums • Health Benefits Advisory Committee led by Surgeon General will recommend essential benefits package (established in 60 days)

19. Expanding Coverage (cont) • Expands Medicaid eligibility to 133 % of Federal Poverty Level (2014) - • approximately $14,600/ individual; $29,400/family of 4 • Includes childless adults • Provides national base of seamless coverage • Federal Share (FMAP): • 100% for newly eligible first 3 years (2014 – 2016) • Phases down to 90% for 2020 and subsequent years • Provides full funding for CHIP through 2015 and continues authority through 2019. Children on CHIP would be transitioned to Medicaid or into Exchange.

20. DE Focus • Medicaid Expansion States are required to extend Medicaid eligibility to everyone younger then 65 with incomes up to 133% of FPL($29,327 family of 4). 2014 – 2016 - Federal government pays 100% 2017 – Delaware will pick up 5% of cost 2020 - 90% of cost • Shift Delaware currently provides expanded coverage to 27,000 Delawareans up to 100% FPL • Currently - Federal government pays 53% of the cost • 2014 – the federal match will increase to 75% and by 2020 up to 90% of cost

21. Other Key Changes: • Market Reforms & Employers • Employer & Individual Responsibilities • Small Business Coverage (i.e. tax credits) • Streamline Practices • Insurance Markey Reform • Health Benefit Exchanges (SHOP)* Quality* • Health Promotion & Wellness • Other

22. DE Health Reformwww.Healthcare.govwww.dhcc.delaware.govOther/Comments

23. 146th DE General Assembly : Example DE Policy Issues New 146th 1/11 Example Health Related Bills - Medical Offices:Safety/Unsanitary Reporting - BPA and child products - License Bills - RN Title Bill Chronic Illness • Cancer (SB90 – Tanning Beds) • Cardiovascular Disease Office (HB352) • HIV (Needle Exchange) Other • Insurance (i.e.Chip Updates) • Prescriptions (i.e Prevent MD Shopping) • Education Funding • Others Etc * Must Act & Advocate

24. DE General Assembly Action

25. Money Committees **Authorized versus Appropriated State Budget—Operating & Capital (Bond) & Rainy Day Fund, Special Funds (i.e. Tobacco) Bill with a Fiscal Note over 50K • Joint Finance Committee • Appropriations

26. DE Health Related Committees “THINK OUTSIDE THE HEALTH BOX: Quality & Health” • Senate & House Committees- - Examples to consider Senate Health, Agriculture, Insurance & Elections, Veterans Affairs, Highways, Small Business, Banking, etc. House Health & Human Development, Homeland Security, Labor, Natural Resources and Environment, Education, Public Safety, Judiciary, etc..

27. Federal Policy Examples Policy  Politics  Policy Politics etc. • Multiple biological, socio-cultural, mental, physical, economic issues impacting individuals, professionals, workplaces, schools, communities, governments etc • Domestic & Global • Other- Nursing, medicine, Allied Health Specific US Senate & US House www.thomas.gov www.nursingworld.com

28. Political Strategies To Influence Policymakers • Use of media • Testimony • Direct & Indirect contacts • PACS • Drafting Policy • Coalition building - Grassroots efforts- Shaping implementation • Others

29. How To’s: Interacting With Elected Officials • Face-to-face meetings • E-mail • Letter writing • Unified Approach • Do’s and Don’ts

30. Quality : ALL Areas ofPublic Policy

31. Federal & State Resources www.delaware.gov Governor Markell 302-744-4101, 1-800-292-9570 Lt Governor Denn 302-744-4333 DE House *302-744-4351 or 302-744-4171 DE Senate 302-744- 4286 or 302-744- 4048 County & Local Governments –Visit as needed www.thomas.gov US Capitol 1-202-224-3121

32. Know Your Resources & Be Politically Active • Know Associations, Alliances & Be Organized • National, State & Local Officials • PROACTIVE Policymaking & Position Statements • Role Model to Peers & Policy & Public Advocates • Other

34. Contact Information Senator Bethany Hall-Long 302-744-4039/4286 bethany.hall-long@state.de.us

35. “Closing Thoughts” • “The further back we look, the further ahead we see”(Churchill) • “It’s always darkest before the dawn” • “Great opportunities are disguised as unsolvable problems”