Healthcare Reform Legislation: Magic Elixir or Bitter Pill? Presented by: Katie O. Orrico, Director, AANS/CNS Washington

1. Healthcare Reform Legislation: Magic Elixir or Bitter Pill?Presented by: Katie O. Orrico, Director, AANS/CNS Washington Office January 23, 2010

2. Health Reform Has Run Into a Buzz Saw: Now What?

3. Drivers of Health Reform • 12- 15 M American UNINSURED and cannot buy coverage • Denial of Coverage for PRE-EXISTING CONDITIONS and routine INAPPROPRIATE DENIALS for medical services • DEFENSIVE medical practice ($210 B/ yr) • Unsustainable COST Increases (20% GDP) • Looming MANPOWER SHORTAGES in surgical and medical specialties (49,000 by 2025) • Current SGR formula will jeopardize access to specialty care

4. Environment for Reform COST Containment is Paramount

5. Key Legislation House • H.R. 3200, America's Affordable Health Choices Act • Initial bill “marked-up” by House committees • H.R. 3962, Affordable Health Care for America Act • PASSED 220-215 (Nov. 7) • H.R. 3961, Medicare Physician Payment Reform Act • PASSED 243-183 (Nov. 19)

6. Key Legislation Senate • S. 1679, Affordable Health Choices Act and S. 1796, American’s Healthy Future Act • Marked-up in Senate HELP and Finance Committees • S. 1776, Medicare Physicians Fairness Act • REJECTED 47-53 (Oct. 21) • S. 3590, Patient Protection and Affordable Care Act • PASSED 60-39 (Dec. 24)

7. Road to the White House HELP Committee Bill Health, Education, Labor & Pensions (HELP ) Committee Senate Debate & Vote Senate Vote Finance Committee Bill Finance Committee President’s desk Conference Ways & Means Committee House Vote Rules House Bill Energy & Commerce Committee House Debate & Vote Education & Labor Committee

8. Why don’t the AANS and CNS support these healthcare reform measures?

9. Neurosurgery’s Healthcare Reform Principles

10. Neurosurgery’s Healthcare Reform Principles

11. Neurosurgery’s Healthcare Reform Principles

12. Current Program: Rules, Regulations, Liability and Payment Policies Affecting Doctors

13. House Healthcare Reform: Rules, Regulations, Liability and Payment Policies Standing Between Patients and Doctors

15. A Word About Medical Liability Reform…

16. Medical Liability Reform Saves Money CBO there is "limited evidence currently available about the effects of tort reform on health outcomes is much more mixed than the larger collection of evidence currently available about the effects of tort reform on health care spending."

17. Medical Liability Reform “The reason that tort reform is not in the bill is because the people that wrote it did not want to take on the trial lawyers in addition to everybody else they were taking on, and that is the plain and simple truth.” Howard Dean, MD, Former Chair Democratic National Committee

18. Why does the AMA support these healthcare reform measures?

19. Addiction to Repeal the Sustainable Growth Rate (SGR) Physician Costs up 20% from 2009-2016 $200+ billion 22% Cut Medicare Payments cut 40% from 2010-2016

20. AMA’s Priority Issues

21. AANS/CNS Actions

22. Organized Coalition Efforts

23. Letters to Congress

24. Letters to AMA and ACS

25. Media Campaigns Operation Patient Access www.operationpatientaccess.org Physicians United for Patients www.operationpatientaccess.org

26. Issued Press Releases

27. Newspaper Ads

28. Radio Ads

29. Letters to the Editor

30. Neurosurgery in the News

31. Next Steps

32. Effects of Massachusetts Special U.S. Senate Election Game changer

33. Outstanding Issues – Before Election • Abortion • Immigration • National vs. State Regulation of Health Exchanges • Increasing Taxes • Taxing “Cadillac” Health Plans • Taxing wealthier individuals • Individual and Employer Mandates • Rationing • Independent Payment Advisory Board (IPAB) • Comparative Effectiveness Research

34. FINAL House-Senate Agreement – Before Election • No formal House-Senate Conference Committee • Ping-Pong Process Instead • Behind the scenes negotiation with Reid, Pelosi, Obama • House will take up Senate bill (H.R. 3590) and make amendments… send to Senate and then continue this process until agreement is reached

35. The Negotiations – Before Election

36. Outlook for Final Reform Bill • Ram it through before Brown gets certified in the Senate • Not going to happen • House folds and passes Senate bill as is + “side car” bill to reflect House-Senate compromises on taxes and other issues • Not likely to happen • Budget Reconciliation for the entire package • Not likely to happen

37. Outlook for Final Reform Bill • Go for Snowe • Not likely to happen • Series of Small Bills on key issues + budget reconciliation on financing issues • Not likely to happen • Bipartisan compromise on significantly scaled back bill • Not as easy as it sounds

38. Scaled Backed Bill Not So Easy Small Bill Bigger Insurance Pool Insurance Reforms Premium Subsidies Individual/Employer Mandates BIG Bill Higher Taxes, Medicare Cuts & Delivery Reform Increased Spending

39. Outlook for Final Reform Bill • Total collapse – no health reform legislation • Likely… but not yet (take a break from healthcare for a few weeks)

40. What A Difference A Week Makes

41. Outlook for Final Reform Bill

43. For More Information More information is available: http://www.aans.org/legislative/aans/Neuro_HealthCareReform.asp http://www.cns.org/advocacy/wc/nsHealthcareReform.aspx Katie O. Orrico, Director AANS/C NS Washington Office korrico@neurosurgery.org 202-446-2024

44. Questions?