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Is a Healthcare Tsunami Really Here ?

Is a Healthcare Tsunami Really Here ?. Cancer Center Administrators Forum Harry Holmes, Ph.D. In Health Care, it was HR 3590. Patient Protection and Affordable Care Act Sponsor:  Rep. Charles B. Rangel  [NY-15] Cosponsors  (40)  9/17/2009 Introduced in House

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Is a Healthcare Tsunami Really Here ?

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  1. Is a Healthcare Tsunami Really Here? Cancer Center Administrators Forum Harry Holmes, Ph.D.

  2. In Health Care, it was HR 3590 • Patient Protection and Affordable Care Act • Sponsor: Rep. Charles B. Rangel [NY-15] Cosponsors (40)  • 9/17/2009 Introduced in House • 10/8/2009 Passed/agreed to in House: Agreed to by the yes and Nays: (2/3 required): 416 - 0 • 12/24/2009 Passed/agreed to in Senate: Passed Senate with an amendment and an amendment to the Title by Yea-Nay Vote. 60 - 39.  • 3/21/2010 Resolving differences -- House actions: On motion that the House agree to the Senate amendments Agreed to by vote: 219 – 212.

  3. HR 3590 (cont.) • 3/21/2010 Cleared for White House • 3/22/2010Presented to President • 3/23/2010Signed by President • 3/23/2010Became Public Law No: 111-148 • HR 3590 and HR 4872 when merged became the Accountable Care Act (ACA)

  4. Health Reform Law (2) – H.R. 4872 • HealthCareandEducationReconciliation Act of 2010 by Rep. John M. Spratt, Jr. [SC-5]. • Introduced 3/17/2010Became Public Law No: 111-152 • Made a number of health-related financing and revenue changes to the Patient Protection and Affordable Care Act (H.R.3590)andmodified higher education assistance provisions

  5. H.R. 4872 (cont.)

  6. ACA in 2010 • Review of Health Plan Premium Increases • Changes in Medicare Provider Rates • Medicaid and CHIP Payment Advisory Commission • Comparative Effectiveness Research • Prevention and Public Health Fund • Medicare Beneficiary Drug Rebate • Small Business Tax Credits • Medicaid Drug Rebate

  7. HR in 2010, cont. • Coordinating Care for Dual Eligibles • Generic Biologic Drugs • New Requirements on Non-profit Hospitals • Medicaid Coverage for Childless Adults • Reinsurance Program for Retiree Coverage • Pre-existing Condition Insurance Plan • New Prevention Council • Consumer Website • Tax on Indoor Tanning Services, Medicaid Coverage of Smoking Cessation

  8. HR – Year 1, cont. • Expansion of Drug Discount Program • Adult Dependent Coverage to Age 26 • Consumer Protections in Insurance • Insurance Plan Appeals Process • Coverage of Preventive Benefits • Health Centers, National Health Service Corps • Coverage of costs of clinical trials • Health Care Workforce Commission • Medicaid Community-Based Services

  9. HR – Year 1, cont. • Minimum Medical Loss Ratio for Insurers • Closing the Medicare Drug Coverage Gap • Medicare Payments for Primary Care • Medicare Prevention Benefits • Center for Medicare and Medicaid Innovation • Medicare Premiums for Higher-Income Beneficiaries • Medicare Advantage Payment Changes • Medicaid Health Homes

  10. HR – Year 1, cont. • Chronic Disease Prevention in Medicaid • CLASS Program • National Quality Strategy • Changes to Tax-Free Savings Accounts • Breast Cancer Education, Research and Prevention • Creates Cures Acceleration Network (CAN) • in NIH for translational research

  11. Health Reform – Year OneHighlights • March 23, 2010 - President signs reform law • Same day, governors and attorneys general in 19 states challenge individual mandate in Florida federal court • Virginia AG Ken Cuccinelli files his own lawsuit in Virginia. • June 10- "early deliverable“ for seniors: $250 Medicare prescription drug rebate checks mailed • 4 million beneficiaries expected to receive checks to fill prescription drug "doughnut hole"

  12. HR – Year 1, cont. • June 22- Three-month anniversary of ACA • ACA Patient's Bill of Rights- new patient protection released • New regulations cover annual, lifetime limits on benefits, rescissions, pre-existing conditions for children, consumers' choice of MD and access to out-of-network emergency care • September- New regs prohibit health plans from denying coverage to sick children • Benefits suffer setback when plans stop issuing new children-only policies in 29 states

  13. HR – Year 1, cont. • October- OCIIO grants 30 temporary waivers from the law's $750,000 floor on annual benefits. It has granted more than 1,000 waivers covering 2.6 million people to date • Nov. 2- Democrats suffer major losses at the polls, losing 63 seats in the House and six in the Senate. Repealing healthcare reform is a key platform for Republicans.

  14. Election 2010 • US Senate • Pre-election: 60-40 Democratic Caucus Majority(with Lieberman and Sanders) • Post-election: 57-43 Democratic Caucus • House • Pre-election: 257-178 Democratic Majority • Post-election: 242-193 Republican Majority

  15. Senate Leadership - 2011 • Sen. Harry Reid (D-Nev.), Majority Leader • Sen. Richard Durbin (D-Ill.), Majority Whip • Sen. Mitch McConnell (R-Ky.), Minority Leader • Sen. Jon Kyl (R-Ariz.), Minority Whip

  16. Senate Cmte Leadership - 2011 • Appropriations Committee • Sen. Daniel K. Inouye (D-Hawaii), Chair • Sen. Thad Cochran (R-Miss.), Ranking • Appropriations Labor-HHS Subcmte • Sen. Tom Harkin (D-Iowa), Chair • Sen. Richard Shelby (R-Ala.), Ranking • Committee on Health, Education, Labor and Pensions (HELP) • Sen. Tom Harkin (D-Iowa), Chair • Sen. Michael B. Enzi (R-Wy.), Ranking

  17. House Leadership - 2011 • Rep. John Boehner (R-Ohio),Speaker • Rep. Eric Cantor (D-Va.), Majority Leader • Rep. Kevin McCarthy (R-Calif.), Majority Whip • Rep. Nancy Pelosi (D-Calif.), Minority Leader • Rep. Steny Hoyer (D-Md.),Minority Whip

  18. House Cmte Leadership - 2011 • Appropriations Committee • Rep. Harold Rogers (R-Ky.), Chair • Rep. Norm Dicks (D-Wash.), Ranking • Appropriations HHS Subcmte • Rep. Denny Rehberg (R-Mont.), Chair • Rep. Rosa DeLauro (D-Conn.), Ranking • Energy and CommerceCommittee • Rep. Fred Upton (R-Mich.), Chair • Rep. Henry Waxman (D-Calif.), Ranking

  19. HR – Year 1, cont. • Nov. 5- HHSannounces choice of high-risk pool plansfor patients with pre-existing conditions • About 12,000 enrolled in pools during the first six months, even though millions are eligible. • Jan. 19- House Republicans fulfill their electoral promise and repeal healthcare reform, 245-189 • Only three Democrats — Reps. Dan Boren (OK), Mike McIntyre (NC) and Mike Ross (AR) — join all GOP members to vote for repeal.

  20. HR – Year 1, cont. • Jan. 31, 2011 - Federal judge in Florida strikes downentire ACA • Sets up Supreme Court showdown, possibly as early as this summer • Judge in Virginia struck down the ACA individual mandate • Three judges — in Michigan, Virginia and District of Columbia found ACA constitutional. • Feb. 2-Vote to repeal in the Senate fails on a 47-51 party-line vote.

  21. ACA Legal Scorecard • Tracking the status of 25 cases: • Court overturned law or part of law:  2 cases • Court ruled law constitutional and dismissed case: 6 cases • Court dismissed for lack of standing or procedural problems: 4 cases • Court dismissed but gave plainiff right to refile: 1 case • Court decision pending: 12 cases

  22. OPT OUT – Be careful what you ask for! • Feb. 28, 2011 - President announces support for bipartisan legislation allowing states to apply as early as 2014 for a waiver from certain requirements of the law, including its individual mandate

  23. Opt Out (cont.) • In speech to NGA President supports legislation allowing states waivers for alternatives to ACA • States could opt out, beginning in 2014, from the requirement that individuals buy insurance • Polls show mandate is deeply unpopular with the public • Opt out bill is S. 248 by Sens. Ron Wyden (D-OR), Scott Brown (R-MA) and Mary Landrieu (D-LA) • Would let states opt out of many of ACA mandates in 2014

  24. Gotcha! • Waiver provision comes with a catch • State’s waiver proposal must show that it is capable of providing coverage that is at least as comprehensive and affordable as that offered through new state-run health insurance exchanges, which also open in 2014 • The state must also provide coverage to as many residents as the exchanges would have, and the proposal must not increase the federal deficit

  25. HHS Opt Out • March 12 - Department of Health and Human Services (HHS) issued rules for states that want to opt out of certain requirements under the ACA and instead implement their own insurance reform • States can receive a "state innovation waiver" that allows them to opt out of some federal requirements in the ACA starting in 2017 if they successfully enact a state-specific plan to cover as many people as the ACA would cover, at a similar cost

  26. HHS Opt Out, cont. • States could create own system • Would receive federal money that would have otherwise been spent there to provide insurance subsidies to residents who couldn't afford to buy insurance on their own. • ACA bars insurance companies from imposing lifetime limits on plans. It also requires them to cover young adults on their parents' plans until their 26th birthday; cover preventive services with no cost-sharing; and have medical loss ratio of at least 80%

  27. HHS Opt Out, cont. • In 2014, more provisions, like expansion of pre-existing medical condition prohibition take effect • States receiving a waiver would be required to keep those insurance company provisions in place • Each application from a state seeking a waiver must explain state plan will meet goals of coverage expansion, affordability, coverage comprehensiveness, and lower costs

  28. Opt Out, cont. • State must also provide actuarial certification and economic analyses to prove plan will meet ACA requirements • Analysis of what happens to a resident’s access to healthcare services when leaving state • How plan will deter waste, fraud, and abuse • Submit quarterly reports that track how state plan is performing

  29. Another HHS ACA Waiver • March 8- Maine is first state to get a waiver from medical-loss ratio requirement • Requires individual and small-group plans to spend at least 80 percent of premiums on healthcare benefits or give consumers a rebate • Six other states — Georgia, Florida, Kentucky, Nevada, New Hampshire and North Dakota — have applications pending

  30. An After Shock Hits NCI • Feb. 8 - at National Cancer Advisory Board meeting, NCI Director Harold Varmussaid cuts to NCI programs were coming • Varmus indicated he was considering reductions to cancer center awards, contracts and inflationary increases for non-competitive awards

  31. Varmus, cont. • Varmus said top priorities will be: • Sustain the same number of new grant awards in FY2011 as was awarded in each of the past two years, • Ensure cancer genomics programs are supported • Pay for the ongoing improvements to the clinical trials program.

  32. President’s Budget • Feb. 14 President submitted FY 2012 budget to Congress • For NIH, the President's budget proposed $31.748 billion, an increase of $745 million (2.4 percent) over the FY 2010 funding level • NIH projects the Biomedical Research and Development Price Index (BRDPI) will increase by 3.0 percent in FY 2011 and 2.9 percent in FY 2012

  33. President’s NIH Budget, cont. • President’s budget emphasized four areas for NIH “investment:” • Advancing translational sciences, including the creation of the National Center for Advancing Translational Sciences (NCATS) • Accelerating discovery through technology • Enhancing evidence base for health-care decisions • Encouraging new investigators and new ideas.

  34. House Budget - H.R. 1 • Feb. 19 House approved H.R. 1, an omnibus appropriations bill for remainder of FY 2011 • Would cut federal discretionary spending by more than $61 billion from FY 2010 levels • $1.6 billion cut to NIH and substantial cuts for the Title VII and VIII health professions programs and the National Health Service Corps • H.R. 1 fails to pass Senate on March 9 and alternative proposal by Senate Appropriations Chair Daniel Inouye (D-HI)

  35. House Budget, cont. • NIHbudget cut of $1.6 billion reduces agency's total budget to $29.6 billion, a 2008 level • Interestingly, cuts are not across the board - specific line items are cut: • Global AIDS Transfer fund, Project Bioshield Special Reserve Fund Transfer • Funds for buildings and facilities • Inflation adjustment for non-competing grants and NIH Common Fund • $640 million is a general reduction to 2008 levels, and would directly impact the National Cancer Institute

  36. Budget by Continuing Resolution (CR) • March 17 - Senate voted, 87-13, to approve three week extension of funding until April 8 • This CR (H.J.R. 48) is sixth for fiscal year that began Oct. 1, 2010 • House passed this latest CR on March 16 by a vote of 271-158

  37. HJR 48 • House Joint Resolution (HJR) 48 continues funding for most federal programs at FY 2010 levels • Cuts $6 billion in spending by reducing or ending 25 programs and eliminating certain earmarks • Latest CR does not affect funding for NIH or Health Resources and Services Administration (HRSA)’s Title VII and VIII health professions programs.

  38. Budget End Game for FY 2011 • House and Senate leaders say they believe they can reach agreement on FY 2011 spending plan with cuts estimated at $33 billion • Alternative is a government shutdown in April • Frustration with piecemeal approach growing • Conservative House members also are unhappy with the CRs because they do not include H.R. 1 funding cuts and policy riders to derail ACA

  39. In Change There is Opportunity but • We’re Going to Need a Bigger Boat!

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