1. WELCOME TO THE 2011 NRHA AND POLICY PARTNERS POLICY INSTITUTE 22st Annual Rural Health Policy Institute

2. Welcome to Washington Maggie Elehwany, JD National Rural Health Association Vice-President Government Affairs

3. Introducing the Policy Partnership  AgriSafe  National Association of Rural Health Clinics (NARHC)  National Cooperative of Health Networks (NCHN)  National Organization of State Offices of Rural Health (NOSORH)  National Rural Health Association (NRHA)  National Rural Recruitment and Retention Network (3RNet)  National Association for Rural Mental Health (NARMH)

4. The Importance of Coming Together  The great impact of the Federal Government:  Legislation  Regulations (meaningful use, direct supervision, provider tax, etc.)  Funding/Appropriations

5. Much change has come to Washington

6. To the White House. And to Congress.

7. Health Reform: “It’s a big f*%#ing deal!” Vice President Joe Biden  Goal to have 95% of population insured  Medicaid expanded (16 million)  Requiring Insurance Coverage – mandate Individuals (subsidies to low-income – up to 400% fpl) Employers (small business will be exempted)  Create more choice -- state-based exchanges  Insurance reforms  New regulations  New requirements  New taxes  Patient Protection and Affordable Care Act (PPACA)  Affordable Care Act (ACA)

8. And big change comes to Congress…again.

9. I took a “ Shellacking” President Obama  House: Democrats lost 63 seats lost - - Not since 1948 has a party captured so many seats in one election. Republicans will control at least 240 seats.  Senate: Loss of 6 seats. Democrats retain majority, but far short of magic 60 seats.  Why does it matter?

10. Last week’s vote to repeal…  245-189. All Republicans and 3 Democrats.  What does it all mean?  National polls: A nation divided.  26 state have filed Federal lawsuit.

11. It means…rural America must take charge of change.

12. So many questions: As a rural health provider…  How will health reform impact me?  As a small business person, how will health reform impact me?  How can I afford the HIT requirements in the American Recovery and Reinvestment Act (the Stimulus Bill)? How can I achieve meaningful use?  Will Federal dollars be cut in the new fiscally conservative congress?

13. Why the next three days are so important  Critical time in Washington, D.C.  Billions of dollars for rural America on the line. (Health Reform, Stimulus Bill, Appropriations)  Anxiety and concern from Capitol Hill and rural America.  The goal of this conference is to make sense of all the chaos.  And send a strong, united voice to Capitol Hill

14. Today’s Highlights 22st Annual Rural Health Policy Institute in Washington, DC CMS Administrator Berwick, HRSA Deputy Director Brand, Natl. Coordinator for HIT Blumenthal.

15. USDA and FCC will outline rural health resources

16. Hear from Capitol Hill experts on how health reform impacts you. Learn what is in store in the new Congress and what you need to know as a rural provider. The Prognosis of Health Reform in Rural America

17. Experts draw a roadmap for rural providers and discuss resources available for rural providers. Health IT Adoption: How Rural Gets There

18. Substance Abuse and Mental Health Services Administration official and rural mental health experts outline great need in rural America and detail resources available. Rural Mental Health Parity and Reform

19. Tonight’s Congressional Reception: A tribute to the progress of health care in Rural America and those who help make it happen. The fulfillment of George Washington’s dream, the U.S. Botanic Garden is the nation’s garden.

20. TOMORROW’S HIGHLIGHTS NRHA Award Ceremony for Outstanding Legislative Leadership, AND TAKING OUR MESSAGE TO THE HILL

21. Wednesday’s Highlights Key Senators, from all sides of the aisle define their fight for Rural America.

22. TAKING OUR MESSAGE TO THE HILL

23. The Challenges of the 112 th Congress  Republican Controlled House  Democratic Controlled Senate  Recession/fiscal conservative tone will create challenges

24. When the battle began…the NRHA and Policy Partners’ Fight  Rural America needs health care reform.  Rural America needs health reform done correctly.

25. The Challenges of Rural  Per capita, rural Americans are older, sicker, and poorer, and have higher uninsured rates than urban residents.  The delivery of rural care is challenged by geography, workforce shortages and payment inequities.  Recession has made deep impact.  Health care key component to rural economy.

26. Our Message has been Consistent  For reform to be effective in rural America, the access to care crisis in rural America must be eliminated. (It does not matter if you have access to insurance if you do not have access to a provider.)  To resolve the access crisis, reform must eliminate:  The workforce shortage crisis  Long-standing payment inequities.

27. Protect and Build Upon  Health reform contains many positive provisions that will improve: 1) the health of rural America; and 2) the access to care crisis in rural America.  Any repeal or modification of the bill should protect provisions that: Improve workforce shortages in rural America; Improve payment inequities of rural providers; and Invest in primary care  These provisions are important building blocks, BUT will not resolve the access to care crisis in rural America. Many other critical rural provisions that were left out of health reform.

28. Protect Rural Safety Net Program  Strengthen the “rural health safety net” by providing modest yet critical increases in funding for fiscal year 2012.  Educate fiscal conservatives on the importance of these programs.

29. Join fellow colleagues in united rural voice  Senate Rural Health Caucus  House Rural Health Care Coalition.  The Caucus and the Coalition are a collection of rural health champions and have passed significant legislation improving the lives of 62 million rural Americans.

30. Right Here. Right Now.  Crucial Time in Washington D.C.  Most significant changes in health care in generations are upon us.  Billions of dollars for rural patients and providers on the line.  Health Reform,  Stimulus Bill  Appropriations.

31. Rural Advocacy, the Urgency of Now  No more opportune time for rural America to unite.  Together, our voice is strong.  So much is at stake.

32. Let’s Take Charge of Change Together.