1. Washington State Hospital Association Association of Washington Public Hospital Districts 2004 Legislative Session For audio, call: 1-800-936-4606 host: WSHA or Cassie Sauer

2. Washington State Hospital Association Association of Washington Public Hospital Districts Presenters Cassie Sauer Director, Advocacy and Public Relations WSHA Cassie Sauer Director, Advocacy and Public Relations WSHA Claudia Sanders Vice President, Policy Development WSHA Claudia Sanders Vice President, Policy Development WSHA Randy Revelle Vice President, Policy and Public Affairs WSHA Randy Revelle Vice President, Policy and Public Affairs WSHA

3. Washington State Hospital Association Association of Washington Public Hospital Districts Webcast Outline Elections and leadership changes State of the state budget The Governor’s budget proposal WSHA and AWPHD policy priorities What you can do Elections and leadership changes State of the state budget The Governor’s budget proposal WSHA and AWPHD policy priorities What you can do

4. Washington State Hospital Association Association of Washington Public Hospital Districts 2004 Legislative Session Very political 2004 elections coming Narrow majorities State budget still shaky Democrats trying to hold together Republicans have major leadership changes Short and fast Very political 2004 elections coming Narrow majorities State budget still shaky Democrats trying to hold together Republicans have major leadership changes Short and fast

5. Washington State Hospital Association Association of Washington Public Hospital Districts Everybody’s Running for Office: Statewide Offices Christine Gregoire Attorney General Candidate for Governor Christine Gregoire Attorney General Candidate for Governor Gary Locke Governor Not Running for Re-Election Gary Locke Governor Not Running for Re-Election Mike Kreidler Insurance Commissioner Running for Re-Election Mike Kreidler Insurance Commissioner Running for Re-Election George Nethercutt Congressman Candidate for U.S. Senate George Nethercutt Congressman Candidate for U.S. Senate

6. Washington State Hospital Association Association of Washington Public Hospital Districts Everybody’s Running for Office: Republican Leadership Changes Dino Rossi Former Senate Ways & Means Chair Candidate for Governor Dino Rossi Former Senate Ways & Means Chair Candidate for Governor Jim West Former Senate Majority Leader New Spokane Mayor Jim West Former Senate Majority Leader New Spokane Mayor Larry Sheahan Senate Former Floor Leader Candidate for Congress Larry Sheahan Senate Former Floor Leader Candidate for Congress Cathy McMorris Former House Republican Leader Candidate for Congress Cathy McMorris Former House Republican Leader Candidate for Congress

7. Washington State Hospital Association Association of Washington Public Hospital Districts Democratic Leadership Frank Chopp Speaker of the House Frank Chopp Speaker of the House Helen Sommers House Appropriations Chair Helen Sommers House Appropriations Chair Eileen Cody House Health Care Chair Eileen Cody House Health Care Chair Lisa Brown Senate Minority Leader Lisa Brown Senate Minority Leader Margarita Prentice Senate Ranking Ways and Means Margarita Prentice Senate Ranking Ways and Means Pat Thibaudeau Senate Ranking Health Care Pat Thibaudeau Senate Ranking Health Care

8. Washington State Hospital Association Association of Washington Public Hospital Districts Republican Leadership Barry Sehlin House Ranking Appropriations Barry Sehlin House Ranking Appropriations Alex Deccio Senate Health Care Chair Alex Deccio Senate Health Care Chair Joe Zarelli Senate Ways and Means Chair Joe Zarelli Senate Ways and Means Chair Bill Finkbeiner Senate Majority Leader Bill Finkbeiner Senate Majority Leader Richard DeBoldt House Minority Leader Richard DeBoldt House Minority Leader Barbara Bailey House Ranking Health Care Barbara Bailey House Ranking Health Care

9. Washington State Hospital Association Association of Washington Public Hospital Districts Washington Hospital PAC: Contributions 200120022003

10. Washington State Hospital Association Association of Washington Public Hospital Districts The State Budget

11. Washington State Hospital Association Association of Washington Public Hospital Districts People Insured by State Health Care (As of April 2003) Also: 300,000 public employees insured by the state Basic Health125,000 Medicaid for Children 565,000 Medicaid for Adults, Aged, Blind, Disabled360,000 Medically Needy16,000 TOTAL1,087,000 Other State Programs (MI, GAU, ADATSA)14,000 Children’s Health Insurance Program (CHIP) 7,000

12. Washington State Hospital Association Association of Washington Public Hospital Districts Governor and Legislature Made Significant Cuts to Health Care Cuts to Health Care 29% Cuts to All Other State Programs 71% Health care took $766 million of $2.6 billion in cuts

13. Washington State Hospital Association Association of Washington Public Hospital Districts Hospital Operating Margins Remain Low

14. Washington State Hospital Association Association of Washington Public Hospital Districts State Budget Process Supplemental budget process to amend the 2003-2005 budget adopted last June Governor released his supplemental budget on December 18 Legislative session January 12 to March 12 (?) Senate and House each propose a budget, likely in February or March Legislators have to pass a compromise the Governor will sign Supplemental budget process to amend the 2003-2005 budget adopted last June Governor released his supplemental budget on December 18 Legislative session January 12 to March 12 (?) Senate and House each propose a budget, likely in February or March Legislators have to pass a compromise the Governor will sign

15. Washington State Hospital Association Association of Washington Public Hospital Districts Governor’s Budget Proposal Declares “the state is turning around” “You will have to go to California or some other state for a story about a budget crisis. We don't have one here.” Adds $200 million in spending, primarily education and health care Leaves $172 million in reserves Extends some business tax cuts Declares “the state is turning around” “You will have to go to California or some other state for a story about a budget crisis. We don't have one here.” Adds $200 million in spending, primarily education and health care Leaves $172 million in reserves Extends some business tax cuts

16. Washington State Hospital Association Association of Washington Public Hospital Districts New Revenues? Legislators questioning Governor’s budget Most services, particularly health care, already badly cut Health care an enormous target with no new money WSHA will support legislators who have the courage to protect health care, even if it means raising taxes Legislators questioning Governor’s budget Most services, particularly health care, already badly cut Health care an enormous target with no new money WSHA will support legislators who have the courage to protect health care, even if it means raising taxes

17. Washington State Hospital Association Association of Washington Public Hospital Districts Budget Priorities

18. Washington State Hospital Association Association of Washington Public Hospital Districts Medicaid Premiums Legislature enacted the highest premiums in the nation for children at poverty Direct impact on hospitals –Termination of insurance for non-payment –Pay in arrears and wait three months New SCHIP money can help ($23 million) Locke’s proposal: Eliminate premiums to 150% poverty level, reduce others WSHA goal: Eliminate or reduce premiums Legislature enacted the highest premiums in the nation for children at poverty Direct impact on hospitals –Termination of insurance for non-payment –Pay in arrears and wait three months New SCHIP money can help ($23 million) Locke’s proposal: Eliminate premiums to 150% poverty level, reduce others WSHA goal: Eliminate or reduce premiums

19. Washington State Hospital Association Association of Washington Public Hospital Districts Proshare Allocation Funding for public hospital district nursing homes Legislature gave $9.6 million, but miscalculated Only $6.5 million available Locke’s proposal: Restores funding WSHA goal: Full $9.6 million to nursing homes Funding for public hospital district nursing homes Legislature gave $9.6 million, but miscalculated Only $6.5 million available Locke’s proposal: Restores funding WSHA goal: Full $9.6 million to nursing homes

20. Washington State Hospital Association Association of Washington Public Hospital Districts Medically Indigent (MI) Funding Legislature eliminated this critical funding for emergencies/trauma Partially replaced with grants Rural grants provide full funding Urban hospitals lost $50 million over two years Now, $36 million in new federal DSH funds Locke’s proposal: no action WSHA goal: Add $20 million to urban hospital grant Legislature eliminated this critical funding for emergencies/trauma Partially replaced with grants Rural grants provide full funding Urban hospitals lost $50 million over two years Now, $36 million in new federal DSH funds Locke’s proposal: no action WSHA goal: Add $20 million to urban hospital grant

21. Washington State Hospital Association Association of Washington Public Hospital Districts Inpatient Mental Health Inpatient mental health services are stressed Many Medicaid patients State hospital bed reductions increases demand Hospitals are reducing / closing units Now, $36 million in new federal DSH funds Locke’s proposal: no action WSHA goal: $10 million (plus potential federal match) to inpatient mental health Inpatient mental health services are stressed Many Medicaid patients State hospital bed reductions increases demand Hospitals are reducing / closing units Now, $36 million in new federal DSH funds Locke’s proposal: no action WSHA goal: $10 million (plus potential federal match) to inpatient mental health

22. Washington State Hospital Association Association of Washington Public Hospital Districts Governor’s Budget Proposal: Other Health Care Issues Creates a patient compensation fund for medical liability Increases Medicaid payments for labor and delivery Provides $6.7 million in additional Disproportionate Share Hospital (DSH) funds to district hospitals Provides $3.7 million to improve rural health Creates a patient compensation fund for medical liability Increases Medicaid payments for labor and delivery Provides $6.7 million in additional Disproportionate Share Hospital (DSH) funds to district hospitals Provides $3.7 million to improve rural health

23. Washington State Hospital Association Association of Washington Public Hospital Districts Questions

24. Washington State Hospital Association Association of Washington Public Hospital Districts Policy Priorities

25. Washington State Hospital Association Association of Washington Public Hospital Districts Policy Priorities Enact medical liability reform Enact mental health parity Defeat nurse staffing plans Limit new regulations Enact medical liability reform Enact mental health parity Defeat nurse staffing plans Limit new regulations PRIORITY

26. Washington State Hospital Association Association of Washington Public Hospital Districts Medical Liability Reform Partnership with Liability Reform Coalition and WSMA seeking broad liability reform Cap on non-economic damages; requires a Constitutional amendment Establish periodic payments Disclose collateral source offset Revise joint and several liability Change ostensible agency Partnership with Liability Reform Coalition and WSMA seeking broad liability reform Cap on non-economic damages; requires a Constitutional amendment Establish periodic payments Disclose collateral source offset Revise joint and several liability Change ostensible agency

27. Washington State Hospital Association Association of Washington Public Hospital Districts Average/Median Liability Premiums (91% of WSHA Hospitals)

28. Washington State Hospital Association Association of Washington Public Hospital Districts Impacts on Health Care Delivery (91% of WSHA Hospitals)

29. Washington State Hospital Association Association of Washington Public Hospital Districts Democrats’ Medical Liability Proposal Focuses on three areas: –Improve patient safety –Assure physicians and hospitals can get insurance –Improve the civil justice system Includes several positive proposals Creates a “patient compensation fund” Separates medical liability from the rest of the Liability Reform Coalition interests Focuses on three areas: –Improve patient safety –Assure physicians and hospitals can get insurance –Improve the civil justice system Includes several positive proposals Creates a “patient compensation fund” Separates medical liability from the rest of the Liability Reform Coalition interests

30. Washington State Hospital Association Association of Washington Public Hospital Districts Mental Health Parity Health insurance discriminates against the mentally ill WSHA goal: Parity between physical and mental health insurance Parity is affordable Direct benefit to hospitals, especially mental health units Health insurance discriminates against the mentally ill WSHA goal: Parity between physical and mental health insurance Parity is affordable Direct benefit to hospitals, especially mental health units

31. Washington State Hospital Association Association of Washington Public Hospital Districts Nurse Staffing Plans WSNA sponsored legislation Fall back is a task force Over-regulation of hospitals Does not account for differences in hospitals Could lead to ratios Create educational opportunities, grow the pool of nurses WSNA sponsored legislation Fall back is a task force Over-regulation of hospitals Does not account for differences in hospitals Could lead to ratios Create educational opportunities, grow the pool of nurses

32. Washington State Hospital Association Association of Washington Public Hospital Districts Regulatory Reform Hospitals face many unnecessary regulations Increase costs Decrease efficiency Every year, new regulations are proposed WSHA goal: Prevent any further unnecessary regulations Hospitals face many unnecessary regulations Increase costs Decrease efficiency Every year, new regulations are proposed WSHA goal: Prevent any further unnecessary regulations

33. Washington State Hospital Association Association of Washington Public Hospital Districts What About Boutique Hospitals? Major priority in 2003 Source of conflict with WSMA Medicare prescription drug law: –Federal moratorium for 18 months –New federal studies WSHA will revisit in 2005 Major priority in 2003 Source of conflict with WSMA Medicare prescription drug law: –Federal moratorium for 18 months –New federal studies WSHA will revisit in 2005

34. Washington State Hospital Association Association of Washington Public Hospital Districts What You Can Do Stay in contact with your legislators Talk to others in your community about what health care spending means Highlight good things government accomplishes Talk to reporters and editorial boards Do not sign any initiatives unless you know they will help! Stay in contact with your legislators Talk to others in your community about what health care spending means Highlight good things government accomplishes Talk to reporters and editorial boards Do not sign any initiatives unless you know they will help!

35. Washington State Hospital Association Association of Washington Public Hospital Districts We Need Your Stories! How are budget cuts affecting you? People who cannot get care? Children without health care access? Program closures? ER volume increases? Charity care increases? No pay, bad debt increases? How are budget cuts affecting you? People who cannot get care? Children without health care access? Program closures? ER volume increases? Charity care increases? No pay, bad debt increases?

36. Washington State Hospital Association Association of Washington Public Hospital Districts Resources on the Web www.wsha.org –Issue briefs –Budget analysis www.leg.wa.gov –State legislature –Contact information; biographies of legislators –Committee/bill information www.access.wa.gov –Executive branch/state agencies –Governor and state budget information www.wsha.org –Issue briefs –Budget analysis www.leg.wa.gov –State legislature –Contact information; biographies of legislators –Committee/bill information www.access.wa.gov –Executive branch/state agencies –Governor and state budget information

37. Washington State Hospital Association Association of Washington Public Hospital Districts Questions and Comments Contact Information: cassies@wsha.org or 206/216-2538