1. Alliance for Health Reform Briefing for Reporters July 1, 2009 Dean A. Rosen, Partner

2. Where Things Stand, And Where They’re Heading Health Reform Goals Reform Drivers Key players –Administration –Congress –Stakeholders Reform timing and process Health reform focus areas Opportunities for progress Remaining challenges and party positioning

3. Four Federal Health Care Goals for 2009 GoalStatus Children’s Health Insurance Program Reauthorization 4.5 year extension Public law – February 4, 2009 American Recovery and Reinvestment Act  Substantial HIT investment  Enhanced Medicaid match  COBRA unemployed subsidies Public law - February 17, 2009 Medicare  Physicians face 20% cut Dec. 2009  Payment reforms to promote value To do Health Reform/UninsuredTo do

4. What’s Driving Reform?

5. National Health Expenditures Health Spending Will Nearly Double Over the Next Decade, Rising to Over 20 Percent of GDP by 2018 Source: Centers for Medicare & Medicaid Services, Office of the Actuary, January 2009. ActualProjected Dollars in trillions

6. Three in four dollars spent on health care in the U.S. are for patients with one or more chronic conditions Health care costs for patients with one or more chronic diseases = ~$1.58 trillion Source: Centers for Disease Control and Prevention. Chronic Disease Overview page. Available a http://www.cdc.gov/nccdphp/overview.htm. Accessed April 6, 2007. http://www.cdc.gov/nccdphp/overview.htm Total U.S. health spending in 2006 = $2.1 trillion

7. * Number of uninsured nonelderly. The Census Bureau periodically revises its CPS methods, which means data before and after the revision are not comparable. Comparison across years can be made between 2000 through 2004, and 2004 though 2007. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2008 ASEC Supplements to the CPS. Number of Uninsured Continues to Climb

8. The Obama Administration

9. The Obama Administration: Key Health and Economic Players Health Care Team WH OHR DeParle Budget & Economic Team Budget Orszag Budget Emanuel NEC Summers Key White House Advisors COS Emanuel Senior Advisor Axelrod DPC Barnes HHS Sebelius HHS/ OHR Lambrew Treasury Geithner

10. The 111 th Congress

11. Democrats Have Large Congressional Majorities, Including 60 In Senate Senate: 60-40 Democratic Majority House: 257-178 Democratic Majority

12. Senate and Health Committee Leaders HELP Ranking MemberChairman Budget Ranking Member Chairman Leadership Minority LeaderMajority Leader Finance Ranking MemberChairman Enzi (R-WY)Kennedy (D-MA) Grassley (R-IA)Baucus (D-MT) Gregg (R-NH)Conrad (D-ND) McConnell (R-KY)Reid (D-NV)

13. House and Health Committee Leaders Education and Labor Ranking MemberChairman Ways and Means Ranking MemberChairman Budget Ranking MemberChairman Energy and Commerce Ranking Member Barton (R-TX)Waxman (D-CA)Spratt (D-SC)Ryan (R-WI) Miller (D-CA)Kline (R-MN) Camp (R-MI)Rangel (D-NY) Chairman Stark (D-CA) Health Subcomm. Chair Leadership Speaker Pelosi (D-CA)Boehner (R-OH) Minority Leader

14. Stakeholders Shaping, Not Stopping, Health Reform Policy This Time Around

15. Building Blocks of Democrats’ Health Reform Strategy Congress drafting legislation Engaging stakeholders Speedy timetable Congressional Committees cooperating closely White House support Bipartisan consensus Lessons learned from 1993-94

16. Reformers, with very different reform visions Moderates, willing to compromise GOP Positioning On Health Reform Budget Hawks/Fiscal Conservatives Undecided

17. Reformers, with very different reform visions Moderates, willing to compromise GOP Positioning On Health Reform Fault Lines Individual mandate Employer mandate Medicare buy-in Medicaid expansions Government-funded comparative effectiveness research Government-run public plan option Overall cost Tax increases Budget Hawks/Fiscal Conservatives Undecided

18. Critical Factors That Will Shape Outcome Budget Neutrality Budget Reconciliation

19. Senate Health Reform Timeline April May June September July October November HELP and Finance Bipartisan Working Groups Finance Committee Roundtables Begin Finance Committee Options Papers Committee Markups ? Conference Committee Agreement Senate Floor Consideration ?

20. House Health Reform Timeline Legislative Plan Release Committee Markups July Floor Consideration Conference Committee Agreement Committee Hearings Hearings Continue April May June September July October November

21. Reform Focus Areas Health System Reforms Expanded Coverage Financing o he o Quality/pay-for- performance o Public reporting o Primary care incentives o Workforce improvement o Medical home o Medicare doctor payment o Bundled payments o Reduce readmissions o Accountable care organizations o Medicare Advantage payment reforms o Comparative Effectiveness o Health information technology o Health insurance exchange o Benefit design o Rating reforms o Small business tax credit o Market reforms o Mandates o Public plan option o Public program expansion o Medicaid reforms, including expansion to 100% FPL o Home and community based services o Long-term care o Health disparities o Prevention o Health care tax exclusion o Other sources of tax revenue o Multinational corporations o Alcohol o Sugary drinks o Additional health system savings o Medicaid rebate o Part D prescription drug cost-savings

22. Health Reform: Opportunities for Common Ground Expanding Coverage System Reform and Quality Improvement Fraud & Abuse Prevention & Wellness

23. Health Reform: Major Challenges Financing Government-Run Public Plan Medicaid Expansion

24. Most Important Economic Issues Source: NBC/Wall Street Journal Survey http://s.wsj.net/public/resources/documents/WSJ-NBC_Poll090617.pdf IssuePercentage of Respondents Unemployment35% The federal budget deficit24% The cost of health care11% Gas prices and energy costs7% The drop in the stock market6% Federal taxes4% Housing prices3% Pension security2%

25. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

26. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

27. Source: ABC News/Washington Post Poll http://abcnews.go.com/images/PollingUnit/1091a1ObamaandPolitics.pdf

28. Alliance for Health Reform Briefing for Reporters July 1, 2009 Dean A. Rosen, Partner