1. The Status of Health Reform Melanie Hobbs Director, Public Policy and Government Relations St.Vincent Health Tory Callaghan Castor Vice President, Government Relations Clarian Health Partners Updated December 14, 2009

2. The White House House “Tri-Committee” House Speaker Nancy Pelosi Ways and Means (Rep Charles Rangel – D., NY) Energy and Commerce (Rep Henry Waxman – D., CA) Education and Labor (Rep George Miller – D., CA) Senate Senate Majority Leader Harry Reid Health, Education, Labor and Pensions (HELP Committee) – (Sens. Dodd & Harkin – D., Ct, IA) Finance Committee - (Sen Max Baucus – D., Mont) Ben Nelson Olympia Snowe Joe Lieberman Blue Dog Democrats The Congressional Budget Office Industry Trade Groups Important Players

3. COMMITTEES FLOOR CONSIDERATION House-Senate Conference Committee HOUSE Energy & Commerce Ways & Means Education & Labor Passed July 31 Passed July 16 Passed July 17 SENATE FinanceHELP Passed July 16 Two bills to be combined into one Regular OrderReconciliation Full Senate vote on bill (simple majority to pass) Unlimited floor debate Filibuster Cloture (60 votes) Limited floor debate Limits on non-budget- related provisions Passed October 13 Three bills combined into one October 29 HOUSE VOTE Passed 220-215 Limited floor debate – One Day Two Amendments Considered; One Adopted November 7 Next Steps: Senate Action Two bills combined into one November 18

4. What the White House Wants

5. House Bill (HR3962) “ Affordable Health Care for America Act ” Passed: November 7, 2009 (220-215) Senate Bill (HR3590) “ Patient Protection and Affordable Care Act ” Currently Being Debated on the Senate Floor Cost $1.2 Trillion over 10 Years$849 Billion over 10 Years Coverage 36 Million (Currently, the House bill covers 96% of those legally residing and 94% of those residing in the country.) 31 Million (Currently, the Senate bill covers 94% of those legally residing and 92% of those residing in the country.) Government-Run Insurance Public Option (negotiated rates with “ corridors ” ) Public Option with Opt-Out Provision (Current) (Federal Employee Health Benefits-type model with Medicare buy-in and public option trigger---being scored by CBO.) Individual Mandate Yes. Individuals must purchase insurance or pay a penalty of 2.5% of income. Yes. Individuals must purchase insurance or pay a penalty. Those obligated to buy coverage who fail to do so would pay a fine starting at $95 in 2014 and rising to $750. Employer Mandate Yes. Employers must pay 65% of family premiums or pay a penalty based on payroll. Small businesses with less than $500,000 on payroll are exempt. Payrolls up to $750,000 have a reduced contribution. No, the bill would not require employers to offer health insurance. However, medium and large employers who do not offer coverage would have to reimburse the government for each full-time employee receiving a health-care affordability tax credit. Revenue Raisers The original proposal imposed a surcharge on families with incomes above $350,000 and individuals with incomes above $280,000. House leaders are considering limiting the surtax to singles who earn more than $500,000 and families who earn more than $1 million. Fees on insurance companies, drug makers, medical device manufactures. Medicare payroll tax would increase to 1.95% on income of more than $200k/yr for individuals; $250k/yr for couples. New 5% tax on elective cosmetic surgery. Tax on “ Cadillac plans ” ($8,500 annually for individuals and $23,000 for families). Insurance Reforms No denial of coverage based on pre-existing conditions. No higher premiums based on gender/age. (2013) No denial of coverage based on pre-existing conditions. No higher premiums based on gender/age/family size. Children up to age 26 can stay on parents insurance. No lifetime limits on coverage. (2014) Medicaid Expansion Yes. Expanded to 150% FPL.Yes. Expanded to 133% FPL. Insurance Subsidies Yes. Available to households earning up to 400% FPL. Yes. Available to households earning up to 400% FPL.

6. Reduce Preventable Readmissions Value-Based Purchasing Reduce Hospital Acquired Conditions Bundled Payments Accountable Care Organizations Improve Quality Reduce Costs Increase Healthcare “Value” Electronic Health Records The Goal Tactics Prerequisite Delivery System Reform

7. Public Opinion

8. The Role of Physical Therapists APTA-Supported Policy Principles for Health Care Reform: Systematic health care reform that provides: Guarantee Issue Guarantee Renewal Guarantee Choice Ensure that rehabilitation services, provided by licensed health care professionals, are an essential element of a standard benefits package in any proposal to reform the insurance delivery system. Enact insurance reforms that: Eliminate arbitrary limits on annual or lifetime benefits; Prohibit cost shifting by increased co-payments, deductibles, and/or premiums; and Ensure non-discrimination on benefits or providers. Reform Medicare payment policies: Permanently repeal the Sustainable Growth Rate (SGR) formula Permanently repeal arbitrary outpatient therapy caps on services; and Eliminate certification of the plan of care for patients to access outpatient physical therapy services.

9. The Role of Physical Therapists APTA-Supported Policy Principles for Health Care Reform: Ensure that policies regarding bundling payments meet the following criteria: Bundled payments should not be implemented without evaluation of its feasibility as a payment model for post-acute care services. Patient safeguards should be established to ensure patient choice and access to the full range and continuum of post-acute and outpatient care. Post-acute care should be defined as Part A services within the first 30 days post discharge from an acute care hospital stay delivered by inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and/or long-term acute care hospitals. Enhance initiatives to develop an adequate health care workforce. Enable physical therapists to participate in current initiatives, such as the NHSC. Expand federal funding for clinical education, fellowships, and faculty development in physical therapy. Reduce unnecessary regulatory burdens on physical therapists to enhance efficiency and effectiveness in delivering health care to their patients at the right time and place.

10. Questions