1. Prospects for Federal Health Legislation 2008 Health Care Forecast Conference February 21, 2008 Terri Shaw The Children’s Partnership

2. Overview Context for (in)action this year Prospects for Congressional action Prospects for Executive action

3. Context for (In)Action On the one hand… Election year Veto threats Pay-go

4. Context for (In)Action On the other hand… “Must-do” items Executive activism Health care continues to be a high-priority item for voters

5. Prospects for Congressional Action “Must-do” items – Health Medicare Medicaid/SCHIP – Not directly/exclusively health-related Economic stimulus AMT and tax extenders Appropriations No Child Left Behind?

6. Prospects for Congressional Action Pending/unfinished items: – CHAMP Act SCHIP reauthorization Physician and other provider reimbursement changes Reduce Medicare Advantage overpayments Beneficiary improvements Eliminate self-referral to physician-owned hospitals Repeal trigger – Mental health parity – Genetic non-discrimination – Health IT – Comparative effectiveness

7. Prospects for Executive Action: Seven Medicaid Proposals Last Year ProposalStatus School-based servicesMoratorium until 6/30/08 Rehab servicesMoratorium until 6/30/08 Targeted case managementEffective 3/3/08; moratorium until 3/09 included in S1200 Hospital cost limitsMoratorium until 5/25/08 GMEMoratorium until 5/25/08 Outpatient servicesTo be finalized early 2008 Provider taxEffective 1/1/08 Cumulative savings: $15B over 5 years Source: Center on Budget and Policy Priorities, February 13, 2008

8. Prospects for Executive Action Regulatory proposals in the President’s budget include: – Medicaid/SCHIP: Specify allowable Medicaid managed care savings Additional SCHIP/Medicaid restrictions? – Medicare: Reimbursement for hospitals, SNFs, hospice Program integrity Others?