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The Politics of Health Care:State and Federal Policy Priorities for Advocate Health Care
Meghan Clune Woltman, Vice President, Government and Community Relations
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Discussion Topics
• State Initiatives
• Federal Outlook
• Supreme Court
• Global Health Care Issues
• Q & A
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State Initiatives2012 Spring Session – what happened?
• Budget Challenges
• Nonprofit Hospital Property Tax Exemption
• Medicaid Changes– SMART Act Implementation
• Rate adjustments
• Utilization controls
• Eligibility, coverage and care coordination
• HACs, therapy, readmissions
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Medicaid 2012: OverviewGovernor’s Proposal Final Legislation
$2.7 billion total: $2.7 billion total:
$1.35 billion targeted savings/reductions $1.36 billion targeted savings/reductions
$675 million cigarette tax $700 million cigarette tax
$675 million provider rate cuts $240 million provider rate cuts
- $350M or 8% hospitals - $108 million or 3.5% hospitals
$100 million new assessment
- $190 million gain for hospitals
$300 million - GRF
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Hospital Payment System Reform• HFS may implement new inpatient and
outpatient payment system by rule as set forth in statute
• Inpatient payment system – 10/1/12 – test & shadow
– 7/1/13 – Implement new system• Base payment only
• Supplemental payments and assessments separate
– 7/1/14 – Begin 2-4 year transition of static payments
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Looking Forward• Continued SMART Act implementation
• CMS approval of Enhanced Assessment
• Medicaid Payment System Reform
• Care Coordination Expansion
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Federal OutlookWhat can we expect from the Congress?
• November Elections
• Bush Tax Cuts Expire
• 10 month Physician Fix expires – 27% cut, costs $376B to fix
• Debt Ceiling Debate…again
• Sequestration Starts– 2% across the board reductions
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Supreme Court• Upheld Individual Mandate through Taxing
Power of the Congress• Found Medicaid Coercion Unlawful• States can opt out of Medicaid Expansion• Congressional Budget Office Assumes $84B
savings through SCOTUS decision• No change for Advocate – already the largest
Accountable Care Organization in the nation.
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2014 Coverage Continuum
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It’s a New Day• Most Insurers Acknowledge Inability to
Manage Rising Costs
• Medicare Finances are Not Sustainable
• Payers Can No Longer Sustain Double-Digit Increases
• Population is Aging - 10,000 New Medicare Beneficiaries Per Day
• Uninsured Will Enter Care Delivery System
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Global Issues• Health Care’s Impact on Economy
• Providers Need to Reduce Costs
• Alignment of Incentives– Patients/Providers/Health Plans
• Medicare/Medicaid– Medicaid is largest expense in state budgets
– Alignment of the patient
• End of Life Cost of Care
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Questions?