A Conversation with Elizabeth Falcone Senior Policy Advisor Office of Senator Mark R. Warner To the Northern Virginia Technology Council Health Technology Committee April 15, 2014 Presentation and comments are representative of speaker s only
Mark R. Warner Mark Warner spent 20 years as a successful technology and business leader in Virginia before he was elected to public office. The first in his family to graduate from college, thanks to the student loan program, he made a career in business and invested in hundreds of start-up companies which created thousands of jobs in the Commonwealth. Mark Warner was elected Virginia Governor in 2001, and worked with a Republican legislature to turn a $6 billion budget shortfall into a $1 billion budget surplus. He brought business efficiency to state government, launched innovative education reforms, and led an economic development effort that created nearly 130,000 new jobs across Virginia. When Mark Warner left the Governor's Office, Virginia was ranked as the best state for business, the best managed state, and the best state in which to receive a public education. Governor Warner was elected to the United States Senate in 2008, and serves on the Banking, Budget, Finance and Intelligence committees. At a time when Washington seems gridlocked by partisan politics, he has emerged as a bipartisan leader who's willing to cross the political aisle to bring people together and get things done. Mark Warner has consistently been in the Senate's sensible center, working with Republicans and Democrats to cut red tape and reduce spending. He has partnered with Senate Republicans on every major piece of legislation he has introduced, including bills to end taxpayer bailouts of failing banks, address our significant infrastructure needs, and promote innovative new tools for start-up companies and job creation. Senator Warner has been recognized as a national leader in fighting for our military men and women and veterans, and working to design a bipartisan, comprehensive plan to address our country's debt and deficit. His brand of bipartisan cooperation is what we need more of today in Washington. 2
AFFORDABLE CARE ACT 3
2010 Immediate benefits 2014 Access High Risk Pool for those who can t get insurance due to pre-existing conditions Dependants on parents coverage until age 26 No denying care to children under 19 because of pre-existing conditions Restrict insurance companies from dropping you if you get sick (rescissions) Benefits Eliminate lifetime spending limits Coverage of preventative services with no cost sharing Creates a formalized appeals process Seniors receive help with Medicare Part D Donut Hole Value Minimum loss ratios (i.e. certain percentage spent on benefits) Evaluate unreasonable rate increases Insurers report on quality, financial, & other factors Standardize explanation of coverage forms Federal website on affordable coverage options
Insurance Coverage Went from these options: Self-employed/ individual Market Small Group employers
To a new type of roof: Health Insurance Marketplaces
92% of Americans would have health insurance, mostly private coverage. 35 million individuals, self-employed people, and small business up to 100 workers, will shop for private insurance through the national exchange. Individuals under 400% FPL get credits to help cover costs of premiums and cost-sharing. 78 million adults, parents, pregnant women, children up to 133% FPL would receive Medicaid. 164 million would buy private coverage from their employer. Non-elderly population for 2022 Source: CBO re-estimate 7/24
Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 8
State Data on Enrollment and Subsidies Received As of March 2014 Source: Data analyzed in Kaiser Family Foundation March 2014 Issue Brief: How Much Financial Assistance are People Receiving Under the Affordable Care Act? NOTE: On April 10, 2014 Secretary Sebelius announced national selection number is closer to 7.5 million; state specific numbers were not released by time of this presentation. 9
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Expanded Consumer Choice Act, S.1729: Creates a new coverage option, the Copper Plan, to be offered to consumers along with the existing Platinum, Gold, Silver and Bronze health care plans. Copper Plans will provide a lower-cost, higher-deductible option for consumers, while also covering the essential health benefits and consumer protections required of all health care plans offered through the Affordable Care Act (ACA). Study commissioned by CAHC says that could lower premiums by as much as 17% compared to bronze plans currently Supported by: Communicating for America, Evolution1, Healthcare Leadership Council, National Association for the Self-Employed, National Association of Manufacturers, National Association of Distributors, National Retail Federation, Small Business and Entrepreneurship Council, The National Grange, BlueCross BlueShield Association 12
Commonsense Competition and Access to Health Insurance Act, S.2174: Directs state insurance commissioners to work together to design an effective model that would allow insurers to offer coverage across state boundaries, increasing competition and choice for both consumers and employers. Directs the National Association of Insurance Commissioners to identify any regulatory and administrative challenges while designing a more open and transparent system to maintain consumer protections while providing insurance products across state lines or within a specific region. 13
Commonsense Reporting Act, S.2176: Seeks to ease reporting requirements for employers. Limits collection of dependent TIN Streamlines employee communication Directs the Department of Health & Human Services and the Treasury Department to design a more workable and less burdensome system for employers to report the hours worked by their employees. Supported by: Retail Industry Leaders Association (RILA), Food Marking Institute, National Restaurant Association. 14
The Increased Competition for Consumers Act, S.1333: restores startup funds for new consumer-driven health insurance cooperatives. This bill will allow families to have more options to access health coverage beyond traditional insurance companies, infusing state marketplaces with more competition to reduce average premiums. The Small Business Stability Act, S.2168: expands the option for voluntary health coverage to employers with fewer than 100 employees, about 98 percent of all businesses. It is currently required that businesses with more than 50 employees must offer employees coverage. Requiring small businesses to provide health care to employees is asking them to become experts in a complicated issue that could put a huge burden on them. This bill aims to let small businesses make their own choices, while still making sure employees can shop for coverage on the individual Marketplace. The Small Business Tax Credits Accessibility Act, S.2069: improves flexibility, increases affordability, and eases the transition for small businesses by making small business health care tax credits available for a longer period of time and accessible to more employers. Small businesses would be able to spend less time and money worrying about how they will provide coverage for their employees. Expanding the current tax credits to include businesses with fewer than 50 employees instead of the current cap at 25 employees would provide a real benefit to hundreds of thousands of small businesses and allow them to offer quality care while recruiting and retaining talented employees. The Consumers Having Options in Choosing Enrollment Act (CHOICE), S. 2173: provides a permanent path for consumers to seamlessly enroll for health coverage directly through insurers or certified webbased entities, in addition to enrolling through healthcare.gov, making it easier for individuals and families to access quality health insurance. The Enhancing Access for Agents and Brokers Act, S. 2175: This proposal improves access for agents and brokers to help families and small businesses enroll in health plans on the Marketplace. Agents and brokers are trusted advisors for many families and businesses and should be able to help with these kinds of decisions. 15
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Source: Marketplace Virginia Presentation by Senate Finance Committee. Access VHHA website 4/14/14 18
Missing out on expansion would cause between $4 - $5 million Virginia tax dollars to not come back to Virginia Source: Marketplace Virginia Presentation by Senate Finance Committee. Access VHHA website 4/14/14 19
Source: Marketplace Virginia Presentation by Senate Finance Committee. Access VHHA website 4/14/14 20
HEALTH INFORMATION TECHNOLOGY 21
Bipartisan Letter asking for additional clarity over current policies and oversight over mobile medical applications and other software 22
Comments Due: July 7, 2014. 23
Supporting telehealth & physicians being listened to practice in multiple states 24
Source: ONC, http://www.healthit.gov/sites/default/files/physicianadoption_of_ehrs2014_01.15.14.pdf 25
Growth is fine But it matters what is growing and what physicians/hospitals/others are using. And whether it is helpful to practitioners, patients, and the system as a whole Expert of Letter to ONC & CMS from Senator Warner 2/21/12: 26
OTHER ISSUES 27
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Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 29
Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 30
Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 31
What is Delivery System Reform? Current System Fragmented Costly Inefficient Poor outcomes Quality issues Quality Reporting Financial Incentives Accountable Care Organizations Medical Homes Bundling Payments Health IT? Ideal System Coordinated Patient-focused High value High quality Slow cost growth
ACA used the power of Medicare to ensure effective change Aggressive Investigation and Elimination of Fraud, Waste, and Abuse Innovative ways to deliver care through Pilot Projects, Shared Saving Models, etc Ensure Payment Policy is Effective through The Medicare Payment Advisory Commission Monitor costs and spending trends through The Independent Payment Advisory Board
Prescription Drugs Pathway for generic biologics drugs Improved Medicare drug coverage, including branded discounts Industry excise tax Comparative Effectiveness Research Workforce Advisory Committee to develop national strategy Loans & scholarships to increase supply and training Redistribute Graduate medical Education (residency) slots Quality Improvement National Quality improvement strategy Expanded Physician quality reporting mechanisms
Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 36
Source: CBO 2/27/14 Presentation: Federal health Care Spending: Why Is It Growing? What can Be Done About it? 37
Thank you & Questions Contact me: Elizabeth Falcone Elizabeth_Falcone@warner.senate.gov (202) 224-2023 Contact Senator Warner http://warner.senate.gov Richmond (804) 775-2314 ** Vienna (703) 442-0670 ** Roanoke (540) 857-2676 Abingdon (276) 628-8158 ** Norfolk (757) 441-6250 ** DC (202) 224-2023