1. 7th Annual Indiana Rural Health Public Policy Forum: Washington Rural Health Policy Update Tim Fry, Government Affairs Manager National Rural Health Association Fry@NRHArural.org / 202-639-0550 Fry@NRHArural.org

2. Agenda Change comes to Washington –New players and new power for old players –Regulations on hold… Health reform coming to Washington? –Stimulus package –The Jigsaw Puzzle of health reform Be a rural advocate!

3. NRHA Mission The National Rural Health Association is a national membership organization with more than 18,000 members whose mission is to provide leadership on rural issues through advocacy, communications, education and research.

6. Change comes to Washington… Jan 20, 2009: Inauguration Day Obama had served on the HELP cmte. Assumption that Biden will focus on foreign policy Campaign promises on health

7. Health Leadership Team Sen. Tom Daschle, Sec. of HHS & WH policy Rep. Rahm Emanuel, Chief of Staff Peter Orszag, Budget Director

8. House of Representatives Democrats gained 21 –Vacant NY (Gildebrand) –Vacant IL (Emanuel) New leader in E&C Who will take the lead? –Rangel troubles? –Stark get his way? Republicans opposition – work with President?

9. Senate Democrats gained at least 7 seats (58) –MN recount make 59 Need 60 votes to end filibuster Republicans will get a chance to play a role

10. Regulations on hold No political appts. –Rural Health Clinics –Health Professional Shortage Areas –Hospital outpatient oversight issue –Other changes…?

11. Health Reform: Desire for change Is this the year? Most buzz since… –92-93 – HillaryCare –70s – too much for Nixon –60s - Medicare/Medicaid –12? - T. Roosevelts failed campaign Campaign promise

12. First stab? - stimulus $787 billion package –$87b for Medicaid –$1.1b for comp. effect research –Includes rural Rural broadband Rural water projects Workforce training Prevention/wellness

13. Rural facility development Grants specific to health $500m Indian Health Srv $1b Veterans Admin $2b Community Health Centers Rural development loans $130 million for rural community facility development –Translate to well over $1 billion in guaranteed loans for rural facilities, including health care facilities –In addition grants through USDA for facilities, including health care

14. Health Information Technology $2b for grants and office of HIT coord. Incentive payments for meaningful adoption: RHC/FQHC –30% needy patients –Medicaid cover no more than 85% of IT costs Eligible providers –Medicare up to 41k –Medicaid, if 30% Medicaid – 85% of IT costs CAHs –Depreciation value of Medicare IP % plus 20% –Paid same yr. as becoming meaningful PPS Hospitals –Base of 2m plus amount per discharge up to 23k –Paid over four year period

15. Down payment on reform? Stimulus got contentious Only 3 Rs voted with President HIT seen as precursor But so many other challenges…

16. Not to mention no money Unified Surplus/Deficit in Billions of Dollars Sources: Office of Management and Budget; Congressional Budget Office

17. Overall Debt Last 10 Years v. 2009 Sources: Office of Management and Budget; Congressional Budget Office

18. Impetus for reform Nearly 50 million uninsured Global economy is hurting companies ability to offer care Providers burdened with paperwork and lots of no-pay patients

19. Obama Campaign Plan 1.Lower costs –HIT, care coord. 2.Universal (or close) –Todays system plus 3.Public health –Preventative services and prepare for emergency

20. 1. Lower Cost Health information technology –Stimulus package Prevention and disease management –Less long-term costs Catastrophic coverage Quality payments –Transparency of care measures Drug/insurance –Insurance comp. –End MA overpayments –Drug price negotiations

21. 2. Increase Coverage End prior condition denial New plan options –Health Exchange to monitor options –Assure these options are as good as public plans –Portability Tax credits for businesses and ind. Employer requirements Children required Expand SCHIP and Medicaid State flexibility

22. 3. Public Health Worksite and school based initiatives Workforce development –Need more primary care and preventive providers Personal responsibility –Encourage families decisions Government, at all levels, have a role

23. Obama and Rural Health Seems committed –Responded to NRHA –Transition teams –Feedback wanted Reimbursement equity Workforce Infrastructure Photo taken by Tim Fry at the Inauguration of President Barack H. Obama, 44 th President of the United States

24. Provider impact? Payment cuts? –Likely long-term Less no pays –Possibly Rural payments? –Likely to continue Federal control –Likely more

25. We Need You! You are your own best voice Your member of Congress listens when you speak You will have more success than I

27. Thank you! Tim Fry, Government Affairs Manager National Rural Health Association Fry@NRHArural.org / 202-639-0550 Fry@NRHArural.org Photo taken by Tim Fry at the Inauguration of President Barack H. Obama, 44 th President of the United States