1. Grassroots Call, July 12, 2011: Emergency GAC Call

2. Today’s Call 1. Debt Ceiling 2. Rumors rural cuts 3. Cantor’s Proposal

3. Background Debt ceiling/August 2 Deadline Must have agreement soon. Will take time to draft legislation This week is critical.

4. Gang of 6 failed Joe Biden negotiations failed President has taken over negotiations “everything is on the table” including rural Medicare payments.

5. Who’s in the room President Obama Senate Reid – D-NV Durbin – D-IL McConnell – R-KY Kyl – R-AZ House Boehner – R-OH Cantor – R-VA Pelosi – D-CA Hoyer – D-MD

6. Earlier Biden proposals may have included reworking cost-based reimbursement. Now Cantor proposal: $16 billion in specific rural cuts.

10. Inside and Outside Strategy NRHA has hit and will continue to hit key Congressional targets Administration; WH call, HRSA Outreach to all rural associations Grassroots must be fully mobilized Call and email Member Go to District Office Letters to editor

11. STATECAHRHC Alabama275 Alaska132 Arizona1418 Arkansas2972 California31285 Colorado2954 Florida13146 Georgia3494 Hawaii92 Idaho2744 Illinois51221 Indiana3563 Iowa82142 Kansas83179 Kentucky30150 Louisiana27106 Maine1639 Massachusetts31 Michigan36157 Minnesota7981 Mississippi31168 Missouri36366 STATECAHRHC Montana4853 Nebraska65138 Nevada118 New Hampshire1311 New Mexico711 New York137 North Carolina2384 North Dakota3658 Ohio3417 Oklahoma3443 Oregon2564 Pennsylvania1363 South Carolina5109 South Dakota3857 Tennessee1762 Texas79316 Utah1118 Vermont815 Virginia746 Washington38129 West Virginia1854 Wisconsin5850 Wyoming1618 Critical Access Hospitals and Rural Health Clinics By State

12. RRCMDHSCH AK003 AL889 AR5311 AZ106 CA6114 CO0111 CT201 DE100 FL536 GA12610 HI005 IA262 ID101 IL597 IN931 KS1511 KY16103 LA5105 MA011 ME144 MI5313 MN038 MO5610 RRCMDHSCH MS131110 MT204 NC8102 ND001 NE112 NH100 NM1012 NV004 NY4813 OH855 OK6815 OR201 PA999 SC315 SD004 TN6246 TX71745 UT007 VA3711 VT011 WA303 WI247 WV644 WY0010 Rural Referral Centers, Medicare Dependent and Sole Community Hospitals

13. Big Plan vs. Little Plan $2.4 trillion - $4 trillion SGR fix? Rural Extenders

14. The costly Doc Fix Congress consistently blocks scheduled cuts from taking effect, and has to come up with new offsets each time. According to the AMA, a permanent SGR repeal would have cost $48 billion in 2005 — compared with a price tag of nearly $300 billion to block the cuts that are scheduled for January. "An agreement on the debt ceiling legislation provides the best — and perhaps only — opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner," the AMA and other organizations said Monday in a letter to President Obama.

15. Rural Provisions set to expire at same time as SGR Positive adjustments in the GPCI Outpatient hospital hold harmless provisions Extension of the Medicare Dependent Hospital Program Section 508 Hospital Payments (reclassification) Rural Ambulance Super bonus Technical component cost for certain pathology services Low volume/high quality adjustment

16. The Message Don’t support debt ceiling proposal that contains devastating cuts to rural health care. $16 billion in Medicare cuts to rural providers will decimate the delivery of health care to the 62 million who live in rural American. Rural hospitals are critical to the patients they serve and to the rural economy.