1. Translating Health Data Into Policy Political Priorities and Fiscal Realities National Association of Health Data Organizations Member Workshop Series April 24, 2003 Presented by Robert J. Burns NGA Center for Best Practices

2. © 2003 National Governors Association 2 Objective State budget process Powers of the Governor (and the office) Common, policy-driven language To share a fiscal and political context through which you can communicate health data issues with policymakers:

3. © 2003 National Governors Association 3 “The budget process…determines public priorities by allocating financial resources among competing claims.” “The budget process…determines public priorities by allocating financial resources among competing claims.” Budget Processes In The States National Association of State Budget Officers (January 2002)

4. © 2003 National Governors Association 4 State Fiscal Crisis Closed $37.2 billion gap going into FY02 Closed $49.1 billion gap going into FY03 Budget gaps widened during FY03 (36 states) –50 percent growth since November 2002 –Must close additional $25.7 billion by July 1 Source: National Conference of State Legislatures, February 2003

5. © 2003 National Governors Association 5 State Budget Actions FY2002FY2003 Budget gaps (in billions) $37.2$49.1+ Budget cuts 29 states Other state reserves 20 states 23 states Tobacco settlement funds 12 states 16 states Income and sales taxes 16 states Rainy day funds 19 states 12 states Other taxes and fees 13 states 10 states Source: National Conference of State Legislatures

6. © 2003 National Governors Association 6 FY2004 Outlook States face $82 billion budget gap going into FY04 (projected) –Revenues inadequate to meet existing commitments 28 states proposing cuts to major programs (previously untouched) 15 states calling for tax increases National Association of State Budget Officers, February 2003

7. © 2003 National Governors Association 7 “The chief executive of a state today holds more power and sway over the public purse and policy—and likely presents more of a leadership profile in the state than any other office holder other than the President.” “The chief executive of a state today holds more power and sway over the public purse and policy—and likely presents more of a leadership profile in the state than any other office holder other than the President.” Ray Sheppach Executive Director National Governors Association

8. © 2003 National Governors Association 8 Gubernatorial Powers (Formal powers that may not require legislative approval) Submit the state budget –Establish policy priorities –Set spending targets Veto components of legislative budget –Appropriations –Selected words –Change meaning –Line item Cut the budget Reorganize departments Spend unanticipated federal funds

9. © 2003 National Governors Association 9 Gubernatorial Elections 2002 36 Governors were up for election –14 term limited –6 voluntary withdrawals –16 incumbent challenges 11 incumbents returned 24 new Governors assumed office –Party changes in 20 states

10. © 2003 National Governors Association 10 Gubernatorial Changeovers (even years only) 200225 20007 199814 19965 199421 199211 199018 19886 198622 198411 198218 Source: National Governors Association, November 2002

11. © 2003 National Governors Association 11 Opportunities New priorities Energy, enthusiasm, personality –Relationship with the public –Relationship with legislature New appointees –Commissioners, deputies, senior staffers –Administer the Governor’s policies –Advance the Governor’s issues Searching for solutions

12. © 2003 National Governors Association 12 Gubernatorial Priorities (Governors-Elect) Fostering economic recovery (balancing state budgets) Bolstering homeland security Maintaining education initiatives Containing health care costs Source: National Governors Association

13. © 2003 National Governors Association 13 Gubernatorial Health Priorities (Governors-Elect) Containing pharmaceutical costs Leveraging Medicaid and SCHIP Bolstering the health care workforce Financing long-term care Source: National Academy for State Health Policy, November 2002

14. © 2003 National Governors Association 14 Why is HIPAA Still “Emerging?” Legally Complex –Privacy –New terms and interpretations Technically Complex –Electronic transactions –Electronic data interchange Poor Guidance –Staggered rule making –No arbitration process –No validation

15. © 2003 National Governors Association 15 “I cannot keep from talking, even at the risk of being instructive.” “I cannot keep from talking, even at the risk of being instructive.” Mark Twain American author, humorist

16. © 2003 National Governors Association 16 Effective Communication What does a Governor really need to know about HIPAA (implementation)? Complicating the budget situation Impeding access to health care Affecting the quality of care Threatening provider solvency Impairing state-level program administration Hindering ability to make good policy decisions

17. © 2003 National Governors Association 17 Recommendations Understand the budget process, environment Get to know the Office, staff, priorities Learn to speak the language –Relate agenda to policy priorities –Offer solutions –Be practical (political, fiscal reality) –Build consensus –Offer (or identify) resources

18. © 2003 National Governors Association 18 NGA Center for Best Practices (http://www.nga.org/center) Robert J. Burns Policy Analyst Health Policy Studies Division National Governors Association Center for Best Practices Hall of States, Suite 267 444 North Capitol Street, NW Washington, DC 20001-1512 (202) 624-7729 fax: (202) 624-5313 email: rburns@nga.org