Advocacy Health Policy - Emergency Medicine Residents ...

Advocacy Health Policy - Emergency Medicine Residents ...

Introduction to Health Advocacy and Resources Sarah Hoper MD,JD EMRA Legislative Advisor What is Advocacy? Advocacy is political activity with the goal of creating change. Based on the power of people to take collective action on their own behalf

Federal, state, and local level Advocacy Physicians public role: advocacy for and participation in improving the aspects of communities that affect the health of individuals. Gruen RL, Pearson SD, Brennan TA. Physician-Citizens Public Roles and Professional Obligations. JAMA. 291: 94-98. 2004. Why Should We Advocate? Our

Patients. Medicaid State Expansion Health Insurance Exchanges Ourselves. Medical GME

Liability Funding Public Awareness of ACA http://www.kff.org/kaiserpolls/upload/8425-C.pdf Public Awareness of ACA Enroll America survey found:

83% of those eligible for Medicaid are unaware they will qualify for the program 78% of those eligible for tax credits to buy insurance through the exchanges are not aware of their eligibility. Available at: http://www.enrollamerica.org/categories/population- Public Awareness of ACA Health Exchanges Medicaid Expansion

Medicaid Expansion ACA expands the number of people the states must cover Any one 64 and younger with income up to 133% of the federal poverty level

will be covered by Medicaid Medicaid Expansion 133% of Federal Poverty level: Family of 1: $14, 856 Family of 2: $20, 123 Family of 3: $25, 390 Family of 4: $30, 657 Family of 5: $35, 923 Family of 6: $41,190

JAMA. 2013;309(12):1219-1219. doi:10.1001/jama.2013.2481 Medicaid Expansion Federal Govt will pay 100% of the costs of new patients until 2016 In the following years the federal payment will gradually decrease to a

minimum of 90% in 2020 Medicaid spending will increase by $100 billion/year 40% increase Alternatives to Medicaid Expansion Missouri

HB 700 Expand Medicaid eligibility up to 100% of the federal poverty line This leaves out 80K Missourians who earn b/ w 100-138%

Alternatives to Medicaid Expansion The Arkansas Plan Use the federal funds to buy private health insurance for the 200,000 people who would have been covered under the expansion HHS

Secretary Kathleen Sebelius has agreed to this proposal Alternatives to Medicaid Expansion Arkansas Florida, Ohio, Louisiana, Maine, Oklahoma, Tennessee and Pennsylvania are considering this option Alternatives to Medicaid Expansion Arkansas Downside:

The CBO estimates it will cost $9,000 per person to buy private insurance compared to $6,000 to add a person to Medicaid because private insurers pay hospitals and doctors more then Medicaid does Advocacy Points

Medicaid expansion will improve the healthcare of millions of people How will the system care manage the influx of patients States that have chosen not to expand will loose out and billions of dollars of federal money But

will the money be there as promised in future years Will Patients flux from one to state to another to get benefits? The House Voted for the 37th time to totally repeal the ACA last week

Advocacy Resources - ACA HealthCare. Gov Governments website on the ACA http://www.healthcare.gov/law/ Health Insurance Exchange Small

employers (100 employees) and individuals will qualify for the exchange Large companies can use the exchanges for pre-Medicare retirees and part-time employees. Health Insurance Exchange Insurers

cannot refuse to insure any individual. The plans cannot have lifetime and annual limits. There will be four plans:

Bronze - will cover 60% of medical costs Silver will cover 70% of medical costs Gold will cover 80% of medical costs

Platinum- will cover 90% of medical costs Health Insurance Exchange Each of the plans will be limited to out-ofpocket expenses of: $5,950 for individuals

$11,900 for families Health Insurance Exchange State Run Partnership Federally Run Health Insurance Exchange Congress

estimates 22 million people will be insured through the exchanges 1 million will be high-risk individuals with pre-existing conditions Rep. Henry A. Waxman; Rep Bart Stupak (October 12, 2012). Re: Coverage Denials for Pre-Existing Conditions in the Individual Health Insurance Market. U.S. House of Representatives Committee on Energy and Commerce. Available @ democrats.energycommerce.house.gov/Press_11/20101012/Memo.Preexisting.Condition.Denials.Individual.Market.2010.10.12pdf Pauly MV, Herring B. Risk Pooling and Regulation: Policy and Reality in Todays Individual Health

Insurance Market. Health Affairs. 2007; 26 (3): 770-779. Health Insurance Exchange In 2017, states can expand their exchanges to include employers with more than 100 employees. RAND report estimated 35 million employees will be covered by exchange Congressional

Budget Office projects 5 million employees Eibner C, Girosi F, Price CC, Cordova A, Hussey PS, Beckman A et al. Establishing state health insurance exchanges: implications for health insurance enrollment, spending, and small businesses. Santa Monica (CA): RAND Corporation; 2010 Available at http://www.rand.org/content/dam/rand/pubs/technical_reports/2010/RAND_927.pdf

Congressional budget Office. Letter to the Hon Nancy Pelosi. Washington (DC): CBO; 2010 March 20. p.9. Available at: http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf Health Insurance Exchange Tax Credits 2014 Available for those with income between 133% and 400% of the poverty line who are not eligible for other affordable

coverage. In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four. Vermont Exchange Rates Rates range from: average

high of $1,700 a month for a family average of $745 for catastrophic coverage, only available to people under age 30 http://www.dfr.vermont.gov/sites/default/files/Filed%20QHP%20rates.p df http://bostonglobe.com/metro/2013/04/01/first-state-post-healthinsurance-rates/GxJWkuKWHoRVy6uJYXNczK/story.html Vermont Exchange Rates

With the tax credit: Family of four with an annual income of $32,000 would end up paying $45 a month out of pocket. Single person with a $40,000 income would pay $317 a month

Health Insurance Exchanges Downside People moving from catastrophic plans to fully insured products will pay more Society of Actuaries showed insurers would pay an average of 32% more per claims on individual polices due to the inability to turn away pre-existing conditions

Bais?-Society of Actuaries and the Health Insurance Companies closely related http://thehill.com/blogs/healthwatch/health-reform-implementation.290603-white-house-on-defense- Health Insurance Exchanges Downsides In California: People

with incomes > 400% of the FPL that are not covered by an employer and are using health exchanges may have an increase of 30% in their premiums and 20% in the total cost of health care However, those with incomes < 400% of the FPL are in line to save 84% on their premiums and 76% on the total cost of health care http://www.latimes.com/business/money/la-fi-mo-calif-health-insurance-premium-rates-20130328,0,4950624.story Health Insurance Exchanges Downsides California - People under 25 will have a 25% increase in premiums Increases

are due to guaranteed coverage of all applicants including sick patients that were previously denied Downsides Insurance Loop Hole ACA allows insurers to extend existing coverage through the end of 2014 without following the new rules Insurers

might rush to enroll more people in individual policies before December so that they then can extend those policies through next year. Advocacy Points Patients need to know they are eligible for the exchanges and how to access the exchanges

Patients need to know if they qualify for the tax credit Different states will have different insurance benefits FUNDING!!!!! Advocacy Resources - ACA

Enroll America http://www.enrollamerica.org/ HR 36 Health Care Safety Net Enhancement Act of 2013 Emergency Medicines Shortcut Around Medical Liability

EMTALA care would be covered under Public Health Service ACT United States. Cong. House. Health Care Safety Net Enhancement Act of 2013. 113th Cong., 1st sess. @ http://thomas.loc.gov/cgi-bin/bdquery/z?d113:H.R.36: Emergency Medical Treatment and Active Labor Act

Enacted in 1986 to stop Patient Dumping All patients must receive a medical screening examination and stabilization prior to transfer Physicians working in an Emergency Department cannot choose who they treat

"Overview EMTALA." Centers for Medicare & Medicaid Services. Web. 17 Aug. 2011. . EMTALA EMTALA EMTALA Flaw Service Payment Service = Liability

Specialist Coverage 2/3 EDs - inadequate on-call specialist coverage Not being paid Sicker population = Bad Outcome Same Liability Vanlandingham B. On-call Specialist Coverage in U.S. Emergency Departments. Irving, TX: American College of Emergency Physicians; 2004 HR 36 Health Care Safety Net

Enhancement Act of 2013 Public Health Service Act Health Care practitioners shall be deemed federal employees for the purposes of medical malpractice liability Except

for gross negligence, physicians cannot be sued BUT United States government may be liable under the Federal Tort Claims Act HR 36 HR The 36 has passed the House 13 times bill has NEVER passed Congress

BUT Sen. Roy Blunt brought the bill to the Congressional Floor Last week GME Funding Proposed GME cuts : Simpson-Bowles

Commission: 60 percent/$60 billion Obama 2014 Fiscal Budget: 10 percent/$11 billion Others 20 percent/$20 billion

GME Funding 10% reduction cut 4,098 residents 33% reduction cut 13,662 residents 50% reduction - cut 22,411 residents

GME Funding The current physician shortage will exceed 130,000 doctors by 2025 (in all specialties). The Medicare population will grow by 36 percent over the next 10 years.

One in three physicians is expected to retire in the next 10 years. Alternate GME Funding Residents Industry More pay tuition sponsored residency training

Residency Positions that area paid for by Foreign Countries GME Funding The Association of American Medical Colleges Advocacy Resources - GME AAMC GME Funding: https://www.aamc.org/advocacy/

Advocacy Resources Kaiser Family Foundation http://kff.org/ http://www.kaiserhealthnews.org/ Advocacy Resources Washington Post Wonk Blog Health

Policy http:// www.washingtonpost.com/blogs/won kblog/wp/tag/health-care / Advocacy Resources Politico Health Policy

http://www.politico.com/healthcare/ Advocacy Resources The Hill Health Watch Blog http:// thehill.com/blogs/healthwatch/health -reform-implementation/300037-over night-health

Advocacy Resources List Serves ACEP 911 A weekly e-mail on Monday's while the House and Senate are in session detailing current health policy activity in Washington Sign Up http://

www.acep.org/Content.aspx?ekfrm=40334 Advocacy Resources List Serves Health Leaders Media http://www.healthleadersmedia.com/ Advocacy Resources- List Serve The

Huddle- Politico A Play by Play Preview of the Days Congressional News http://www.politico.com/huddle/ More then just Healthcare Advocacy Resources List Serves

National Journal http:// www.nationaljournal.com/n2ksignup Advocacy Resources List Serves American Health Line

http://www.americanhealthline.com/ Not Free Advocacy Resources EMRA Health Policy Committee Facebook Page https://www.facebook.com/EMRA.Health.Policy EMRA

Twitter Account @EM Advocacy Advocacy Resources ACEP StateScan http://www.acep.org/StateScan/

Advocacy Resources Open Secrets. Org http://www.opensecrets.org/lobby/ Lobbying Dollars Spent 3500000 3000000 2500000 2000000 1500000

1000000 500000 0 2005 2006 2007 ACEP Nurse Anesthestists 2008

2009 2010 2011 American Nurses Association Anesthesiologists 2012

Recently Viewed Presentations

  • Organizational Supplier Management

    Organizational Supplier Management

    Supplier Selection: Case Study 1. Technetium-99 is an isotope used in healthcare as a radiotracer . Widely used in healthcare worldwide since the 1960s
  • What is this thing? Essential Learning: I can

    What is this thing? Essential Learning: I can

    2. Texture: Clastic, Crystalline, Bioclastic. 3. Grain Size... 4. Composition category... 5. Comments category... 6. Fossils? Describe if present. 7. How do you think if formed? Compaction Cementation, water solution, evaporation. 8. Other observations? Do this for all 7 samples....
  • Applied Sciences Program - Wildfires Earth Science Serving

    Applied Sciences Program - Wildfires Earth Science Serving

    Points of Contact: Dr. Wilfrid Schroeder (Univ. of Maryland) Project Principal Investigator (202) 341-7763, [email protected] Dr. Janice Coen (NCAR) (303) 497-8986, [email protected] CAWFE simulation of the 2012 High Park wildfire. The rate of heat release (W.m-2) is shown, according to...
  • CMMI HCIA Awardee Progress Report: Ochsner Clinic Foundation ...

    CMMI HCIA Awardee Progress Report: Ochsner Clinic Foundation ...

    Renard Murray, D.M. Consortium Administrator for Quality Improvement and Survey and Certifications Operations (CQISCO) Centers for Medicare & Medicaid Services (CMS) The Search for Health Equity through Legislation and Regulation. October 14, 2016
  • Racial and Ethnic Identity - SSCC - Home

    Racial and Ethnic Identity - SSCC - Home

    Racial and Ethnic Identity Racial Formation and Social Construction Introductory Questions Which of the following identities is socially constructed? Race Ethnicity Class Gender Merit Questions, continued Which of the following is most important in determining one's life chances in American...
  • Présentation PowerPoint

    Présentation PowerPoint

    VISION 2020. Increasing disposable income, Expanding urban population, Growing internet penetration and . Availability of strong distribution network
  • VISION 2.0 OPEN FORUM  WRAP UP November 2

    VISION 2.0 OPEN FORUM WRAP UP November 2

    UMA Mission & Vision Statements. UMA Mission. UMA transforms the lives of students of every age and background across the State of Maine and beyond through access to high-quality distance and on-site education; excellence in student support, civic engagement, and...
  • Revolutions and National States in the Atlantic World

    Revolutions and National States in the Atlantic World

    Nat. Assem. declared war on Austria, Prussia, Spain, Britain, Netherlands. The Convention (legislative body elected by universal male suffrage) Universal conscription of people and resources for war. Sought out enemies at home: executed many with guillotine (Louis and Marie Antoinette)