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{ timecode: 0, handler: 'blob', id: 1, data: {text: 'DAVID WHITE: Good afternoon everyone. Good afternoon everyone! Okay, welcome. We are getting started a little bit late and it is my job to kind of keep us more or less on track. It is going to be a '}},
{ timecode: 19, handler: 'blob', id: 2, data: {text: 'little hard to do that. Again, my name is David White, I’m with Coordinated Transportation Solutions in Connecticut and I’m also the New England representative on the CTAA Board. I’m '}},
{ timecode: 29, handler: 'blob', id: 3, data: {text: 'very pleased to have you here for the Partnership and Wellness Conference this afternoon. The last couple of sessions of what I think have been, and I hope everybody would agree, has been a very good '}},
{ timecode: 41, handler: 'blob', id: 4, data: {text: 'couple of days. A couple of housekeeping items that we wanted to go over; one is we have two flip charts on, one on either side of the room here, if everyone, we’re trying to figure out of '}},
{ timecode: 57, handler: 'blob', id: 5, data: {text: 'course with your help, how to keep the group sort of together after the close of the conference. How to communicate with you, how you can communicate with one another with ideas and thoughts, not only '}},
{ timecode: 71, handler: 'blob', id: 6, data: {text: 'on the conference but as you go back to your offices and your agencies, on the subjects that came up over the last couple of days. And if you would put down some ideas for us, I see I think a couple '}},
{ timecode: 86, handler: 'blob', id: 7, data: {text: 'of people have but I think there has certainly been a lot of juices flowing here over the couple of days, so if you could put some ideas down we would really appreciate it. Also, of course, we want to '}},
{ timecode: 100, handler: 'blob', id: 8, data: {text: 'remind everybody including myself, let’s make sure our cell phones are off or on vibrate. That would be good. And, we have 3 panels left for the afternoon. Before I introduce the first one, the '}},
{ timecode: 116, handler: 'blob', id: 9, data: {text: 'one that is going to start in about a half an hour, it will be led by Dave Raphael, and that is going to be a really good panel on policy discussion on Medicaid non-emergency medical transportation. '}},
{ timecode: 132, handler: 'blob', id: 10, data: {text: 'David always, always leads a very exciting and though provoking panel. And then the last one at the end of the day is something we haven’t done before, and that is on Stretcher Transportation, '}},
{ timecode: 148, handler: 'blob', id: 11, data: {text: 'which isn’t everywhere in the country, but we know it’s in New York, it’s in Florida, it’s in Georgia. I’m told by Dave Cyra, who is going to be leading the conversation '}},
{ timecode: 160, handler: 'blob', id: 12, data: {text: 'that there is only one state in the country that are actually putting regulations together on it. It’s out perhaps in Washington State, and so it’s at the end of the day, but it is a '}},
{ timecode: 174, handler: 'blob', id: 13, data: {text: 'critically, what we’re seeing in non-emergency medical transportation, it’s a critically important subject that’s starting to pop up and that’s why we wanted to get it on the '}},
{ timecode: 185, handler: 'blob', id: 14, data: {text: 'conference agenda. So, looking forward to having you stick around for that. So, without further ado, I would like to introduce Jennifer Sullivan. Jennifer is a Senior Health Policy Analysis with '}},
{ timecode: 202, handler: 'blob', id: 15, data: {text: 'Families U.S.A. She has been with, who’s going to be talking about Health Care Reform and challenges and the way forward to kind of get us started off this afternoon. Jennifer has been with '}},
{ timecode: 216, handler: 'blob', id: 16, data: {text: 'Families U.S.A. for about 3 years. Prior to that she was with the Urban Institute in her area of expertise and we are really glad to have her with us today and is with Medicaid and the S-Chip '}},
{ timecode: 231, handler: 'blob', id: 17, data: {text: 'programs. And I was talking to Dave Raphael a few minutes before the program stuff before we got started here, and Families U.S.A., of course, has been around for many, many years and actually CTAA '}},
{ timecode: 245, handler: 'blob', id: 18, data: {text: 'and its predecessor organization actually has experience working with Families U.S.A. going back into the early 80s, rural America. So, we’re very pleased that we’re continuing our '}},
{ timecode: 262, handler: 'blob', id: 19, data: {text: 'association with Families U.S.A. and without further ado, let me introduce Jennifer Sullivan. JENNIFER SULLIVAN: Thanks very much. When I found out last Thursday that I would be coming here today, I '}},
{ timecode: 280, handler: 'blob', id: 20, data: {text: 'looked at the agenda and thought, okay they have me after lunch so either they think I’m going to be really enthusiastic and keep you all awake, or they don’t really care if you sleep '}},
{ timecode: 288, handler: 'blob', id: 21, data: {text: 'through my presentation. So, take whatever option you’re most comfortable with, I’ll try and keep you awake. So I’m here, of course, jetting in from the beltway to give you a little '}},
{ timecode: 298, handler: 'blob', id: 22, data: {text: 'brief on what’s going on with Healthcare Reform. It would seem as though now that congress is back from the most recent recess over Memorial Day, this is the week. Things are kicking off, things '}},
{ timecode: 308, handler: 'blob', id: 23, data: {text: 'are happening. If I don’t check my blackberry during the middle of this presentation I might miss something. It’s a very exciting time to be working on this stuff. A little bit more, just '}},
{ timecode: 318, handler: 'blob', id: 24, data: {text: 'about Families U.S.A. for those of you who don’t know who we are. We are a non-profit, non-partisan, consumer-advocacy organization. We are dedicated to high quality, affordable health coverage '}},
{ timecode: 328, handler: 'blob', id: 25, data: {text: 'for all Americans. That of course, has a strong emphasis on low-income Americans and by that association, we do quite a bit with the uninsured, Medicaid policy and the State Children’s Health '}},
{ timecode: 340, handler: 'blob', id: 26, data: {text: 'Insurance program, or CHIP, and as well, a little bit of Medicare. Although, I have one slide on Medicare in this presentation, it is not my area of expertise but I will welcome your questions by '}},
{ timecode: 350, handler: 'blob', id: 27, data: {text: 'e-mail and I can forward those to my colleagues who are much more steeped in the Medicare issues. In today’s presentation, there are basically four key questions that I hope to at least get you '}},
{ timecode: 365, handler: 'blob', id: 28, data: {text: 'to start thinking about. Why are we doing Healthcare Reform now? Why is now the time that we’re talking about this issue? What’s happening of course with Medicaid and Health Reform, '}},
{ timecode: 376, handler: 'blob', id: 29, data: {text: 'that’ll be the bulk of the presentation. A little bit on what’s happening with Medicare and health reform, less than you might hope if that’s your issue. And then finally, where are '}},
{ timecode: 387, handler: 'blob', id: 30, data: {text: 'things going? What does the timeline look like? Where is congress at? Where do they hope to be by the end of the summer? So, there are a lot of reasons that we are doing Healthcare Reform right now. '}},
{ timecode: 397, handler: 'blob', id: 31, data: {text: 'Depending on who you talk to, it could be because people are concerned about costs. Costs, obviously, are continuing to rise at unsustainable rates, as an effect of that, fewer and fewer people can '}},
{ timecode: 410, handler: 'blob', id: 32, data: {text: 'afford coverage or can afford meaningful coverage, which means that people are experiencing higher and higher rates of medical debt, not able to get the services that they need under the plans that '}},
{ timecode: 420, handler: 'blob', id: 33, data: {text: 'they have, even if they get to count to net insured column. The number of uninsured, in the meantime, is continuing to go up and with the economy looking the way it is we can expect that, '}},
{ timecode: 431, handler: 'blob', id: 34, data: {text: 'unfortunately, to continue probably for some time if something is not done. In the meantime, the counter-cyclical effect, of course, of Medicaid is that as state budget deficits go up and the economy '}},
{ timecode: 445, handler: 'blob', id: 35, data: {text: 'gets worse, more and more people need those Medicaid services that the states are less and less able to afford to provide, so we’re in some interesting times. However, on a hopeful note, kind of '}},
{ timecode: 455, handler: 'blob', id: 36, data: {text: 'echoing what we heard at lunchtime, the political climate is perhaps the best it has been in the last 15 years easily for Healthcare Reform, so those of us that are looking forward to that and hopeful '}},
{ timecode: 466, handler: 'blob', id: 37, data: {text: 'that something will happen this year. I think we at least have time on our side in that way. And I was reading some clips this morning and the democrats have said that they are “tabling other '}},
{ timecode: 476, handler: 'blob', id: 38, data: {text: 'domestic issues for the rest of the year,” was the quote to work on Health Reform. This is priority number one when it comes to domestic issues at the federal level. So the next few months are '}},
{ timecode: 487, handler: 'blob', id: 39, data: {text: 'going to be very exciting. A little bit of look at the data, as was said before, I did work at the Urban Institute briefly, so we have to look at the data a little bit. It is data from Families U.S.A. '}},
{ timecode: 499, handler: 'blob', id: 40, data: {text: 'though of course. One in three Americans over the past two years, and this is non-elderly Americans, experiences a period of un-insurance at some point during those two years. So one in three people '}},
{ timecode: 509, handler: 'blob', id: 41, data: {text: 'is experiencing this in a real way. The next thing is that if you’re not experiencing this in a real way, you don’t think you are, you actually are even if you’re insured because as '}},
{ timecode: 523, handler: 'blob', id: 42, data: {text: 'the report that we released last week showed, there is what we call the hidden health tax, that is that those who are uninsured still need services, they still get some services, even though '}},
{ timecode: 533, handler: 'blob', id: 43, data: {text: 'it’s maybe at not the most opportune time or the most opportune setting, but when they do eventually get care, a lot of that is uncompensated care and those costs are passed onto those of us '}},
{ timecode: 543, handler: 'blob', id: 44, data: {text: 'with coverage to the tune of over a 1,000 dollars per family per year in hidden health taxes to cover those who are uninsured. If numbers are not compelling enough, I will point you to an Urban '}},
{ timecode: 559, handler: 'blob', id: 45, data: {text: 'Institute study that also came out this month. If I had a dollar for every healthcare study that came out this year, man. We can’t afford to do anything, to do nothing (to do anything), to do '}},
{ timecode: 570, handler: 'blob', id: 46, data: {text: 'nothing. We can’t afford to do anything is really more the truth, right? But we really can’t afford to do nothing. The Urban Institute, this study that just came out took a pretty complex '}},
{ timecode: 586, handler: 'blob', id: 47, data: {text: 'model and looked as if nothing else changed other than economic projections over the next few years, a best-case-scenario being that the economy improves, does well, the number of uninsured '}},
{ timecode: 597, handler: 'blob', id: 48, data: {text: 'doesn’t increase quite as much, the best-case-scenario, you still have employer insurance decreasing in a worse-case-scenario it decreases even more and then the uninsured regardless are going '}},
{ timecode: 609, handler: 'blob', id: 49, data: {text: 'to continue to go up. And then for most of us in the room, I think are more concerned or most concerned with Medicaid and no matter what happens, Medicaid enrollment will continue to grow. It’s '}},
{ timecode: 618, handler: 'blob', id: 50, data: {text: 'just a question of how and what that coverage will look like. So, now we have a little bit of a problem statement. We need some sort of Health Reform, right? So what is Health Reform? I could ask each '}},
{ timecode: 632, handler: 'blob', id: 51, data: {text: 'and every one of you in this room and I would get a unique answer from every one of you I bet. So it really depends on who you ask. It can mean anything, and you have people in Washington who are '}},
{ timecode: 644, handler: 'blob', id: 52, data: {text: 'pushing for each of these things and combinations of these things and things that are not here at all, and everybody has a different idea of what Health Reform is or what it should be, or what, if we '}},
{ timecode: 654, handler: 'blob', id: 53, data: {text: 'fail to achieve, we won’t have achieved Health Reform. However, as I said before, we can’t afford to do anything. Congress has to consider these in a real-budget picture and in a situation '}},
{ timecode: 668, handler: 'blob', id: 54, data: {text: 'where at least the congressional democrats are very committed to paying for new expenditures. So there are limited resources and limitless possibilities for what needs to be done, or changed, or '}},
{ timecode: 680, handler: 'blob', id: 55, data: {text: 'improved. So what I am going to present to you is, of course, Family U.S.A.’s vision for what we hope will happen in Health Reform. And that is, number one, to make coverage more affordable, and '}},
{ timecode: 692, handler: 'blob', id: 56, data: {text: 'that starts with creating for us, being concerned with low-income folks, creating a Medicaid eligibility floor at, at least 133% of poverty. We’re seeing some talk of it being even higher than '}},
{ timecode: 705, handler: 'blob', id: 57, data: {text: 'that, maybe even up to 150% of poverty depending on how incumbents calculated and there’s quite a bit of talk of changing how income is calculated. But, creating a Medicaid eligibility floor, '}},
{ timecode: 719, handler: 'blob', id: 58, data: {text: 'which is to say that everybody in the country no matter what state you live in, if your income is below that level, you qualify for Medicaid. It doesn’t matter if you are a parent, or a pregnant '}},
{ timecode: 728, handler: 'blob', id: 59, data: {text: 'woman, or a child, or a person with a disability. If you’re poor, you get Medicaid. As a floor we hope that states that have historically been more generous will continue to have the freedom to '}},
{ timecode: 740, handler: 'blob', id: 60, data: {text: 'do so and hopefully, the incentives to do so as well. For those that wouldn’t qualify, that’d be above that floor or above wherever their states set eligibility, we hope that those folks '}},
{ timecode: 751, handler: 'blob', id: 61, data: {text: 'get a robust sliding scale premium subsidies more heavily weighted to those of course, at the lower end of that income spectrum, up to 3, 4, or 500% of poverty. We also hope for those folks that would '}},
{ timecode: 766, handler: 'blob', id: 62, data: {text: 'probably be getting coverage through some sort of exchange or connector-type model like that has been done in Massachusetts, that the out-of-pocket costs would also be capped, so that folks, once they '}},
{ timecode: 777, handler: 'blob', id: 63, data: {text: 'reach an annual cap aren’t liable for any other expenses above that level. Because of course, if people can’t afford the services then they are just not going to get them. Let’s talk '}},
{ timecode: 791, handler: 'blob', id: 64, data: {text: 'a little bit more subjectively about Medicaid and Health Reform and about the last slide, I will say that in addition to Families U.S.A., we’re not the lone wolf shouting these from the rooftop, '}},
{ timecode: 802, handler: 'blob', id: 65, data: {text: 'there’s actually some very unlikely folks who’ve espoused some of these very same ideas, including PHRMA, including America’s Health Insurance Plans, American Hospital Association, '}},
{ timecode: 814, handler: 'blob', id: 66, data: {text: 'various provider associations, etc. The list goes on, it’s a very diverse coalition and things are going to start to get challenging over the next few months, but so far, people are hanging in '}},
{ timecode: 826, handler: 'blob', id: 67, data: {text: 'there and at least trying to stick to some core principles that we can all agree on to make some progress. I touched on this a moment ago, but why should we set a Medicaid eligibility floor? For most '}},
{ timecode: 839, handler: 'blob', id: 68, data: {text: 'of you, I am probably preaching to the choir here, but it’s not that easy to get into Medicaid. You have to do a lot more than just be poor. You have to be a child, or a pregnant woman, or a '}},
{ timecode: 850, handler: 'blob', id: 69, data: {text: 'person with a disability for a certain amount of time and have been working for a certain amount of time. They are really complicated rules and it’s very different if you live in Rhode Island, '}},
{ timecode: 859, handler: 'blob', id: 70, data: {text: 'or Washington State, or Texas, or Alabama. It just, it varies widely and that doesn’t necessarily make a lot of sense, which is part of our argument for that. For parents, the median, the median '}},
{ timecode: 873, handler: 'blob', id: 71, data: {text: 'Medicaid eligibility level is just over 12,000 dollars a year for a family of three this year. That’s not a lot of money, and that’s definitely not enough money to afford family coverage. '}},
{ timecode: 884, handler: 'blob', id: 72, data: {text: 'So we would argue for that being much higher. Only 16 states right now go above 100% of the poverty level right now, so that, if we could at least get the other states to that bar, that would be a '}},
{ timecode: 897, handler: 'blob', id: 73, data: {text: 'start, but 18,000 dollars is also not a lot of money for a family of three. You want to move beyond parents who can categorically get into the program right now. In 43 states adults without dependent '}},
{ timecode: 911, handler: 'blob', id: 74, data: {text: 'children can be truly 100% penniless and not qualify for Medicaid. It depends on the state, but unless a state has done a waver program, Medicaid is not available to them right now. One other thing I '}},
{ timecode: 925, handler: 'blob', id: 75, data: {text: 'wanted to add on that note was that if we moved Medicaid to 100% of poverty, we could get roughly a quarter of the uninsured covered, right off the bat. If we also implemented the simplifications and '}},
{ timecode: 938, handler: 'blob', id: 76, data: {text: 'the outreach strategies to reach those people and get them enrolled, we could go a long way. If we went to 200% of poverty, we could get over half of the uninsured covered. So, many of the uninsured '}},
{ timecode: 948, handler: 'blob', id: 77, data: {text: 'are quite low income and are not eligible for any kind of coverage right now. A quick overview, just to point out the fact that it’s not a red-state issue or a blue-state issue or a North/South '}},
{ timecode: 962, handler: 'blob', id: 78, data: {text: 'issue. Medicaid eligibility is fairly universally low, whether you’re in Alabama, or Oregon. Folks tend to think that the programs out west are far more generous, and to some extent that’s '}},
{ timecode: 975, handler: 'blob', id: 79, data: {text: 'true, but I would not like to be a working parent in Oregon. And finally, my home state, that my heart particularly goes out to this week, you have to be fairly poor to be in Michigan and although, '}},
{ timecode: 989, handler: 'blob', id: 80, data: {text: 'right now, if you’re a childless adult with income up to 35% of poverty, it’s a pretty paltry income, you could have gotten into coverage, but that coverage actually is financed through '}},
{ timecode: 999, handler: 'blob', id: 81, data: {text: 'CHIP and will be going away, much like everything else in Michigan right now, pensions and jobs and everything else. So, now is definitely the time to be looking at this issue. Why do we want to '}},
{ timecode: 1012, handler: 'blob', id: 82, data: {text: 'expand Medicaid? It covers some critical services that just are not found in other kinds of insurance. If we have an exchange or a connector-type, in fact, I question whether many of them would '}},
{ timecode: 1028, handler: 'blob', id: 83, data: {text: 'covered at all. And of course, that starts with transportation services, but it’s also the EPSDT program for children that ensure that children get all of the screenings and the treatments for '}},
{ timecode: 1040, handler: 'blob', id: 84, data: {text: 'the issues that they face and get all the medically necessary care that they need. Language-access services are just going to continue to become more and more important. Those are available through '}},
{ timecode: 1049, handler: 'blob', id: 85, data: {text: 'Medicaid, not necessarily as universally available through other types of coverage. Dental and mental health services, optional benefits, but still very important and not available to low-income folks '}},
{ timecode: 1061, handler: 'blob', id: 86, data: {text: 'for the most part other than through Medicaid. And the list goes on. And then of course, in Medicaid, you also can’t be denied coverage because of a pre-existing condition and there are no '}},
{ timecode: 1071, handler: 'blob', id: 87, data: {text: 'lifetime caps on benefits. So there’s a lot of reasons, in addition to these that Medicaid is a critical program and it’s probably the right program for low-income folks. For those that '}},
{ timecode: 1086, handler: 'blob', id: 88, data: {text: 'doubt that Medicaid is the right vehicle or question whether it provides the access or provides the high quality care that people need, there is always room for improvement and we’d be the first '}},
{ timecode: 1096, handler: 'blob', id: 89, data: {text: 'to say that some folks are not getting what they need. And those improvements need to be made, and as hopefully we get more federal funding to the states, in the process of Health Reform, some of '}},
{ timecode: 1106, handler: 'blob', id: 90, data: {text: 'those improvements can take place. But this is a fairly interesting study from Kaiser Family Foundation that shows that not only do folks in Medicaid fair far better than the uninsured, they actually '}},
{ timecode: 1120, handler: 'blob', id: 91, data: {text: 'do better than people with private coverage when it comes to having usual sorts of care; seeing a doctor and getting their healthcare needs met. So despite some of the stigma issues, folks that are in '}},
{ timecode: 1131, handler: 'blob', id: 92, data: {text: 'Medicaid do actually tend to be getting the services that they need and they’re protected from cost sharing in a way that you may not be in other programs. The public actually supports expanding '}},
{ timecode: 1143, handler: 'blob', id: 93, data: {text: 'these programs. This is a somewhat surprising step, but almost three quarters of people favor or strongly favors expanding Medicaid or state-funded programs to cover more low-income people. So this may not be as'}},
{ timecode: 1158, handler: 'blob', id: 94, data: {text: 'heavy of a political lift as it seems, and in fact, the things we see coming down from the senate committees right now bear that out because they are calling for increased or expanded Medicare for '}},
{ timecode: 1171, handler: 'blob', id: 95, data: {text: 'low-income folks. So if I had only one slide for this whole presentation, this would be it. Unfortunately it’s all questions and not answers. I wish I could provide you some answers today, but '}},
{ timecode: 1184, handler: 'blob', id: 96, data: {text: 'time will tell. These are the issues that folks making decisions right now are thinking about, we hope they’re thinking about and it’s the types of things that if you have a strong feeling '}},
{ timecode: 1196, handler: 'blob', id: 97, data: {text: 'about or a strong inclination, now is the time to weigh in. Will there be an eligibility floor like I mentioned in Medicaid? A connected lever to that is; do we have an individual mandate? If everyone '}},
{ timecode: 1209, handler: 'blob', id: 98, data: {text: 'has to get covered, folks may be more likely to say yeah, put the lowest-income people in Medicaid, that’s an easy way to get that group taken care of. Because otherwise, you’re probably '}},
{ timecode: 1219, handler: 'blob', id: 99, data: {text: 'going to exempt those folks and allow them to continue to be uninsured; because how could you provide them affordable coverage that they would have to be required to buy. So that’s the connected '}},
{ timecode: 1229, handler: 'blob', id: 100, data: {text: 'issue. How will the expanded coverage be financed? We don’t know and we’ve gone round and round in our offices and with folks on the hill about how you make this equitable for states and '}},
{ timecode: 1242, handler: 'blob', id: 101, data: {text: 'the federal government. If you do what we would call a full-federal buyout and just say okay, we’re going expand Medicaid; every state has to do it so the federal government is going to pay for '}},
{ timecode: 1251, handler: 'blob', id: 102, data: {text: 'it all. Do you think the Massachusetts’s of the world and the Alabamas of the world are going to get along and agree about that? Because it’s just, it’s a tough situation. States '}},
{ timecode: 1261, handler: 'blob', id: 103, data: {text: 'that have been traditionally more generous, fine, buy us out, but why are you buying out the folks that haven’t been very generous? They’re getting a lot more bang-for-their-buck as it '}},
{ timecode: 1270, handler: 'blob', id: 104, data: {text: 'were. So that’s a tough issue and some of the big players, whether it’s NCSL (I’m sorry, National Conference of State Legislatures), or National Governor’s Association, '}},
{ timecode: 1280, handler: 'blob', id: 105, data: {text: 'they’re big players in this and they must be made happy, which is not an easy thing. Similarly, what will the financial contributions be? How will you tier things in a way that doesn’t '}},
{ timecode: 1294, handler: 'blob', id: 106, data: {text: 'disadvantage anybody else, one group over the other? For this group, probably one of the most important questions is; what will the new Medicaid benefits package be? When we talk about expanding '}},
{ timecode: 1307, handler: 'blob', id: 107, data: {text: 'Medicaid, we just kind of assume we mean traditional Medicaid, but that’s very costly and it’s not clear whether newly covered people would be eligible for long term care services. Would '}},
{ timecode: 1320, handler: 'blob', id: 108, data: {text: 'they be eligible for transportation services, some of the other services that I mentioned before that are integral to Medicaid. It’s unclear whether those are going to be carried through or '}},
{ timecode: 1330, handler: 'blob', id: 109, data: {text: 'whether this new Medicaid is going to be something more paired down. There’s been some suggestions in the Senate Finance Committee’s paper that came out a few weeks ago that low-income '}},
{ timecode: 1342, handler: 'blob', id: 110, data: {text: 'people that would be getting coverage through an exchange situation, and those would be folks just above a Medicaid eligibility level, they would be required to have what they are calling the lowest '}},
{ timecode: 1353, handler: 'blob', id: 111, data: {text: 'benefit package. There are four benefit packages that would be available through an exchange and it would be lowest, low, medium-high, and the lowest income folks would get the lowest benefit package. '}},
{ timecode: 1368, handler: 'blob', id: 112, data: {text: 'So that means fewer benefits, probably less cost sharing but not something that’s likely to include a robust benefit package that would include transportation services or EPSDT for children; '}},
{ timecode: 1379, handler: 'blob', id: 113, data: {text: 'things like that. Provider rates; obviously there’s certainly folks that want provider rates to be increased and it’s hard to argue against that. If we’re going to cover lots more '}},
{ timecode: 1391, handler: 'blob', id: 114, data: {text: 'people, how are we going to improve access or ensure that access at least doesn’t suffer. It’s going to take some pretty strategic efforts when it comes to provider payment rates. That '}},
{ timecode: 1403, handler: 'blob', id: 115, data: {text: 'finance committee paper that I mentioned before talked also about pegging, raising Medicaid rates to at least 80% of Medicare rates. I’m not clear whether that is affordable or enough on both '}},
{ timecode: 1417, handler: 'blob', id: 116, data: {text: 'sides of the coin. So there are many, many questions you could add to this list, but that’s a few to get you thinking. Quickly, I will talk a little bit about Medicare, very little bit and refer '}},
{ timecode: 1430, handler: 'blob', id: 117, data: {text: 'you to my colleague, Mark Steinberg for all of your detailed Medicare questions. Medicare is of course, where we’re going to see many of the delivery system reforms that are proposed in Health '}},
{ timecode: 1441, handler: 'blob', id: 118, data: {text: 'Reform. It’s a large population, the government can control it, it’s a nice study group to figure out what works to bring the costs of healthcare down, to improve efficiency, etc. '}},
{ timecode: 1453, handler: 'blob', id: 119, data: {text: 'Hopefully we’ll see some savings out of that, and I think some of the so-called “pay-fors” for Health Reform are likely to come through delivery system improvements in Medicare, but '}},
{ timecode: 1463, handler: 'blob', id: 120, data: {text: 'those can be done well and those can be done poorly. So it’s an interesting field right now. I’m not going to get too much into it. But our priority is, coming from the low-income '}},
{ timecode: 1476, handler: 'blob', id: 121, data: {text: 'perspective, are to eliminate or increase asset limits. The current rules penalize folks for saving throughout their lifetime and if you do have savings, even if it’s a few thousand dollars, '}},
{ timecode: 1491, handler: 'blob', id: 122, data: {text: 'then you end up not being eligible later on for some of the low-income programs for Medicare even though you can’t afford the existing premiums and cost sharing for Medicare. We would call for '}},
{ timecode: 1503, handler: 'blob', id: 123, data: {text: 'aligning and increasing income limits for the low-income programs. The Medicare savings programs, which helps folks pay for the premiums and cost sharing in Medicare that when they do have low '}},
{ timecode: 1514, handler: 'blob', id: 124, data: {text: 'incomes, and then the low income subsidy which is for Part D, those programs don’t have the same eligibility levels right now, so it just makes it all the more complicated to get folks into '}},
{ timecode: 1524, handler: 'blob', id: 125, data: {text: 'them. And as a result, only about a third of the folks that are eligible for those Medicare savings programs aren’t even enrolled right now. So we are concerned about that, to the extent that '}},
{ timecode: 1537, handler: 'blob', id: 126, data: {text: 'you’re bringing more people into the tent, costs are going to go up, so that’s a trade off. But stabilizing and simplifying the programs are the things that Families U.S.A. is focused on '}},
{ timecode: 1549, handler: 'blob', id: 127, data: {text: 'when it comes to Medicare. Where do we go from here? This, like I said, this is it. This week things have really kicked off. The organizing for America campaign which kind of grew out of the Obama '}},
{ timecode: 1565, handler: 'blob', id: 128, data: {text: 'campaign after he transitioned to the administration, they started their kickoff this week in really focusing on Healthcare Reform. We hear folks on the hills getting things going and I’m going '}},
{ timecode: 1576, handler: 'blob', id: 129, data: {text: 'to show you the timeline in a minute here. I am not allowed to take vacation for pretty much the rest of the year, so thanks for getting me out of the building for a day, because it’s going to '}},
{ timecode: 1586, handler: 'blob', id: 130, data: {text: 'be a rough few months. In the Senate, things started rolling back in November when Senator Bach was the chairman of the Senate Finance Committee that is in charge of the public programs and the tax '}},
{ timecode: 1603, handler: 'blob', id: 131, data: {text: 'side of the Health Reform equation. He released his white paper with some of his ideas. They were ideas that Families U.S.A. largely supported, it was a good start. Last month and the month before we '}},
{ timecode: 1616, handler: 'blob', id: 132, data: {text: 'saw so-called roundtables and walkthroughs, we like our compound words in the Senate Finance Committee, where essentially the roundtables were hearings with strategic folks called to the table, '}},
{ timecode: 1629, handler: 'blob', id: 133, data: {text: 'although they were closed. You could watch them online but they weren’t open as a hearing would be. And then walkthroughs afterwards which were definitely closed door things where they went '}},
{ timecode: 1638, handler: 'blob', id: 134, data: {text: 'through in the committee and walked through the options. And the results of those were three options papers. Unfortunately, they didn’t come out and say what they are going to be putting in the '}},
{ timecode: 1649, handler: 'blob', id: 135, data: {text: 'legislation but it was a hefty paper; the coverage paper was the one I paid the most attention to, although there were also papers on the delivery system and financing. Those went through and said we '}},
{ timecode: 1661, handler: 'blob', id: 136, data: {text: 'could do this, or we could do that. We’re thinking about doing this, or that. So it really was kind of a multiple choice, choose-your-own-adventure Health Reform guide. So a little bit of a hint '}},
{ timecode: 1675, handler: 'blob', id: 137, data: {text: 'of where things are going, but we won’t know until we see some legislative language. That should be happening this month; both in the Senate Finance Committee and in the Health Education Labor '}},
{ timecode: 1686, handler: 'blob', id: 138, data: {text: 'and Pensions Committee, Senator Kennedy’s committee. We were hearing that we might get something today. The Health Committee met with I believe some senate democrats today and possibly the White '}},
{ timecode: 1700, handler: 'blob', id: 139, data: {text: 'House before the President left to go to the Middle East about their bill. We’ve seen a rough outline of the bill. That should be, the language should be out this week. And then of course, later '}},
{ timecode: 1712, handler: 'blob', id: 140, data: {text: 'this month and next month we will see those bills marked up in committee and then we will see hopefully a combined bill introduced before the August recess. Because Health Reform spans multiple '}},
{ timecode: 1725, handler: 'blob', id: 141, data: {text: 'issues, you have to do some of it through the Senate Finance Committee, some of it through the Health Committee, and our understanding is that they’re just going leave parts of the bill blank '}},
{ timecode: 1734, handler: 'blob', id: 142, data: {text: 'and kind of weave it together. Hopefully most of the issues overlap. The house hasn’t, the senate’s definitely been taking the lead. The house is working on things; we recently heard kind '}},
{ timecode: 1746, handler: 'blob', id: 143, data: {text: 'of their rough schedule. Again we’ve got multiple committees working together to get patch legislation together and they also have a plan of getting something through the house before the August '}},
{ timecode: 1756, handler: 'blob', id: 144, data: {text: 'recess so that after the recess when they all come back to town they can have a conference bill and try and get something done. And that’s an optimistic paraphrase, but that is basically where '}},
{ timecode: 1769, handler: 'blob', id: 145, data: {text: 'we are going. I didn’t do a conclusion slide, but hopefully, I don’t really want to conclude, I would like to get some of your questions and input. And also, thank you for having me here '}},
{ timecode: 1777, handler: 'blob', id: 146, data: {text: 'today, because I think I probably learned more about what you all do than you have learned from my presentation today. So thank you for giving me a little bit of education as well. Questions? You did '}},
{ timecode: 1801, handler: 'blob', id: 147, data: {text: 'fall asleep. Does Families U.S.A. support a single-payer approach? Families U.S.A. supports high-quality affordable healthcare for all Americans. We certainly support, I think if you were to take a '}},
{ timecode: 1825, handler: 'blob', id: 148, data: {text: 'poll around our office, we all support that individually speaking. As an organization, we are trying to be as pragmatic as possible. And so knowing the players and knowing the fine balance that is '}},
{ timecode: 1838, handler: 'blob', id: 149, data: {text: 'Washington politics, we are trying to move forward in the most pragmatic way, which at this point is not a single-payer option. But it’s, yeah, we’ll live to fight another day. AUDIENCE '}},
{ timecode: 1851, handler: 'blob', id: 150, data: {text: 'MEMBER: How are you doing? Actually, I have a question. Do you have any kind of a study where you record the cost, indirect cost to private ambulance companies, volunteers, especially volunteer '}},
{ timecode: 1867, handler: 'blob', id: 151, data: {text: 'companies, how many trips are missed because people who are uninsured require ambulances because they can’t access regular doctors? How much an emergency room visit costs more than a regular '}},
{ timecode: 1882, handler: 'blob', id: 152, data: {text: 'visit and how we don’t catch illnesses until they are chronic instead of catching it earlier, which costs less to fight the healthcare? All that should prove that it might not be in one '}},
{ timecode: 1899, handler: 'blob', id: 153, data: {text: 'person’s pocket, but it’s in the local people’s pockets and private people’s pockets and in the federal pockets. When you take that total amount of money, we’re throwing '}},
{ timecode: 1910, handler: 'blob', id: 154, data: {text: 'away money when we could be insuring people. Isn’t that a case in itself? JENNIFER SULLIVAN: Definitely. We don’t have specific studies that have looked at some of those things. I think '}},
{ timecode: 1918, handler: 'blob', id: 155, data: {text: 'that hidden health tax ID, it tries to get as some of the cost shifting that goes on, but certainly delayed care is more costly to the system. Folks delay care; they don’t get things when they '}},
{ timecode: 1929, handler: 'blob', id: 156, data: {text: 'need them on time. They end up either in an emergency room or having a longer term chronic condition that could have been avoided and we certainly are cognizant of that and those arguments; I wish '}},
{ timecode: 1939, handler: 'blob', id: 157, data: {text: 'rational arguments worked better. AUDIENCE MEMBER: I currently work with Maryland Medicaid; I have been doing it for the past 20 years. One of the problems we have had consistently with getting '}},
{ timecode: 1963, handler: 'blob', id: 158, data: {text: 'Medicaid recipients quality care is a severe lack of providers willing to accept the Medicaid program. We’ve got excellent doctors and providers in Maryland, most of them don’t want to '}},
{ timecode: 1975, handler: 'blob', id: 159, data: {text: 'take it. Starting July 1st, we’ve got a special dental all-service organization because we can’t give children appropriate dental care. And I know in terms of Medicaid transportation, it '}},
{ timecode: 1984, handler: 'blob', id: 160, data: {text: 'really brings my cost up because we’ve got to bring people all over God’s creation to doctors that take Medicaid. Can you basically summarize any solutions or strategies you want do to try '}},
{ timecode: 1996, handler: 'blob', id: 161, data: {text: 'to get more providers online to deal with the Medicaid population? JENNIFER SULLIVAN: It’s an excellent point. It absolutely is a problem now and I think we’re starting to see some of the '}},
{ timecode: 2008, handler: 'blob', id: 162, data: {text: 'repercussions of rapid expansions in coverage coming out of Massachusetts and I don’t have, if I had a money tree I would have the solution, but unfortunately in these times it’s really '}},
{ timecode: 2023, handler: 'blob', id: 163, data: {text: 'going to come down to what congress decides and how they weight all the different things that are tugging on them. I know that providers have a very strong platform to stand on and are calling for '}},
{ timecode: 2035, handler: 'blob', id: 164, data: {text: 'higher reimbursement rates and that, and Families U.S.A. is also very supportive of that. It’s going to be tough; it’s going to be a tough row to hoe. VALERIE MILLER: Okay, we have time '}},
{ timecode: 2047, handler: 'blob', id: 165, data: {text: 'for about one more question. AUDIENCE MEMBER: Have they considered actually helping increase the number of healthcare providers through educational loans, things like that, so that when doctor’s '}},
{ timecode: 2061, handler: 'blob', id: 166, data: {text: 'get out they don’t have mountains of debt that they have to pay off with their reimbursement fees? JENNIFER SULLIVAN: There is actually, in one of those options papers I referenced that the '}},
{ timecode: 2072, handler: 'blob', id: 167, data: {text: 'Senate Finance Committee has put out, their piece on financing does get into some of that. It gets into some of the graduate medical education issue. Really, I can’t encourage you enough to pay '}},
{ timecode: 2087, handler: 'blob', id: 168, data: {text: 'attention to the news, because it’s just going to be everywhere over the next few months and we’re going to see legislation, probably out of both the house and senate in four to six weeks, '}},
{ timecode: 2096, handler: 'blob', id: 169, data: {text: 'and these are issues that clearly you all care about and I really hope that you’re weighing in with your elected officials or through your organizations to the extent that you can because now is '}},
{ timecode: 2106, handler: 'blob', id: 170, data: {text: 'definitely the time. Yesterday was the time; you can’t weigh in soon enough or loud enough. And if you need any guidance on doing that, please contact us. Thank you very much for your time, I '}},
{ timecode: 2118, handler: 'blob', id: 171, data: {text: 'appreciate it. Oh, there’s one more question Valerie tells me. AUDIENCE MEMBER: This is a revisitation for the question you had earlier, this is about the single-payer option. A week ago last '}},
{ timecode: 2132, handler: 'blob', id: 172, data: {text: 'Friday there was devastating, I thought a devastating, critique of the current process from Bill Moyer’s journal providing with some doctors and some historians who have studied this, a critique '}},
{ timecode: 2144, handler: 'blob', id: 173, data: {text: 'of all but what’s left out when you have not addressed when you don’t have a single payer system. Pointing out that we’re the only industrialized nation with our peculiar system and '}},
{ timecode: 2157, handler: 'blob', id: 174, data: {text: 'nobody has imitated us. In light of the precedent of history, in light of the votes of other industrialized countries we’re different systems; do you really have any confidence that we’re '}},
{ timecode: 2170, handler: 'blob', id: 175, data: {text: 'going to emerge with something better out of the current reform or just in evolution of our current mess? JENNIFER SULLIVAN: Um, I’m going to stick with the, excuse my non-partisanship here, but '}},
{ timecode: 2186, handler: 'blob', id: 176, data: {text: 'I’m going to stick with the Obama theme of hope, I do hope that we come out of this better than we stand today, which is probably not a very tough task, but I hope that we come out of things '}},
{ timecode: 2199, handler: 'blob', id: 177, data: {text: 'better. Well, thank you very much.'}},
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