Gerry Shea, AFL-CIO

1. Gerry Shea, AFL-CIO SOS Rx Meeting April 2, 2008

2. AFL-CIO Health Care Campaign Goals • Preserve the comprehensive benefits built over decades • Constrain costs • Improve quality and efficiency • Provide health care to everyone • Make government an effective watchdog on cost, quality and fairness • Keep a significant role for workplace-based benefits

3. The Path to Health Care Reform Runs Through the 2008 Elections Overarching AFL-CIO Health Care Campaign Goals: 1. Educating and Mobilizing Members for Candidates for President and Congress Committed to Comprehensive Federal Action 2. Building an Army of Activists for the 2009 Congressional Debate.

4. Workplace-Based Coverage Is the Backbone of Health Care in America • Covers 71% of all Americans ages 18-64 • Pays nearly half of all health costs • Sets a standard of comprehensive benefits built in decades of union negotiations • Despite cost pressures, workplace-based coverage has proven resilient because: • It has clear strengths • It is virtually the only affordable coverage for working and middle-class Americans

5. Advantages of ESI Over Individual Insurance • Natural risk pools • No underwriting • Easy to join and choose coverage options • Resources to advocate for consumers • Valuable health initiatives • Prevention and wellness • Chronic care programs • Comparative information on health quality

6. High Health Costs & Employers Who Refuse to Pay Are Eroding Workplace-Based Coverage • Since 2000, insurance costs have doubled and workplace coverage has dropped five points • Caring for the uninsured adds $922 to cost of family coverage • In 2007, non-union contractors UNDERSPENT union employers by $2.49 per hour (BLS) • In a 2007 AFL-CIO survey of union members, 35% of union members in multi-employer plans rated cost as their top health concern – compared to 29% of all union members.

7. Employer-Sponsored Insurance Is Eroding, But Not (yet) Collapsing • Premium payments for family coverage in Employer-Sponsored Insurance (ESI) doubled for both employers and workers from 2000-2007, leading to • A decline in the number of workers offered health care at work and higher contributions demanded of workers, producing • A five point drop in coverage from 2000-2007 • But 70.9% of workers still have ESI, because • ESI is highly valued by both employers and workers • Comprehensive health reform is essential for the survival of ESI Without comprehensive health reform, the erosion of workplace-based coverage will only accelerate

8. Health Premiums Rising 3 Times Faster Than Wages and Inflation Percent Change 1988–2006 Out-of-pocket costs are going up, too Kaiser Family Foundation Employer Benefits Surveys

9. We’re Feeling It —And So Are Our Employers Annual Premium Costs for Family Coverage $12,106 $6,351 Kaiser Family Foundation Employer Benefits Surveys, 2000-2006

10. Working Middle Class Losing Coverage Fastest of All Percent of working adults who are uninsured, by income quintile *In 1999, CPS added a follow-up verification question for health coverage. Source: Analysis of the March 1988–2004 Current Population Surveys by D. Ferry, Columbia University, for The Commonwealth Fund.

11. Costs of care for uninsured adds to costs for everyone else High drug costs, & non-competitive market What’s Wrong? Structure is wasteful, inefficient Unfair competition from companies that don’t provide benefits Lack of government oversight Arbitrary eligibility decisions by insurers High costs deepen disparities

12. Quality & Safety Problems 180,000 people die each year from medical errors and medication mistakes No independent information available on new drugs or medical technology at introduction Low nurse to patient inpatient ratios substantially raise mortality risk Lack of transparency

13. YOU’RE ON YOUR OWN Limited plan with high price tag No watchdog role for government! Which Path Are WeGoing to Take? WE’RE IN IT TOGETHER • Choice to keep what you have or improve on it • Government doesn’t control but is a watchdog • Shared responsibility—employers, government and individuals work together False Solutions

14. “People have access to health care in America. After all, you just go to an emergency room.” President George W. Bush Cleveland, Ohio July 10, 2007

15. Health Care for America:Our Principles • Care that is High-Value and Patient-Centered • Pooled Risk instead of “Go-It-Alone” Individual Market • Guaranteed Coverage through New Program built on Medicare • Continuation of Employer & Union Sponsored Benefits • Shared Responsibility in Financing & Health Status • Government is Watchdog on Costs, Quality and Fairness

16. Health Care for America: Pathway to Reform I • High-Value and Patient-Centered • Requires reporting on quality standards developed by health professionals, health researchers, policy experts, consumers and purchaser • Provides comparative performance information on physicians and hospitals so consumers can make informed choices • Adequate staffing and ban on mandatory overtime • Funds preventive care and screenings to reduce use of expensive emergency room and chronic care • Addresses staffing squeeze and mandatory overtime • Standardizes billing and claims payment • Automates transactions • Pooled Risk instead of Individual Market

17. Health Care for America: Pathway to Reform II • Guaranteed Coverage through New National Program • Makes sure everyone gets good health care—as good as you have now or better • Guarantees choice of plan, physician and hospital • Choice of a public alternative to private insurance • Continued Role for Workplace-Based Benefits • Supplements Benefits in National Plan

18. Health Care for America: Pathway to Reform III • Shared responsibility among employers, government and individuals • Employers contribute and make screening, consumer information and advice available at the worksite. • Everybody contributes on a sliding scale, based on ability to pay or negotiated contribution • Government is watchdog on costs, quality and fairness, and offers • Lets public know about hospital and physician performance on standards • Offers option of strong public or private plan • Prevents claims denials for preexisting conditions or status

19. Scare Tactics! You’ll lose the good coverage you have ‘Government-controlled health care’ Covering the uninsured will drive up your health costs You’ll have to give up your own doctor and go to a government-issued provider ‘Socialized medicine’

20. AFL-CIO Health Care Campaign • Define McCain on Health Care • McCain is more of the same. This will be the third Bush Presidency. • Watch out for lies and confusions • ACTIONS • Keep the heat on all candidates. • Get Out The Vote! • Fight for Reform in 2009 and beyond!

21. AFL-CIO Health Care Campaign 2008 Action Plan • March – SF/CLC Regional Conferences • April - Health care at every CLC meeting nationwide: 117 currently signed up. • May - Take it to union locals, shop floors, Labor 08 walks • November - Vote to Turn Around America • 2009 – Legislative fight to Make Reform Real

22. Labor ’08 Health Care & Economy Neighborhood Walks – May 17112 Sites…And Counting AFL-CIO

23. AFL-CIO