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Rx for Successful SEIU Strategy for Health Care

Rx for Successful SEIU Strategy for Health Care

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Rx for Successful SEIU Strategy for Health Care

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  1. Rx for Successful SEIU Strategy for Health Care SERVICE EMPLOYEES INTERNATIONAL UNION November 30, 2007 Chris Jennings, Jennings Policy Strategies, Inc.

  2. Outline • The Return of Health Debate: Issues that Frame SEIU Priorities • Health Care Strategies for • Cost Containment • Coverage • Long-Term Care/Re-Balancing

  3. The Health Care Debate Today • Health care is now a leading issue for Americans • Health care is the most important domestic issue to Americans • One of top priorities overall, second only to the war in Iraq Source: Kaiser Family Foundation, March 2007

  4. Why? Cost…Costs Drive the Concern and the Debate • Cost to Families:Premiums reached an average of $11,480 annually for family coverage in 2006 (87% increase since 2000) • Cost to Businesses:Fewer firms offering coverage (especially small business); CEOs cite health care as largest cost pressure on corporate America • Cost to Government, Now and into Future:Medicare and Medicaid spending threaten to devour large portions of budget • Cost to Nation:Health care costs to hit $4.0 billion by 2015, or 20% of GDP

  5. Current System Shifts -- Not Contains -- Costs Uninsured  Insured Government Businesses Businesses Workers …and adverse selection gaming between insurers and patients

  6. Not All Cost ChallengesUniformly Harmful to SEIU 74.8 Million Medicare Beneficiaries 36.4 Million Source: KFF, 2005; Census

  7. …Because Biggest Cost Driver are Those With Chronic Disease Who Need Care Overall • The 10% of patients that suffer from chronic disease account for 75% of the nation’s health care spending • Studies show that virtually ALL of the spending growth in Medicare over the last 15 years resulted from increased spending on people with multiple, chronic conditions • The number of chronically ill expected to DOUBLE by 2020 Medicaid Source: Thorpe K. Health Affairs, 2006; Gillespie, J., et al, February 2003; Johns Hopkins, Partnership for Solutions, 2006

  8. Budget Deficit Constrains AgendaDeficit, Dollars in Billions, FY 2000-8 $86 B -$278 B* ($192 B)* Source: CBO, March 21, 2007 * Assumes extension of tax cuts

  9. Nonetheless, Reform PressuresExceed 1993-’94 • Greater recognition that health costs are threat to competitiveness and economic growth • Broader pool of business validators supporting • Traditional stakeholders as well as “strange bedfellows” embracing comprehensive reform • Emerging consensus that quality/value issues can bring stakeholders together • Stronger and more bipartisan relationships on Committees

  10. Three Priority Issues and Possible Strategies • Cost containment: Rising costs force need to be a constructive player • Coverage: Initiatives should be framed to meet SEIU priorities -- WINNING • Long-Term Care Rebalancing Agenda:Ensuring that LTC is central component of reform must be a priority

  11. Cost Containment Strategy • SEIU needs to inoculate itself from being perceived solely as a spender • SEIU needs to be associated with politically-viable modernization initiatives that can achieve savings and credibility • Failure to do so undermines credibility for opposing cost-shifting policies that hurt • SEIU particularly well-positioned to support modernization reforms

  12. Possible Cost Containment Agenda • Value-purchasing, e.g. P4P • HIT/e-Prescribing • Comparative effectiveness • Chronic care management • Biogenerics and other pharmaceutical cost containment initiatives • Targeted DSH and HMO overpayments

  13. Coverage Strategy • Number one priority because: • Helps with organizing and securing affordable care for members • Reduces pressure on compensation negotiations • Creates demand for SEIU-provided services • SEIU needs to continue to make health care significant part of Presidential and Congressional 2008 debate • Needs to ensure that priority SEIU provisions are incorporated without excessive micro-management of policy

  14. Coverage Strategy • Strong messaging about consequences of inaction needs to be developed and implemented • Candidates must be put on defense about flawed policy; champions must not always be defending • Messaging about why this is a sympathetic working Americans issue must effectively be delivered

  15. Coverage Policy Strategy • Debate around covering ALL vs. covering SOME must be won by stressing that policies for incremental, individual market, high cost-share reforms will harm workforce • Macro debate between extending or rolling back tax cuts must be won • Policies that promote quality through improved workforce should be better integrated and promoted • Policies that promote affordability for workers need to be highlighted • Detailed policy advocacy should be minimized

  16. Long-Term Care Environment • Long-term care agenda is largely invisible and needs to resurface • Democrats already being charged as “big spending tax hikers” • Promotion of unrealistic policies is ticket to nowhere • Little appetite for costly program add-ons, but increasing interest in transition policies

  17. Long-Term Care Policy Strategy • Get long-term care/rebalancing agenda on table through strategic policy positioning in 2008: • Target committees of jurisdiction to advocate for potentially achievable policy • Develop and implement integrated financing strategy with ongoing health reform debate • Lay foundation for strong state advocacy to be financed by health reform state savings

  18. Long-Term Care Policy Strategy • Ensure introduction of – and movement on – bipartisan rebalancing legislation in Finance Committee • Give states the authority to provide home and community-based services at same level of institutional care • Provide grants to expand public authorities and provider registries • Utilize grassroots and messaging strategy to up-lift the policy and strategy