Patricia Lynch Vice President, Government Relations
KP Government Relations MISSION To advance and protect the ability of Kaiser Permanente to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We do this by: shaping the public policies needed to create a favorable environment in which to operate, advising the organization on the anticipated impact of external forces on KP to inform organizational decisions and practices, and ensuring the organization speaks with one voice.
KP Government Relations Kaiser Foundation Health Plan The Permanente Federation Tony Barrueta, JD Senior Vice President, Government Relations Stephen Parodi, MD VP External Affairs, Communications, and Brand Regional Medical Groups Oakland Sacramento State GR Washington D.C. Federal GR KP Regions State & Local GR Issues & Brand Mgmt Comms Institute Health Policy
Our Work KP has a broader range of legislative issues than other health care organizations, due to our integrated financing and delivery system functions Health Plan Hospitals Medical Groups Labor Partners Coverage for large and small employers Ancillary Medical Services Health IT
KP and Health Reform 1930s – 1940s Henry J. Kaiser worked with the Roosevelt and Truman Administrations on proposals for national health coverage 1950s • Federal Employees Health Benefits Plan • KP’s general counsel wrote the “choice” features of the plan • The FEHBP is seen as a potential model for universal health care. 1960s • Medicare/Medicaid legislation • KP involved in negotiations • Henry J. Kaiser ensured physician group practices would be permitted under Medicare. 1970s • HMO Act of 1973 • KP’s Scott Fleming and Paul Ellwood, MD met and developed a proposal for President Nixon to respond to rising health costs • Fleming characterized the meeting with Ellwood as “the beginning of the HMO Act.”
1990s • Clinton plan for universal coverage • Based in large measure on Stanford Professor Alain Enthoven’s Consumer-Choice Health Plan • First developed in the late 1970s and based on the experiences of Kaiser Permanente and other large, prepaid group practices 2000s • Governor Schwarzenegger and universal coverage for Californians • KP leaders, Chairman and CEO George C. Halvorson; Permanente Federation Executive Director Francis J. Crosson, MD, and General Counsel Steve Zatkin, published their own proposal for universal health care • Many elements of this proposal were included in the governor’s proposal 2010s • The Affordable Care Act • KP worked with CMA, AMA, health plans, leaders in the state legislature, and more • Argued for the importance of issues such as guaranteed issue, structured rate bands, and comprehensive benefits.
The Patient Protection and Affordable Care Act Quality and system improvements Individual mandate Essential benefit package Employer requirements Subsidies to employers Prevention services Cost containments Health insurance exchanges Expansion of public programs
The ACA Exchanges and Quality Reporting • Exchanges • States establish American Health Benefit Exchanges • Small Business Health Options Program (SHOP) Exchanges • Quality reporting • Reporting requirements for group and individual health plans developed • Improve health outcomes, prevent hospital readmissions, improve patient safety and reduce medical errors, and implements wellness and health promotion activities
The ACA Guaranteed Issue
The ACA and Rate Bands • Bronze plan • minimum creditable coverage • essential health benefits • cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit • Silver plan • essential health benefits • covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limits • Gold plan • essential health benefits • covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limits • Platinum plan • essential health benefits • covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limits
The ACA’s Essential Health Benefits Ambulatory services Emergency services Hospitalization Pregnancy, maternity, and newborn care Mental health and substance use disorder services Prescriptions drugs Rehabilitative services and devises Laboratory services Preventive and wellness services and chronic disease management Pediatric services 1 2 3 4 5 6 7 8 9 10