Editor's note: This is the third post from the Nashville Health Care Council's 2013 Leadership Health Care Delegation to Washington. Click here for other entries from this year and last.

Attendees of Leadership Health Care’s 2013 Delegation to Washington, D.C., were treated to a keynote speech by David Wasserman, house editor for The Cook Political Report. Founded in 1984, The Cook Political Report provides analyses of Presidential, U.S. Senate, House and gubernatorial races. In addition to his current role, Wasserman served as an analyst for the NBC News Election Night Decision Desk in 2012, 2010 and 2008, and has appeared on a number of networks.

Wasserman hosted a lively discussion with the group on political forecasting trends and gave the audience insight on the current political landscape and what’s in store for the 2014 and 2016 elections. After the event had wrapped up, Wasserman took a few minutes to further discuss health care policy, including the big choices many Republican governors need to make in the next year and a half.

Editor's note: This is the second post from the Nashville Health Care Council's 2013 Leadership Health Care Delegation to Washington. Click here for other entries from this year and last.

On the second day of the Nashville Health Care Council’s 11th annual Leadership Health Care delegation to Washington, D.C., Tennessee’s Congressional Delegation spoke to LHC members about the health care challenges facing the nation and its policymakers, and the steps that legislators are pursuing to move those issues toward favorable resolution.

The meetings occurred just hours before Senate Republicans were scheduled to meet with President Obama on Capitol Hill. Sens. Bob Corker and Lamar Alexander said that among the topics they hope to discuss with the president — in addition to the prospects for a “grand bargain” fiscal deal — is the need for a 75-year fix on Medicare benefits payment structure to ensure the program remains solvent for America’s seniors.

“This is the biggest issue facing our nation, and there’s no way to solve it without [the President’s] leadership in making the tough decisions we need to make, and I hope he takes us up on that,” Corker said. “I think we have the environment set to do something really great for our nation.”

The senators also discussed the continued challenges for health care reform implementation facing Americans in the years ahead. Alexander, who has voted several times to repeal the Patient Protection and Affordable Care Act, said he expects the country will experience “rate shock” at health care premium costs, that some employees will lose employer-based health insurance and more and more individuals will move onto Medicaid rolls.

“There are a lot of things we could do to change that law,” Alexander said. “But fundamentally what we need to do is focus on the real problem, which is the total cost of health care, and then focus on ways to involve consumers as a way of bringing that down.”

According to Rep. Jim Cooper of Nashville, health care costs are two thirds of the problem when it comes to deficits and debt. He noted that the Affordable Care Act is a focused law trying to reduce some of the drivers behind ballooning health care costs via the Independent Payment Advisory Board and so-called “Cadillac tax” on the most expensive health insurance plans.

Digging deeper into the various Affordable Care Act programs under development and implementation, Director of the Office of Health Reform in the U.S. Department of Health and Human Services Michael Hash provided delegates with a point-by-point walk-through of his office’s activities. Among the work he discussed was the status of health insurance marketplace development in states across the country, the creation of a streamlined application process for individuals who want to purchase insurance through these marketplaces, and implementation of programs designed to improve the health care delivery system, such as the Accountable Care Organization initiative and the Hospital Value-Based Purchasing Program.

Without delivery system reform that looks at lowering health care cost increases over time, “much of the promise of the Affordable Care Act will not become a reality,” Hash said. “We’ve been laying what we think is the groundwork for delivering on the promises of the ACA.”

Looking ahead, Rep. Marsha Blackburn provided some insight into the future of what could happen with regard to a fix for the Sustainable Growth Rate — the so-called “Doc Fix” — which was not addressed in the Affordable Care Act. She said that she and her colleagues on the House Energy & Commerce Committee, as well as those on the House Ways & Means Committee, are working toward a long-term solution, which will help remove one driver of perpetual financial uncertainty in the health care market. She said to expect to see action on the doc fix to move forward before the August congressional recess.

Cooper also argued that, in addition to making changes to improve the financial side of our health care system, more must be done on the behavioral side of the equation to help individuals live healthier lives. He suggested LHC members and other Nashville health care leaders could help attack both behavioral and cost challenges by developing solutions that are not focused solely on growing profits and stock prices, but at improving efficiency and making people healthier.

Cooper, Alexander and the other speakers all congratulated LHC delegates for the work they’re doing in Nashville to improve the health care system.

“We’re very proud of Nashville and entrepreneurial health care,” Alexander said. “Nashville has always been the entrepreneurial center for health care, and it should help us with innovation and help us as we go through the next decade look at lowering the total cost of health care.”

Sen. Bob Corker, Rep. Marsha Blackburn, Sen. Lamar Alexander and Mike Hash, director of the Office of Health Reform at U.S. Department of Health & Human Services

Editor's note: This is the first in a series of posts from the Nashville Health Care Council's Leadership Health Care Delegation to Washington. Look for more information from the trip in the coming days.

The prospects for reforming entitlement programs led the conversation during the first day of sessions in the Nashville Health Care Council’s Leadership Health Care 11th annual delegation to Washington, D.C. Health care policy and political experts spoke to 80 delegates from Nashville and across the country about the budgetary dynamics that are creating pressure for long-term entitlement reform and what, if any, changes we might expect in the coming years.

“There’s no way you can look at the long-term fiscal health of the country and think you can avoid taking on entitlements,” said Gail Wilensky, economist and senior fellow with Project Hope and the former administrator of the Health Care Financing Administration.

Wilensky, pictured above, said the country spent 5.6 percent of GDP on entitlement programs last year, which is nearly three times what we were spending in 1985, and projections show that by about 2030 or 2035 entitlement program spending will grow to between 9.5 percent and 10.5 percent of GDP on Medicare and Medicaid alone. When you add in Social Security, entitlement programs will account for about 17 percent of the U.S. economy.

The main challenge of entitlement reform, Wilensky said, is Medicare. She and members of a later panel discussion about entitlement reform agreed that any reforms to Medicare will need to do more than simply reduce reimbursements to health care providers. Reforms will need to include changes that affect the actual Medicare beneficiary, such as increasing the eligibility age from 65 to 67.

“It’s pretty straightforward” why entitlement programs have not had any meaningful reform to date while other programs have seen obvious funding reductions, said Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy with the American Enterprise Institute. “Other programs tend not to provide direct income support to individual voters.”

In the near term, cuts will probably continue to be more “hidden” within reduced payments to providers, said Stuart Butler, Distinguished Fellow and director of the Center for Policy Innovation at the Heritage Foundation. “But the fact is, that does have an effect, and over the long haul it will start to hollow out those programs,” Butler said. “And that may be the only way you can do it, rather than an explicit decision to make fundamental change to the program.”

Some of the larger, more fundamental changes that should perhaps be on the table, according to the panelists, include income-related premiums for Medicare, restructuring Medicare cost sharing, repositioning Medicare as more of a “true insurance program” where individuals with the highest incomes pay the full cost of premiums and individuals only get a benefit when something goes wrong.

In a separate presentation on the state of affairs in Washington, Michael Ramlet, principal of public affairs firm Purple Strategies, said a lot of the discussions about changes to Medicare are purely hypothetical.

“I don’t think there will be any major moves in the Medicare environment; it’s not a place right now where there’s a lot of compromise.”

Ramlet explained that discussions in Washington are instead focused on issues such as the nuts and bolts of how to run insurance exchanges — the number of individuals who will be enrolled, the levels at which they will participate in exchanges, how much premiums will cost, how to make the “Herculean lift” of allowing multiple federal agencies share the data necessary to make exchanges work.

“This is where 2014 will be really interesting,” he said. “We’re trying to do a big technical lift, where at the same time you know insurance plans are changing a lot, and no one really knows what’s going to happen.”

From left: Joseph Antos of the American Enterprise Institute, Stuart Butler of The Heritage Foundation and Paul Van de Water from the Center on Budget and Policy Priorities

Several Leadership Health Care members who last week traveled to Washington shared some closing thoughts about the trip, which saw them interact with industry leaders as well as Tennessee's Congressional delegation. One common thought: Change is always in the offing and even those whose job it is to track it closely are unsure just how things will turn out going forward.

For more posts from the LHC Delegation to Washington, click here.

Editor's note: This is the third in a series of posts from the Nashville Health Care Council's Leadership Health Care Delegation to Washington. Click here for other installments from the trip.

The Tennessee delegation and key congressional staff members spoke with members of the Nashville Health Care Council’s Leadership Health Care group during a second day of sessions for LHC’s 10 Year Anniversary trip to Washington, D.C.

Tennessee Congressional Delegation members Sen. Lamar Alexander (R-TN), Rep. Marsha Blackburn (R-TN), Rep. Jim Cooper (D-TN) and Sen. Bob Corker (R-TN) discussed the top health care policy issues they think Congress and the American public should be most concerned. Notably, Rep. Cooper and Sen. Corker discussed the “unsustainable” economics of Medicare, wherein the average American receives two or three times the benefit from the government health care program over their lifetime than the amount of money they pay in.

Sen. Corker gave the example of a two-wage family paying $117,000 into Medicare over their lifetimes and receiving $357,000 out of the program.

“Until we change that formula, everything we care about will continue to diminish,” he said. “What we’re doing is not investing in research and development, not doing the things that make our country more economic and efficient because we’re not dealing with this issue.”

Sen. Alexander said there will “have to be a restructuring of our entitlement programs ... to get it down to some reasonable level of growth.”

Following the discussion with the Tennessee delegation, Andrew Shin, acting director of stakeholder engagement for the Center for Medicare and Medicaid Innovation, talked about the ways in which CMS is working to develop care delivery and payment models that improve quality while reducing costs for the health care system. Specifically, he discussed the Innovation Center’s first active initiative — the Pioneer ACO Program — and the programs in process, including a national patient safety campaign, a comprehensive primary care initiative, a bundled payment for care improvement initiative, and the Health Care Innovation Challenge.

Shin (above in a Bill Burke/Page One photo) said the Center is working to reduce the time it takes to spread nationwide innovative health care delivery and payment models from roughly 17 years to just three or four years.

“It’s an exciting time to do what we do in health care. The opportunities are immense, and the risks and challenges are immense,” Shin said. “But [CMS] can’t create a movement. It’s up to people on the ground, the employers and businesses, the people who know that rising health care costs is not just a business issue, it’s an economic issue.”

The day wrapped up with a panel discussion of key congressional staff, including Elizabeth Falcone, health legislative assistant for U.S. Senator Mark Warner (D-VA); Ruth McDonald, senior legislative assistant for Rep. Cooper; Anne Oswalt, health legislative assistant for Sen. Corker; and Monica Popp, health legislative assistant for the U.S. House Committee on Energy and Commerce. The panel was moderated by Sheryl Coughlin, head of research for the Deloitte Center for Health Solutions, and focused on what Congress is facing in health care policy and the budget.

McDonald pointed out that, even if Congress goes through the budget sequestration process, it will still need to look at further deficit reductions through programs such as health care.

“This is a serious problem that affects all of our bottom lines,” she said of growing health care costs. “It’s not just a Congressional problem, it’s a fifth-of-our-economy problem. There needs to be some realistic discussion about what we need to do to change the system.”

The group also talked about the importance of having individuals in Nashville and beyond reach out to their senators and representatives to share their perspectives and expertise on the health care issues before Congress.

“It’s important to have for-profit, nonprofit, boots-on-the-field advice for how things are actually working and how health care is actually working,” said Falcone, who challenged attendees to be partners and not adversaries in helping Congress make important decisions about health care policy.

Falcone, who is working on the staff level with the bipartisan ‘Gang of Eight’ focused on a creating a resolution to the national debt crisis, added: “Your opportunity is not to just say no, it’s to say ‘No, and here’s why’ or ‘Here’s how you can fix it because I think it will be a better system.’”

“Regardless of the outcome of the upcoming Supreme Court deliberations and the election, unavoidable fiscal insolvency issues must be addressed by Congress next year,” said Council President Caroline Young. “It has been gratifying to hear members of our Tennessee Congressional Delegation voicing a strong willingness to build consensus.”

Robert Gibbs, former White House press secretary and special advisor to President Barack Obama, called on Nashville’s health care leaders to help forge political compromise and move the nation forward after the 2012 election season comes to a close.

“I hope we have a boisterous, loud debate leading up to the election on November 6th,” said Gibbs, speaking to the 100 attendees of Leadership Health Care’s 10-Year Anniversary Delegation to Washington, D.C. “After that, leaders need to sit down and work together to solve problems.”

Groups like the Nashville Health Care Council’s Leadership Health Care, he said, should then “push political leaders of both parties” to move the country forward through compromise so, at the end of the day, we achieve progress on the substantive issues facing the nation.

In his keynote address, Gibbs (at left in a Bill Burke/Page One photo) also provided his thoughts on the closely contested 2012 presidential primary as well as campaigning. As one of President Obama’s closest advisors since the 2004 Senate win, Gibbs noted the most grueling days on the campaign trail did not compare to the easiest days of the White House because the decisions that make it to the Oval Office have no easy answers.

Gibbs noted that LHC’s visit comes at an interesting time just ahead of the Supreme Court’s review of the constitutionality of the Patient Protection and Affordable Care Act. He said he expects one of three things will happen with the court’s review: The law will be struck down, it will be upheld or the individual mandate will be struck down and the rest of the law will be upheld.

But on one thing, he said, we can all agree.

“We have the greatest health care system on the planet,” he said. “But it also needs updating.”

Click here for some post-event video of Gibbs further discussing some of these topics.

Editor's note: This is the first in a series of posts from the Nashville Health Care Council's Leadership Health Care Delegation to Washington. Look for more information from the trip in the coming days.

What will be the outcome of the Supreme Court’s review of the Patient Protection and Affordable Care Act? How much will the 2012 election influence the direction of health care policy? What’s next for payers and providers? These were just some of the questions considered during the first day of sessions at the Nashville Health Care Council’s Leadership Health Care 10-Year Anniversary Delegation to Washington, D.C.

One hundred Leadership Health Care delegates from Nashville and other parts of the country heard from a slate of speakers on March 21, including the dean of the Supreme Court Press Corps Lyle Denniston, who outlined the Court’s schedule for reviewing the reform law early next week. Though Denniston declined to make a prediction about the decision, he described several possible scenarios — including one in which the court rules part or all of the law unconstitutional or even decides there is no legal right to challenge the individual mandate clause until its actual enforcement in 2014.

Denniston (pictured above) also stressed the importance of the court’s look at the issue of severability — whether judges can strike down the individual mandate separately from the rest of the Affordable Care Act, or if striking it down requires negating other parts of the law, or the law in its entirety.

“Don’t overlook the argument about severability,” Denniston said. “It’s a very interesting argument.”

Prior to Denniston’s talk, the delegation heard from Sheila Burke, professor at the John F. Kennedy School of Government and Georgetown University and senior public policy advisor to Baker Donelson Bearman Caldwell & Berkowitz. Burke provided an overview of the political landscape in Washington with regard to health care in which she stressed that nothing is certain — from the fate of the Affordable Care Act to the 2012 election season to future changes or reductions to Medicare and Medicaid.

Longtime health policy analyst Burke noted, “What we know is that everything is in play.”

With regard to the upcoming election, she said one can imagine a scenario of status quo or radical change, but no matter what, partisanship is a given.

“One thing we can assume is a continued deep partisan divide,” she said. “With less and less incentive to compromise, there will be more polarization.”

Political predictions also were part of the panel discussion that wrapped up the day’s sessions. Chip Kahn, president and CEO of the Federation of American Hospitals, called the coming election seminal.

“If the president is re-elected, I’ll predict health reform in some form like it was legislated will happen,” he said. If not, he expects the coverage aspects of the law will be repealed eventually, if not immediately in 2013.

Joining Kahn on the panel, which moderated by Ernst & Young’s Anne Phelps, were Jonathan Bush, co-founder and CEO of athenahealth; Rich Deem, senior vice president for advocacy with the American Medical Association; and Karen Ignagni, president and CEO of America’s Health Insurance Plans. (Ignani is in the center of the photo below talking with LHC members.)

The panel touched on topics ranging from the future of Medicare to end-of-life care to the physician payment formula.

“The breadth and depth of expertise involved in this year’s delegation is phenomenal,” said Judith Byrd, director of Leadership Health Care. “This event truly showcases the intersection of policy and health care at a time when challenges are increasingly complex and the environment is uncertain.”