LHC in DC: The role of health care in upcoming federal, state races

The 100-strong Leadership Health Care delegation to Washington, D.C., enjoyed a keynote address by David Wasserman, House editor of The Cook Political Report. Wasserman offered a dynamic analysis of the road to the White House in 2016. In this video, he names his picks for presidential candidates and outlines the role of health care in both federal and state races.

Founded in 1984, The Cook Political Report provides analyses of presidential, U.S. Senate, U.S. House and gubernatorial races. Wasserman served as an analyst for the NBC News Election Night Decision Desk in 2012, 2010 and 2008, and has appeared on NBC Nightly News, ABC World News, C-SPAN Washington Journal, CNN and NPR.

Photo by Keith Mellnick

Mar 13, 2015 7:23 AM

LHC in DC: The need to clean up laws and free up data

Editor's note: This is the second post from the Nashville Health Care Council's 2015 Leadership Health Care Delegation to Washington. Look for more content from the trip in coming days and click here for entries from past visits.

During the second day of Leadership Health Care’s annual trip to Washington, D.C., 100 of Nashville’s emerging health care leaders heard from members of the Tennessee delegation to Congress, as well as key members of the Obama Administration, about the health care topics that are shaping policy discussions in the nation’s capital.

Sen. Lamar Alexander (R-TN) and Sen. Bob Corker (R-TN) kicked off the day’s sessions. Alexander discussed his work as chairman of the Senate committee on Health, Education, Labor and Pensions, including trying to find ways to shorten the time and cost associated with bringing a new medical treatment, pharmaceutical or device from the discovery and development phase to the physician’s office or medicine cabinet.

Corker discussed work with U.S. Department of Health & Human Services Secretary Burwell on a long-term fix to Disproportionate Hospital Share payments for Tennessee, which is the only state that doesn’t have a permanent DSH solution.

And Rep. Jim Cooper (D-TN) (pictured) delivered a talk on fraud and waste in the health care system, providing an overview of the laws — such as the False Claims Act whistleblower protection and the Stark law’s anti-kickback statute — that are intended to eliminate costly fraud but can actually create more problems than they solve.

“If we cleaned up the laws, there would be less fraud, but also the government would be saving a whole lot more money,” Cooper said. “And that’s my goal, to save money.”

LHC members also heard from Meena Seshamani, M.D., director of HHS’ Office of Health Reform and Karen B. DeSalvo, M.D., National Coordinator for HIT and Acting Assistant Secretary of HHS, about topics surrounding the implementation of the Affordable Care Act and health information technology initiatives.

Seshamani (pictured at left) provided an overview of consumerism in the health insurance marketplaces, discussing the successes of the most recent health insurance open enrollment period and the ongoing work to reach new enrollees to encourage use of those plans. She talked about her office’s desire to work with states that are interested in expanding Medicaid, noting that $4.2 billion of the $5.7 billion of uncompensated care costs that were eliminated because of the expansion of insurance coverage came in states that expanded Medicaid. And she outlined steps being taken to reform the health care delivery system, including incentives to reward value over volume, initiatives encouraging providers to deliver better coordinated care and improving the distribution of information so providers can make better care decisions.

On the health IT front, DeSalvo discussed the activities of the Office of the National Coordinator for Health IT in advancing the interoperability and usability of health data so providers can more easily share patient health data and use the information to provide better care, reduce costs, improve population health and advance scientific initiatives like precision medicine.

The key ingredients to achieving interoperability are to “standardize the standards,” create incentives to use the standards, and to create a “trust environment” where providers and consumers understand expectations around security and privacy.

“I feel really strongly that we need to unlock this data,” DeSalvo (pictured at right) said, noting that consumers know the data is useful and are frustrated that they have to keep filling out forms on a clipboard at their doctors’ offices and can’t get their children’s immunization records when they’re trying to sign up for school.

“We know the data is there,” she said. “We just have to find a way to get the data to move.”

Photos: Keith Mellnick

Mar 11, 2015 7:43 AM

LHC in DC: Supreme Court case front and center on first day of delegation

Editor's note: This is the first post from the Nashville Health Care Council's 2015 Leadership Health Care Delegation to Washington. Look for more content from the trip in coming days and click here for entries from past visits.

Less than a week after the Supreme Court heard oral arguments in the controversial King v. Burwell case, 100 of Nashville’s emerging health care leaders visited Washington, D.C., to gather insight into the policy and politics that will shape the health care industry in the year ahead. A slate of expert speakers told attendees of the 13th Annual Leadership Health Care Delegation that Washington is holding its breath as it awaits the court’s ruling, which could eliminate health insurance subsidies for about eight million Americans.

“Everyone is waiting on Secretary Burwell, and I don’t think anybody (in Washington) has a really clear idea of how they’re going to move forward, what the next play is, until they get a ruling on that case,” said CNN Investigative Correspondent Chris Frates (pictured at left), who kicked off the delegation’s two days of sessions with a briefing on the state of affairs in Washington.

Former U.S. Senate Majority Leader Tom Daschle said there’s a general consensus in Congress that something must be done to assist the millions of Americans who would lose their insurance subsidies if the court decides in favor of the petitioners in the case.

Daschle asserted that, while there are areas for bipartisan support on issues like precision medicine, telehealth and the Sustainability Growth Rate (SGR) reform, Congress remains divided on issues related to the ACA.

Anne Filipic, president of Enroll America, echoed other comments about the significance of King v. Burwell, saying there’s “absolutely no way” the eight million people who may lose benefits will be guaranteed the same level of coverage if the court decision comes down against subsidies. As part of a panel discussion on what’s next for the implementation of the Affordable Care Act, Filipic (pictured at right) and her co-panelists said a Supreme Court ruling against subsidies would be devastating for many Americans — particularly since the primary reason most Americans who remain uninsured have not purchased coverage is they assume they can’t afford it.

Of course, as the nation learned with the 2012 Supreme Court decision striking down the ACA provision requiring state Medicaid expansions, most people trying to predict the outcome of King v. Burwell are not constitutional scholars, said panelist Cheryl Jaegar, principal with Williams & Jensen and longtime former staff member for Republican leaders in the House of Representatives. It’s difficult to predict what will happen or how the industry will have to react.

Looking ahead, the panel discussed the possibility of Medicaid expansion in additional states. Mary Grealy, president of the Healthcare Leadership Council, said she could see more states expanding if their Republican governors can find a “Republican way to do it” and the federal government is willing to work with them on waivers.

The first day’s sessions also included discussion of the future of value-based purchasing initiatives, how to continue supporting providers as they work toward achieving meaningful use of electronic health records, the nature of political discussions around fixing the SGR, and of course, the 2016 general election.

Frates, who provided delegates a primer on recent happenings (or lack thereof) in Congress, said he doesn’t see a clear challenger for Hillary Clinton for the Democratic nomination. For Republicans, he thinks timing is an important factor for whoever emerges from the field, given how party favorites like Chris Christie and Marco Rubio have ascended and fallen.

Of course, it could just be a throwback year: “If you have 1992 yard signs, you might want to dust them off: Clinton v. Bush,” Frates said.


Former U.S. Senate Majority Leader Tom Daschle, right, talks to Dick Cowart, chair of the health law and public policy department at Baker Donelson, about King v. Burwell and other Washington topics affecting health care.

Photos: Keith Mellnick

Mar 10, 2015 7:13 AM

LHC in DC: Politico editor puts a bow on visit

Editor's note: This is the last post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Click here for other entries from this year and past visits.

Attendees of Leadership Health Care’s 2014 Delegation to Washington were treated to a keynote speech by John Harris, editor in chief of Politico. Co-founded in 2007 by Harris, Politico has developed a reputation as the go-to source for nonpartisan, in-depth coverage of D.C. politics. Harris spent two decades covering politics at The Washington Post and is the author of “The Survivor: Bill Clinton in the White House,” which was a New York Times bestseller.

The delegation of 100 LHC members heard spirited remarks from Harris on the current political and media climate in Washington. In this video, he took a few moments to further discuss health care’s role in recent and upcoming elections, including an apparent upswing in Republican chances of regaining control of the Senate.


Photo Keith Mellnick

Mar 14, 2014 7:14 AM

LHC in DC: 'No matter how painful it is for your individual company or for the industry'

Editor's note: This is the second post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Click here for other entries from the current and past years' visits.

Leadership Health Care’s annual two-day delegation to Washington, D.C., came to a close on Tuesday with a morning of meetings featuring key policymakers. Following a breakfast reception with Sen. Lamar Alexander (R-TN) and Sen. Bob Corker (R-TN), the nearly 100 delegates heard remarks from Rep. Jim Cooper (D-TN) about the long-term outlook for health care spending growth. Rep. Cooper challenged delegates to take leadership roles in helping to solve the problem.

If health care spending growth continues, it’s going to take every tax dollar in America to pay for social security, Medicare and Medicaid by 2040, he said —so there won’t be anything left over for things like defense.

Sen. Rand Paul (R-KY), right, noted in his remarks that as the Baby Boomer generation ages, there are fewer workers paying in to the Medicare system, resulting in payment squeezes to hospitals and physicians. Additionally, he argued that the health care system is broken “because the consumer doesn’t care about the price of health care and neither does the provider. No one shops based on price,” he said. “Market forces have been largely removed from health care services leading to an explosion of costs that will be passed on to future generations without significant reform.”

However, Cooper noted that several factors have led to a slowdown in health spending growth in the past four years — including the slowdown in technology spending, higher cost sharing among consumers and increased provider efficiency around issues like hospital readmissions — making a material positive impact on the federal budget.

“We’ve had some good years,” Cooper said. “We’ve got to make it continue, no matter how painful it is for your individual company or for the industry.”

Rahul Rajkumar, MD, senior advisor for the Centers for Medicare and Medicaid Innovation, spoke to delegates about some of the 20 payment and service delivery model programs that the Innovation Center is testing across the country in an effort to reduce costs while improving quality. Noting the decline in health care spending, he said, “We now feel fairly confident that these changes in health care payment and delivery are beginning to bear fruit.”

In addition to slowing in cost growth, he highlighted the 1.5 percentage point decline in the 30-day hospital readmission rate since January 2010, as well as the 40 percent reduction in central line infections as evidence of improving quality as the industry experiences a paradigm shift around new quality incentives.

The Accountable Care Organization model championed by the Innovation Center is also showing positive results, he said, citing an independent evaluation that found the Pioneer ACOs had gross savings of $147 million and beat quality benchmarks on all of 15 published measures.

Looking ahead, Rajkumar (pictured at right) urged delegates to look at the changes they can make to continue building on the successes to date — such as focusing on better health, better care and lower costs; engaging in accountable care; investing in quality infrastructure; and testing new models and innovations.

Cooper challenged delegates to turn Nashville into “more of a health policy center” by focusing on finding solutions to the problems and hurdles the industry faces.

“This is not someone else’s problem; this is not another generation’s problem,” Cooper said. “This is why you, who are currently in positions of power and influence in your companies, need to figure this out and need to have business plans that make the problem better.”


Photos by Keith Mellnick

Mar 12, 2014 1:16 PM

LHC in DC: On the numbers, expansion and politics of health insurance

Editor's note: This is the first post from the Nashville Health Care Council's 2014 Leadership Health Care Delegation to Washington. Look for more content in the coming days and click here for other entries from past years' visits.

As the 2014 election season begins to heat up, nearly 100 of Nashville’s emerging health care leaders have gathered in our nation’s capital to get an inside look at the health policy discussions that will shape the mid-term elections and affect the industry throughout 2014 and beyond. During the first day of sessions at the 12th Annual Leadership Health Care Delegation to Washington, D.C., delegates heard from a slate of speakers about topics ranging from health insurance exchange enrollment to new payment and delivery models to patient engagement.

Michael Ramlet, founder and editor of digital media company “The Morning Consult,” kicked off the delegation by discussing what he predicts will be a key factor for the industry and politicians in the coming months — whether insurance exchange enrollment will reach the Obama administration’s projected goal of 7 million. With enrollment estimates now above 4 million and a new set of data expected in the weeks ahead, these figures will help determine whether the ACA can be considered effective.

However, Ramlet (pictured at right) noted that one of the biggest, yet under-reported stories of 2014 has been the number of health insurance exchange enrollees — one in five — who have failed to pay their premiums, meaning they don’t actually have coverage. And keynote speaker Dora Hughes, senior policy advisor in the government strategies group of law firm Sidley Austin (pictured), noted that there will be an estimated 5 million individuals who will not be able to get coverage because their states are not expanding Medicaid or they do not qualify for premium subsidies but still cannot afford premium costs. 

The expansion of coverage under the ACA was cited as the best part of the law by a panel of policy experts, although they argued that issues such as timing of the individual mandate and the Supreme Court ruling that made state Medicaid expansion optional have created challenges across the industry.

“What keeps me up at night is coverage expansion, and that it hasn’t happened as quickly as we would have hoped,” said Mary Ella Payne, senior vice president of policy and system legislative leadership for Ascension Health. “We don’t have coverage in Tennessee with the expansion of Medicaid and…many states have not expanded coverage. Related to that are delays that we have been seeing in moving to ACA-compliant plans and delays in the marketplace for small companies.”

Tom Nickels, senior VP of federal relations for the American Hospital Association, said although insurance coverage levels are “nowhere near what we had hoped,” he expects it will take a three-year timeframe for coverage to reach desired levels through Medicaid and the exchanges.

“So I think judgment ought to be suspended at least until we get to the end of 2016,” he said.

In the meantime, Hughes noted that the Centers for Medicare and Medicaid Services’ Innovation Center is working on more than 40 models for improving care delivery in terms of cost and quality, such as accountable care organizations and bundled payments. And although there are more than 260 active ACOs around the country, reports on their effectiveness so far have been mixed.

But one thing is certain. Health care will have a leading role in the 2014 elections.

Ramlet pointed to a poll that shows independent voters evenly spit on which of the major parties they trust more on health care issues. Because of that split, what happens in the months ahead — with exchange enrollment and the perceived value of the health plans, provider experiences, and whether employers drop coverage in favor of pushing employees to exchanges — will be critical.

“There will probably be three big issues,” Ramlet said. “The economy, health care, and the third is open to debate… but health care, you can be sure, will be a major election issue.”


Photos by Keith Mellnick

Mar 11, 2014 6:55 AM

LHC in DC: Forecaster says GOP at 'huge fork in the road' on health care

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.


Mar 19, 2013 6:59 AM

LHC in DC: A pat on the shoulder and a prod from the Tennessee Delegation

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

Mar 15, 2013 7:17 AM

LHC in DC: Talking about entitlement reform

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

Mar 14, 2013 6:57 AM

Hovering near the hub of change

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.

Mar 26, 2012 7:09 AM