Washington State Hospital Association Association of Washington Public Hospital Districts 2004...

Washington State Hospital Association Association of Washington Public Hospital Districts

2004 Legislative Session2004 Legislative Session

For audio, call: 1-800-936-4606host: WSHA or Cassie Sauer


PresentersPresenters

Cassie SauerDirector, Advocacy and Public RelationsWSHA

Cassie SauerDirector, Advocacy and Public RelationsWSHA

Claudia SandersVice President, Policy DevelopmentWSHA

Claudia SandersVice President, Policy DevelopmentWSHA

Randy RevelleVice President, Policy and Public AffairsWSHA

Randy RevelleVice President, Policy and Public AffairsWSHA


Webcast OutlineWebcast Outline

• Elections and leadership changes

• State of the state budget

• The Governor’s budget proposal

• WSHA and AWPHD policy priorities

• What you can do

• Elections and leadership changes

• State of the state budget

• The Governor’s budget proposal

• WSHA and AWPHD policy priorities

• What you can do


2004 Legislative Session2004 Legislative Session

• Very political

• 2004 elections coming

• Narrow majorities

• State budget still shaky

• Democrats trying to hold together

• Republicans have major leadership changes

• Short and fast

• Very political

• 2004 elections coming

• Narrow majorities

• State budget still shaky

• Democrats trying to hold together

• Republicans have major leadership changes

• Short and fast


Everybody’s Running for Office:Statewide Offices

Everybody’s Running for Office:Statewide Offices

Christine GregoireAttorney General

Candidate for Governor

Christine GregoireAttorney General

Candidate for Governor

Gary LockeGovernor

Not Running for Re-Election

Gary LockeGovernor

Not Running for Re-Election

Mike KreidlerInsurance CommissionerRunning for Re-Election

Mike KreidlerInsurance CommissionerRunning for Re-Election

George NethercuttCongressmanCandidate for

U.S. Senate

George NethercuttCongressmanCandidate for

U.S. Senate


Everybody’s Running for Office:Republican Leadership ChangesEverybody’s Running for Office:Republican Leadership Changes

Dino RossiFormer Senate

Ways & Means ChairCandidate for Governor

Dino RossiFormer Senate

Ways & Means ChairCandidate for Governor

Jim WestFormer Senate

Majority LeaderNew Spokane Mayor

Jim WestFormer Senate

Majority LeaderNew Spokane Mayor

Larry SheahanSenate

Former Floor LeaderCandidate for Congress

Larry SheahanSenate

Former Floor LeaderCandidate for Congress

Cathy McMorrisFormer House

Republican LeaderCandidate for Congress

Cathy McMorrisFormer House

Republican LeaderCandidate for Congress


Democratic LeadershipDemocratic Leadership

Frank ChoppSpeaker of the House

Frank ChoppSpeaker of the House

Helen Sommers House

Appropriations Chair

Helen Sommers House

Appropriations Chair

Eileen Cody House

Health Care Chair

Eileen Cody House

Health Care Chair

Lisa Brown Senate

Minority Leader

Lisa Brown Senate

Minority Leader

Margarita Prentice Senate Ranking Ways and Means

Margarita Prentice Senate Ranking Ways and Means

Pat Thibaudeau Senate Ranking

Health Care

Pat Thibaudeau Senate Ranking

Health Care


Republican LeadershipRepublican Leadership

Barry Sehlin House Ranking Appropriations

Barry Sehlin House Ranking Appropriations

Alex Deccio Senate

Health Care Chair

Alex Deccio Senate

Health Care Chair

Joe Zarelli Senate

Ways and Means Chair

Joe Zarelli Senate

Ways and Means Chair

Bill Finkbeiner Senate

Majority Leader

Bill Finkbeiner Senate

Majority Leader

Richard DeBoldt House

Minority Leader

Richard DeBoldt House

Minority Leader

Barbara Bailey House Ranking

Health Care

Barbara Bailey House Ranking

Health Care


Washington Hospital PAC:Contributions

Washington Hospital PAC:Contributions

$40,000

$24,000

$62,000

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

$40,000

$24,000

$62,000

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2001 2002 2003


The State Budget The State Budget


People Insured by State Health Care(As of April 2003)

People Insured by State Health Care(As of April 2003)

Also: 300,000 public employees insured by the stateAlso: 300,000 public employees insured by the state

Basic Health 125,000

Medicaid for Children 565,000

Medicaid for Adults, Aged, Blind, Disabled 360,000

Medically Needy 16,000

TOTAL 1,087,000

Other State Programs (MI, GAU, ADATSA) 14,000

Children’s Health Insurance Program (CHIP) 7,000


Governor and Legislature Made Significant Cuts to Health Care

Governor and Legislature Made Significant Cuts to Health Care

Cuts to HealthCare29%

Cuts to All Other

State Programs

71%

Health care took $766 million of $2.6 billion in cutsHealth care took $766 million of $2.6 billion in cuts


Hospital Operating Margins Remain LowHospital Operating Margins Remain LowOperating Margin

3.9%

2.3%2.0%

1.3%

2.4% 2.5%

-1%

0%

1%

2%

3%

4%

5%

1997 1998 1999 2000 2001 2002

Rural Urban All Hospitals


State Budget ProcessState Budget Process

• Supplemental budget process to amend the 2003-2005 budget adopted last June

• Governor released his supplemental budget on December 18

• Legislative session January 12 to March 12 (?)

• Senate and House each propose a budget, likely in February or March

• Legislators have to pass a compromise the Governor will sign

• Supplemental budget process to amend the 2003-2005 budget adopted last June

• Governor released his supplemental budget on December 18

• Legislative session January 12 to March 12 (?)

• Senate and House each propose a budget, likely in February or March

• Legislators have to pass a compromise the Governor will sign


Governor’s Budget ProposalGovernor’s Budget Proposal

• Declares “the state is turning around”

• “You will have to go to California or some other state for a story about a budget crisis. We don't have one here.”

• Adds $200 million in spending, primarily education and health care

• Leaves $172 million in reserves

• Extends some business tax cuts

• Declares “the state is turning around”

• “You will have to go to California or some other state for a story about a budget crisis. We don't have one here.”

• Adds $200 million in spending, primarily education and health care

• Leaves $172 million in reserves

• Extends some business tax cuts


New Revenues?New Revenues?

• Legislators questioning Governor’s budget

• Most services, particularly health care, already badly cut

• Health care an enormous target with no new money

• WSHA will support legislators who have the courage to protect health care, even if it means raising taxes

• Legislators questioning Governor’s budget

• Most services, particularly health care, already badly cut

• Health care an enormous target with no new money

• WSHA will support legislators who have the courage to protect health care, even if it means raising taxes


Budget PrioritiesBudget Priorities


Medicaid PremiumsMedicaid Premiums

• Legislature enacted the highest premiums in the nation for children at poverty

• Direct impact on hospitals– Termination of insurance for

non-payment– Pay in arrears and wait three months

• New SCHIP money can help ($23 million)• Locke’s proposal: Eliminate premiums to 150% poverty

level, reduce others• WSHA goal: Eliminate or reduce premiums

• Legislature enacted the highest premiums in the nation for children at poverty

• Direct impact on hospitals– Termination of insurance for

non-payment– Pay in arrears and wait three months

• New SCHIP money can help ($23 million)• Locke’s proposal: Eliminate premiums to 150% poverty

level, reduce others• WSHA goal: Eliminate or reduce premiums


Proshare AllocationProshare Allocation

• Funding for public hospital district nursing homes

• Legislature gave $9.6 million, but miscalculated

• Only $6.5 million available

• Locke’s proposal: Restores funding

• WSHA goal: Full $9.6 million to nursing homes

• Funding for public hospital district nursing homes

• Legislature gave $9.6 million, but miscalculated

• Only $6.5 million available

• Locke’s proposal: Restores funding

• WSHA goal: Full $9.6 million to nursing homes


Medically Indigent (MI) FundingMedically Indigent (MI) Funding

• Legislature eliminated this critical funding for emergencies/trauma

• Partially replaced with grants

• Rural grants provide full funding

• Urban hospitals lost $50 million over two years

• Now, $36 million in new federal DSH funds

• Locke’s proposal: no action

• WSHA goal: Add $20 million to urban hospital grant

• Legislature eliminated this critical funding for emergencies/trauma

• Partially replaced with grants

• Rural grants provide full funding

• Urban hospitals lost $50 million over two years



• WSHA goal: Add $20 million to urban hospital grant


Inpatient Mental HealthInpatient Mental Health

• Inpatient mental health services are stressed

• Many Medicaid patients

• State hospital bed reductions increases demand

• Hospitals are reducing / closing units



• WSHA goal: $10 million (plus potential federal match) to inpatient mental health

• Inpatient mental health services are stressed

• Many Medicaid patients

• State hospital bed reductions increases demand

• Hospitals are reducing / closing units



• WSHA goal: $10 million (plus potential federal match) to inpatient mental health


Governor’s Budget Proposal:Other Health Care Issues

Governor’s Budget Proposal:Other Health Care Issues

• Creates a patient compensation fund for medical liability

• Increases Medicaid payments for labor and delivery

• Provides $6.7 million in additional Disproportionate Share Hospital (DSH) funds to district hospitals

• Provides $3.7 million to improve rural health

• Creates a patient compensation fund for medical liability

• Increases Medicaid payments for labor and delivery

• Provides $6.7 million in additional Disproportionate Share Hospital (DSH) funds to district hospitals

• Provides $3.7 million to improve rural health


QuestionsQuestions


Policy Priorities Policy Priorities


Policy PrioritiesPolicy Priorities

• Enact medical liability reform

• Enact mental health parity

• Defeat nurse staffing plans

• Limit new regulations

• Enact medical liability reform

• Enact mental health parity

• Defeat nurse staffing plans

• Limit new regulationsPRIORITY


Medical Liability ReformMedical Liability Reform

• Partnership with Liability Reform Coalition and WSMA seeking broad liability reform

• Cap on non-economic damages; requires a Constitutional amendment

• Establish periodic payments

• Disclose collateral source offset

• Revise joint and several liability

• Change ostensible agency

• Partnership with Liability Reform Coalition and WSMA seeking broad liability reform

• Cap on non-economic damages; requires a Constitutional amendment

• Establish periodic payments

• Disclose collateral source offset

• Revise joint and several liability

• Change ostensible agency


Average/Median Liability Premiums (91% of WSHA Hospitals)

Average/Median Liability Premiums (91% of WSHA Hospitals)

$370,000

$157,000

$545,597

$228,402

$1,022,769

$1,215,428

$0

$500,000

$1,000,000

$1,500,000

Average Premiums Median Premiums

2001 2002 2003

$370,000

$157,000

$545,597

$228,402

$1,022,769

$1,215,428

$0

$500,000

$1,000,000

$1,500,000

Average Premiums Median Premiums

2001 2002 2003


Impacts on Health Care Delivery(91% of WSHA Hospitals)

Impacts on Health Care Delivery(91% of WSHA Hospitals)

30%24%

37%

86%

14%

44%

0%

25%

50%

75%

100%

More difficultto recruit

physicians

Significantimpact onhospitalfinances

Loss ofphysician oremergency

roomcoverage

NegativeImpact onability toprovideservices

Significantimpact on

access

Physiciansleaving orreducingpractice

30%24%

37%

86%

14%

44%

0%

25%

50%

75%

100%

More difficultto recruit

physicians

Significantimpact onhospitalfinances

Loss ofphysician oremergency

roomcoverage

NegativeImpact onability toprovideservices

Significantimpact on

access

Physiciansleaving orreducingpractice


Democrats’ Medical Liability ProposalDemocrats’ Medical Liability Proposal

• Focuses on three areas:– Improve patient safety– Assure physicians and hospitals

can get insurance– Improve the civil justice system

• Includes several positive proposals• Creates a “patient compensation fund”• Separates medical liability from the rest of the

Liability Reform Coalition interests

• Focuses on three areas:– Improve patient safety– Assure physicians and hospitals

can get insurance– Improve the civil justice system

• Includes several positive proposals• Creates a “patient compensation fund”• Separates medical liability from the rest of the

Liability Reform Coalition interests


Mental Health ParityMental Health Parity

• Health insurance discriminates against the mentally ill

• WSHA goal: Parity between physical and mental health insurance

• Parity is affordable

• Direct benefit to hospitals, especially mental health units

• Health insurance discriminates against the mentally ill

• WSHA goal: Parity between physical and mental health insurance

• Parity is affordable

• Direct benefit to hospitals, especially mental health units


Nurse Staffing Plans Nurse Staffing Plans

• WSNA sponsored legislation

• Fall back is a task force

• Over-regulation of hospitals

• Does not account for differences in hospitals

• Could lead to ratios

• Create educational opportunities, grow the pool of nurses

• WSNA sponsored legislation

• Fall back is a task force

• Over-regulation of hospitals

• Does not account for differences in hospitals

• Could lead to ratios

• Create educational opportunities, grow the pool of nurses


Regulatory ReformRegulatory Reform

• Hospitals face many unnecessary regulations

• Increase costs

• Decrease efficiency

• Every year, new regulations are proposed

• WSHA goal: Prevent any further unnecessary regulations

• Hospitals face many unnecessary regulations

• Increase costs

• Decrease efficiency

• Every year, new regulations are proposed

• WSHA goal: Prevent any further unnecessary regulations


What About Boutique Hospitals?What About Boutique Hospitals?

• Major priority in 2003

• Source of conflict with WSMA

• Medicare prescription drug law:– Federal moratorium for 18 months– New federal studies

• WSHA will revisit in 2005

• Major priority in 2003

• Source of conflict with WSMA

• Medicare prescription drug law:– Federal moratorium for 18 months– New federal studies

• WSHA will revisit in 2005


What You Can DoWhat You Can Do

• Stay in contact with your legislators

• Talk to others in your community about what health care spending means

• Highlight good things government accomplishes

• Talk to reporters and editorial boards

• Do not sign any initiatives unless you know they will help!

• Stay in contact with your legislators

• Talk to others in your community about what health care spending means

• Highlight good things government accomplishes

• Talk to reporters and editorial boards

• Do not sign any initiatives unless you know they will help!


We Need Your Stories!We Need Your Stories!

• How are budget cuts affecting you?

• People who cannot get care?

• Children without health care access?

• Program closures?

• ER volume increases?

• Charity care increases?

• No pay, bad debt increases?

• How are budget cuts affecting you?

• People who cannot get care?

• Children without health care access?

• Program closures?

• ER volume increases?

• Charity care increases?

• No pay, bad debt increases?


Resources on the WebResources on the Web

• www.wsha.org– Issue briefs– Budget analysis

• www.leg.wa.gov – State legislature– Contact information;

biographies of legislators– Committee/bill information

• www.access.wa.gov– Executive branch/state agencies– Governor and state budget information

• www.wsha.org– Issue briefs– Budget analysis

• www.leg.wa.gov – State legislature– Contact information;

biographies of legislators– Committee/bill information

• www.access.wa.gov– Executive branch/state agencies– Governor and state budget information


Questions and Comments Questions and Comments

Contact Information:[email protected] 206/216-2538

Washington State Hospital Association Association of Washington Public Hospital Districts 2004...

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