Adult Day Services: Effectively Advocating in Washington D'C'

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Adult Day Services Effectively Advocating in
Washington D.C. Becoming an Integral Part of
Health Reform

• National Adult Day Service Association Conference
• San Antonio, TX
• Jodie Curtis
• Drinker Biddle Reath, LLP
• November 9, 2008

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(No Transcript)
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Presidential Results

• Obama wins the White House
• 53-46 with MO still to be decided
• 364-163 electoral college votes
• GW Bush 51/286,48/271
• Clinton49/379, 43/370
• GHW Bush 53/426

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House of Representatives

• Democrats pick up seats
• Was 236-199
• Now 255-174, 6 undecided
• 47 Blue Dogs
• 71 Progressive Caucus

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Senate

• Democrats pick up seats
• Was 51-47-2
• 57-40-2
• MN-AP called Coleman over Franken 600 votes
  recount
• GA-Chambliss leads Martin but possible runoff
• AK-Stevens too close to call
• Unlikely Dems will get to 60

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What is Lobbying?

• Showing up
• Educating
• Persuading
• Asking
• Following through

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Lobbying The Basics

• Strategic relationship-building over an extended
  period of time
• Its never too early to start
• Development of policy supported by persuasive
  arguments and evidence
• Strategic planning
• Importance of understanding the legislative and
  regulatory calendars
• Polished execution grunt work
• Thank supportive Members of Congress

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What is Federal Government Relations?

• Lobbying Congress
• Members of the House and key committees
• Members of the Senate and key committees
• Lobbying the Executive Branch
• Government agencies (e.g. CMS)
• White House (i.e. Executive Office of the
  President)

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Lobbying 101 in a Nutshell Turning Ideas into
Action
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Policy Makers Work for You

• Washington, DC
• Legislative staff
• -- policy focus
• District/State
• caseworkers
• outreach staff
• -- local focus

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Health Care is Political

• Medicaid/Medicare Policy - Medicare Modernization
  Act and Deficit Reduction Act Implementation
• Budget cuts
• Health care reform

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Congress The Basics

• Senate
• 100
• 2 per state
• 1/3 every2 years

• House
• 435
• Pop. based every2 years
• 1 Memberlocal district

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Key Committees
Senate
House

• Ways and Means
• (Medicare Parts A B)
• Energy Commerce
• (Medicaid)
• Appropriations (CMS)
• Budget

• Finance Committee (Medicare/Medicaid)
• Health, Education, Labor, and Pensions (HELP)
  Committee
• Appropriations (CMS)
• Budget

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Im Only a Bill

• Bill introduced ()
• Ref. committee
• Ref. subcommittee
• Reported out favorably
• Full chamber
• Repeat in other chamber
• Conference Committee

President ??
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Typical Elements of a Government Relations
Campaign

• Set up meetings with Members of key congressional
  committees and your companys state delegations
• Enlist support of key Members to help secure a
  meeting with senior-level CMS staff

• Develop data/evidence and persuasive rationale
  for the proposed policy
• Develop "leave-behind" packets including issue
  briefs, talking points, patient access impact
  analysis, and other advocacy materials for
  Members and their staff

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Typical Elements of a Government Relations
Campaign

• Direct outreach and education with key agency
  staff and conduct periodic follow-up with
  congressional offices to keep supporters apprised
  of status of the effort
• Invite Members of Congress and their staff to
  visit your facilities in their district
• Conduct outreach to other advocacy groups and
  seek to enlist their support

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Government Relations Myths

• Real lobbying is done in a smoke-filled
  backroom
• Only large companies do it
• Send in one well-connected lobbyist and it will
  all be fine

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Putting Advocacy Into Action Getting Started

• Get to know your congressional delegation in
  Washington by meeting with Members staff,
  ideally before you need something
• Introduce your company (provide materials)
• Do background research on Member prior to meeting
  (common priorities?)
• www.house.gov
• www.senate.gov
• thomas.loc.gov

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www.house.gov
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www.congress.gov
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Getting Started

• Find local offices of your Members of Congress
  and visit them
• Invite Member or staff to visit your facility
• Try to start small with any requests
• Be respectful and patient
• Congressional offices are understaffed for the
  volume of work they produce, and your priority is
  just one of many
• Always follow up with requested information and
  thank you letters

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Getting Started

• Before engaging in advocacy activities, discuss
  internally
• Possible existing political relationships
• Need for prioritization and coordination of
  congressional requests
• Democracy is slow persistence, patience, and a
  long-term commitment are required

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Health Care Reform Overall
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Almost Everyone Agrees About

• Controlling health care costs
• Providing cost transparency
• Increasing information about quality of care
• Promoting use of evidence-based medicine and
  health information technology (including
  electronic prescribing)
• Improving chronic disease management and health
  promotion/prevention
• Permitting drug re-importation and generics
• Supporting expansion and development of health
  professionals

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Then the Differences Start
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Republicans Generally

• Market-based approaches
• Consumer responsibility
• Private insurance options
• Health savings account
• Use of tax incentives

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Democrats Generally

• Federal subsidies
• Expansion of public sector coverage
• Increased government oversight and regulation

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Obama Health Plan Executive Summary

• Preserves current employer-based system
• Creates a National Health Insurance Exchange
  modeled after the Federal Employees Health
  Benefits Program (private plans compete with
  public plan)
• Requires pay or play for employers
• Mandates all children be covered by 2012
• Expands eligibility for Medicaid/SCHIP
• Permits young adults to be covered by parents
• Promotes health care access and interventions at
  schools and worksites

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Positives of the Obama Plan

• People can maintain current coverage
• Near universal coverage
• Subsidies for those who cannot afford health
  insurance

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Pitfalls of the Obama Plan

• High taxpayer cost, possibly 110 billion per
  year
• Coverage is not universal
• Affordable premium is subjective

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So What Will Really Happen?
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So What Will Really Happen?

• Financial bail-out changes everything
• Outcome of the election impacts the national
  agenda
• Need bipartisan will and cooperation to make
  health reform a reality

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So What Will Really Happen?

• Health care reform will never happen
• This was the conventional wisdom about a Medicare
  prescription drug benefit, but it happened
• Senator Kennedys leadership could be critical to
  outcome he is writing his own bill
• No one knows more
• Polarizing
• Senator Clinton will play an important role
• Where does she throw her support?

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So What Will Really Happen?

• Unprecedented unity among interest groups
  regarding the need for reform Harry Louise
  change their tune
• Some sort of bipartisanship is a key to success
• In 1993-1994, the moderates wanted an individual
  mandate.
• Liberals wanted employer mandate and said my way
  or no way.
• Conservatives wanted to kill reform.
• No one wanted to see the moderates succeed.

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So What Will Really Happen?

• 2008-2009 The side that finds common ground
  with the moderates can win.
• No health care reform will go forward without
  discussion of Medicaid and Medicare

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ADHCs Role in Health Care Reform

• Should ADHC be part of health care reform?
• Absolutely
• Will ADHC be part of health care reform?
• Unclear

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ADHCs Role in Health Care Reform

• Challenges
• Average policymakers dont understand what ADHC
  is or its advantages
• Not a strong grassroots political voice
• Not a cadre of Washington lobbyists
• CMS recent actions

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ADHCs Role in Health Care Reform

• Opportunities
• Saves money makes this attractive for balancing
  more expensive components
• Increasing trend to want to keep people out of
  institutionalized health care as long as possible
• Better health outcomes
• Influential Members of Congress do know about
  ADHC
• CMS recent actions
• Attention starting to focus on chronic care mgmt

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Opportunities for ADHC

• Health care policy will be considered on some
  level in Congress
• Everything on the table
• ADHC has a great story
• No health care reform will go forward without
  discussion of Medicaid and Medicare
• The groundwork has been laid here
• Medicaid rehabilitation regulation moratorium
• Medicare Adult Day Health Care Demonstration
  Project

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Considerations for ADHC Providers

• A large part of HC Reform is controlling cost
• How will providers be a part of the solution for
  managing costs for those with chronic medical,
  cognitive, and psych conditions?
• Can we show cost savings on the Medicare side?
  Right now ADHC saves Medicare   with reduced
  hospitalizations and ER visits but the Medicaid
  side gets no "credit" for that since they are two
  different systems.
• Bridging Medicare and Medicaid is a fundamental
  issue
• Does the ADHC business model need to change to
  work with Medicare?
• If so, how?
• Should health care reform include some new hybrid
  of Medicare/Medicaid?
• Can that be done around the issue of
  dual-eligible's?
• How does ADHC position itself as part of the
  solution?

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Final Thoughts

• Building relationships is key and an investment
  in the future for adult day services position
  within Medicaid and Medicare reforms
• New Congress creates new opportunity for our
  proposal to protect ADHC from a waiver

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Contact Information

• Jodie Curtis
• Drinker Biddle Reath
• jodie.curtis_at_dbr.com