The document summarizes key aspects of the proposed US health care reform plan, including: 1) It would require all Americans to have health insurance and businesses to provide it or pay a penalty. Subsidies would help lower-income families purchase insurance. 2) Health insurance exchanges would be created to allow consumers to compare plans starting in 2013. 3) While hospitals, doctors, and private Medicare plans oppose aspects of the plan, supporters argue it will reduce costs and improve care by covering more of the uninsured.

1. The Proposed Health Care Reform’s Impact on Marketing Presented to: Arkansas Society for Health Care Marketing & Public Relations Summer 2009 Conference Presented by: Blake S. Rutherford Director of Public Communications Stone Ward

2. The Health Insurance Reform Plan What does it propose to accomplish? Require virtually all Americans to carry health insurance or pay a penalty. Require all but the smallest businesses to provide and subsidize health insurance for their workers or pay a penalty. Expand Medicaid to the poorest uninsured.

3. The Health Insurance Reform Plan Those earning $66,000 - $88,000 for a family of four would have access to subsidies to help them purchase coverage. Create health insurance exchanges allowing customers to compare health plans. Launch date of 2013 Congressional Budget Office estimates 37 million people will participate in the exchanges Questions remain over how many; whether providers can sell coverage outside the exchanges

4. The Health Insurance Reform Plan Allow consumers to keep their existing plan if they like it. Employers would remain free to to change or drop coverage at any time, but they would be forced to pay a penalty to help off-set the cost for their workers to buy coverage through an exchange. Eventually, employers could enroll in the exchanges.

5. The Health Insurance Reform Plan Who benefits? Uninsured They will be compelled to purchase insurance. Insured With most of the uninsured covered, this should limit the amount of charity care delivered by hospitals and eliminate the need to shift such costs with private insurance.

6. The Health Insurance Reform Plan Cost shifting to cover care for the uninsured adds about $1,000 to a family’s annual insurance premiums.* Health insurance exchanges would create more competition in the marketplace. * New York Times, July 25, 2009.

7. The Health Insurance Reform Plan Seniors People over the age of 65 that are already covered by Medicare or Medicaid will remain as they are. Chronically ill Medicare beneficiaries will receive a 50% reduction in the cost of brand name drugs once they reach the “doughnut hole” where they are required to pay full price.

8. The Health Insurance Reform Plan Military TRICARE will continue Uniformed personnel will not suffer a penalty if they fail to take advantage of the universal options.

9. The Health Insurance Reform Plan Who doesn’t like it? Hospitals and doctors Long-term goal of health care reform is to get rid of the fee-for-service system in which patients often get very expensive care, but sometimes not the best care. “ Most experts blame the system for runaway health care costs because it pays doctors and hospitals for each service it performs, thus providing a financial incentive to order excessive treatments or tests.”* * New York Times, July 25, 2009

10. The Health Insurance Reform Plan The reform bill provides for research and pilot programs to find ways to both control costs and improve patient care. Medicare/Medicaid reimbursement New insurers may be on plans with similar reimbursement rates to Medicare/Medicaid. Assuming the it works out as agreed, the rates for the public option will be higher, although we don’t know the degree.

11. The Health Insurance Reform Plan Medicare Advantage plan members Private plans that participate in Medicare. They are heavily subsidized and all evidence suggests the subsidies will be discontinued.

12. The Health Insurance Reform Plan This guy

13. The Health Insurance Reform Plan Where are we today? Hospital Associations and the White House have agreed to $155 billion in Medicare and Medicaid reimbursement cuts over the next 10 years. Idea being that by insuring more people hospitals will be able to afford these cost cuts.

14. The Health Insurance Reform Plan Pharmaceutical companies have agreed in principle to cut the cost of brand name medicine by 50% for those seniors covered by Medicare who have reached the “doughnut hole” period where they must pay the full amount for medicine.

15. The Health Insurance Reform Plan How will this affect hospitals? What will the reduction in Medicare reimbursements mean from a messaging perspective? House Minority Whip Eric Cantor (R-OH) issued a memo this week saying that hospitals in the fourth congressional district of Arkansas would see cuts in Medicare payments of at least $324.8 million.

16. The Health Insurance Reform Plan What impact will this have on your customers perceptions of your ability to provide services and technology?

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18. The Health Insurance Reform Plan Will there be a push from the top down to focus more on health than on sickness? Dr. Delos Cosgrove, CEO, The Cleveland Clinic: “Doctors like me have spent many years in the sickness business. We need to get into the health business.” The Cleveland Clinic has a Chief Wellness Officer, Chief Experience Officer and an Art-Program Curator.

19. The Health Insurance Reform Plan Offers Yoga 10 times a day; specialty entertainment programs like “Dancing Wheels” for wheelchair bound patients; an Executive Chef; and Lifestyle 180, a program to assist the chronically ill through yoga, cooking and stress management. President Barack Obama visited the clinic two weeks ago and references it in speeches as a model approach.

20. The Health Insurance Reform Plan “ And that means they can track patients and their progress. It means that they can see what treatments work and what treatments are unnecessary. It means they can provide better care for patients. They don't have to duplicate test after test because it's all online. They can help patients manage chronic diseases like diabetes and high blood pressure and asthma and emphysema by coordinating with doctors and nurses both in the hospital and in the community.” - - President Barack Obama, July 23, 2009.

21. The Health Insurance Reform Plan How will rural hospitals manage their message? Consistently serve more people per capita that are older, sicker and poorer. “ Due to the low number of patients, rural hospitals operate with little to no profit margin. Lowering these hospitals' badly needed federal reimbursements could result in reduced services, or even worse, the closure of entire facilities.” - - Texas Sen. Kay Bailey Hutchinson, RealClearPolitics.com, July 20, 2009

22. The Health Insurance Reform Plan What impact with the “public option” have on customers’ perceptions? It is meant to lower the burden on charitable care. Will it? Will it make up the difference created from the Medicare reimbursement cuts? How will customers view coverage as compared to services?

23. The Health Insurance Reform Plan Don’t ignore the media swell around this: “ When patients are not protected by large private or public insurers, doctors and hospitals charge them two-and-a-half times more than the insured; and three times more than their costs.” - - Mark Hall and Carl Schneider, “Patients as Consumers: Courts, Contracts, and the New Medical Marketplace.” 106 Mich. Law Review 643 (2009)

24. The Health Insurance Reform Plan What public pressure will there be for hospitals to improve efficiencies in the way you do business? Will public sentiment demand pay-for-care rather than pay-for-service? How will all of this impact your ability to attract the best doctors?

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27. The Health Insurance Reform Plan Thank you Blake S. Rutherford Director of Public Communications Stone Ward [email_address] http://www.twitter.com/blakerutherford http://www.facebook.com/blake.rutherford