washington state hospital association. washington state legislature 2011/2012 sessions randy...

Washington State Hospital Association


Washington State Legislature2011/2012 Sessions

Randy Revelle, Senior Vice PresidentCassie Sauer, Vice President

Len McComb, Lobbyist

79th WSHA Annual MeetingOctober 12, 2011

Washington State Hospital Association 33

Outline of the Presentation

• Washington State Legislature – Randy

• Policy Priorities – Cassie

• Washington State Budget – Len

• Budget Priorities – Len

• Hospital Safety Net Assessment – Randy

• “Hospitals: Essential Community Partners” – Cassie

• WSHA Information and Resources – Cassie

• Washington Hospital PAC – Randy


Washington State Legislature


Democratic Leadership

Frank ChoppSpeaker of the House

Frank ChoppSpeaker of the House

Ross Hunter House

Ways and Means Chair

Ross Hunter House


Eileen Cody House

Health Care Chair

Eileen Cody House

Health Care Chair

Lisa Brown Senate

Majority Leader

Lisa Brown Senate

Majority Leader

Ed Murray Senate


Ed Murray Senate


Karen Keiser Senate

Health Care Chair

Karen Keiser Senate

Health Care Chair


Republican Leadership

Gary Alexander House Ranking Ways and Means

Gary Alexander House Ranking Ways and Means

Randi BeckerSenate Ranking

Health Care

Randi BeckerSenate Ranking

Health Care

Joe Zarelli Senate RankingWays and Means

Joe Zarelli Senate RankingWays and Means

Mike Hewitt Senate

Minority Leader

Mike Hewitt Senate

Minority Leader

Richard DeBoldt House

Minority Leader

Richard DeBoldt House

Minority Leader

Joe SchmickHouse Ranking

Health Care

Joe SchmickHouse Ranking

Health Care


2011 Session Overview

• Hard work by the Policy/Advocacy Team

• Extensive grassroots campaign

• Great success on numerous policy bills

• Frustrating results on the Washington State budget

• State legislature raided the Hospital Safety Net Assessment.


Policy Priorities


Policy Priorities: 2011 Session

• Nurse staffing agreement• Health insurance exchange• Adverse events reporting• Public Hospital District

fundraising


Policy Priorities: 2011/2012 Sessions

• Health care reform

• Meal and rest breaks (?)

• Executive compensation

• Freestanding emergency departments

• Physician peer review

10


Washington State Budget


* Data Sources: Washington State Department of Health Year-End Reports, Fiscal Years 2007-2010. DataBank; January to March, 2011

** First Quarter 2011 (estimate)

2007 2008 2009 2010 2011**0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

Washington Hospital Operating Margins2007 to First Quarter 2011 (Estimated)

Hospital Margins Are Declining

5.22% 5.27% 6.10% 5.62% 4.69%


Data Source: Washington State Department of Health Year End Reports, Fiscal Year 2010

Wide Range of Operating Margins(65 of 97 Hospitals Reporting)

14

24

1710


Government Cost Shift(1995 to 2009)

Health Information Program

Data Source: Washington State Department of Health – Hospital Fiscal Year-End Reports

101.3%

89.3% 87.7%91.5%

73.4%

77.4%

120.1%

144.2% 148.1%

70%

80%

90%

100%

110%

120%

130%

140%

150%

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Medicare Medicaid Other Payers

Other Payers

Medicare

Medicaid


Impact of Initiative 1053

or2/3

Very difficult to increase revenues and close tax loopholes

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Impacts of the Recession

• Increased case loads for education and health care

• Reduced revenue as sales tax receipts decline

• Since more than two-thirds of the state budget is protected, $5.1 billion had to be cut from a budget base of about $13 billion.

• The June 2011 forecast predicted $570 million less revenue for 2011-2013, reducing the state’s ending fund balance to $160 million.

• The September 15, 2011 revenue forecast predicts an additional $1.4 billion shortfall in revenues for the 2011-2013 biennium.


Three Budget “Whacks” to Hospitals

About $310 million in hospital cuts in 2009; partially restored by the assessment in 2010.

More than $800 million in additional direct and indirect cuts to hospitals for the 2009-2011 biennium

More than $400 million in additional direct and indirect cuts to hospitals for the 2011-2013 biennium


Budget Priorities


Budget Priorities: 2011 Session

(1) Protect the Hospital Safety Net Assessment

(2) Maintain access to health care

(3) Protect mental health funding

(4) Protect health clinic funding

(5) Maintain maternity support services


Budget Priorities: 2011/2012 Sessions

• Supplemental budget shortfall Access to health care Mental health funding Critical Access Hospitals Certified Public Expenditure hospitals Other budget priorities

• State revenues/referendum

• Hospital Safety Net Assessment

20


Hospital Safety Net Assessment


Preserve the Hospital Safety Net Assessment

• Hospitals volunteered to pay an assessment to augment state funds.

• The assessment is matched by the federal government.

• Hospitals receive enhanced Medicaid payment rates and Disproportionate Share Hospital payments.

• The assessment stabilizes quality care for Medicaid and Apple Health enrollees.


Assessment: Benefits to the State

• 2009-2011 bienniumAbout $60 million in new state general funds

Saved the state millions of dollars by providing payment increases without state funds

• 2011-2013 biennium About $50 million in new state general funds

Saved the state millions of dollars by providing payment increases without state funds


Assessment: Benefits to Hospitals

• More than $70 million net for the 2009-2011 biennium

• More than $100 million net for the 2011-2013 biennium

• Restores a significant portion of the hospital payment cuts enacted by the 2009 legislature

• Requires no additional state funds


Impact of House Bill 2069 (2011-2013)

Reduces payments to Prospective Payment System (PPS) hospitals by about 10 percent

Takes $110 million from the assessment for state general funds

Forgoes $110 million in Medicaid match funds for hospital payments

Keeps $40 million in surplus assessment funds

No direct cuts to Critical Access Hospitals, Certified Public Expenditure hospitals, and psychiatric hospitals

L Total impact is $260 million L


Impact on PPS Hospitals (2011-2013)

April 2010 Law

$1 from the hospital

$1 from the hospital

80 cents to the hospital

$1.50 to the hospital

HB 2069

26


WSHA Board of Trustees’ Goals

Pursue a lawsuit against Washington State to:

• Preserve the Hospital Safety Net Assessment;or

• Negotiate a mutually agreeable settlement with the state


Status of the Assessment Lawsuit

• Lawsuit filed in King County, July 2011.

• Claims: The state legislature violated the Washington State Constitution and several provisions of the assessment law.

• Hearing is scheduled for November 2011.

• WSHA is requesting a summary judgment and a writ of mandamus.

28


“Hospitals: Essential Community Partners”


Legislators’ Perceptions of Hospitals

• Statewide grassroots campaign to improve legislators’ perceptions of hospitals and health systems

• “Hospitals: Essential Community Partners”

• Address a variety of controversial issues

• Highlight hospital and health system accomplishments and benefits

• Educate and lobby all state legislators

30


Hot Buttons

• Margins above eight percent

• Executive compensation more than $500,000

• Rural hospitals with low census

• Integration of physician practices

• Affiliation with a system

• New construction

• Public Hospital Districts

• Free-standing emergency rooms

31


WSHA Information and Resources


WSHA Information

• Inside Olympia and Inside D.C.

• 2011 Legislative Summary

• Health care reform resources on WSHA’s web site

• Hospital-specific reports

• Presentations to management staff, boards, and organizations


WSHA Resources

• Policy: Research, analysis, and writing

• Media: Editorials, op-eds, and news articles

• Lobbyists: WSHA lobbyists, as well as mobilizing other hospital lobbyists

• Grassroots: Unleashing the persuasive power of our membership

• Political Action Committee (PAC): Using campaign donations to promote access to elected officials


Washington Hospital PAC


Washington Hospital PAC

• In 2001, WSHA membership urged PAC expansion.

• In 2010, 531 donors from 92 hospitals/health systems and several organizations donated $154,713.

• Success in the 2010 elections: 88 of the 94 (94%) candidates we supported won their elections!

• PAC donations give WSHA access to elected officials.

• From 2001 to now, the PAC has raised a total of:

$1,056,897!


$82,751

$109,345

$135,446

$154,713

$126,501$111,000

$137,076

PAC Donations: 2005 to 2011


Legislative Composition

38

2227

Senate

RepublicansDemocrats

425

6

House

RepublicansDemocrats


2010 PAC Contributions(State Legislative Candidates)

• Individual Candidates Senate: 10 Democrats, 7 Republicans House: 43 Democrats, 25 Republicans

• Democratic Funds Senate: Roosevelt Fund – Tied for first House: Truman Fund – Fourth

• Republican Funds Senate: Leadership Council – Second House: Reagan Fund – Tied for third


We Need Your Help!

• Stay in contact with your legislators and arrange a hospital visit this year

• Answer calls to action in Inside Olympia and Inside D.C.

• Talk to community leaders about hospitals, health systems, and health care

• Educate reporters and editorial boards

• Contribute generously to the Washington Hospital PAC!


Thank you!

Contact Information:

Randy RevelleSenior Vice President

[email protected]

Questions and Comments

washington state hospital association. washington state legislature 2011/2012 sessions randy...

Documents

washington state budget

health care slide

health care joe schmick

policy priorities slide

estimate hospital margins

house ross hunter house

chair ed murray senate

chair ross hunter house