Grassroots Call July 12 2011 Emergency GAC Call

Grassroots Call, July 12, 2011: Emergency GAC Call

Today’s Call • 1. Debt Ceiling • 2. Rumors rural cuts • 3. Cantor’s Proposal

Background • Debt ceiling/August 2 Deadline • Must have agreement soon. Will take time to draft legislation • This week is critical.

• • Gang of 6 failed Joe Biden negotiations failed President has taken over negotiations “everything is on the table” including rural Medicare payments.

Who’s in the room • President Obama Senate • Reid – D-NV • Durbin – D-IL • Mc. Connell – R-KY • Kyl – R-AZ House • Boehner – R-OH • Cantor – R-VA • Pelosi – D-CA • Hoyer – D-MD

• Earlier Biden proposals may have included reworking cost-based reimbursement. • Now Cantor proposal: • $16 billion in specific rural cuts.

Inside and Outside Strategy • NRHA has hit and will continue to hit key Congressional targets • Administration; WH call, HRSA • Outreach to all rural associations • • Grassroots must be fully mobilized Call and email Member Go to District Office Letters to editor

Critical Access Hospitals and Rural Health Clinics By State STATE Alabama Alaska Arizona Arkansas California Colorado Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri CAH STATE RHC 2 13 14 29 31 29 13 34 9 27 51 35 82 83 30 27 16 3 36 79 31 36 75 2 18 72 285 54 146 94 2 44 221 63 142 179 150 106 39 1 157 81 168 366 Montana Nebraska Nevada New Hampshire New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CAH RHC 48 65 11 13 7 13 23 36 34 34 25 13 5 38 17 79 11 8 7 38 18 58 16 53 138 8 11 11 7 84 58 17 43 64 63 109 57 62 316 18 15 46 129 54 50 18

Rural Referral Centers, Medicare Dependent and Sole Community Hospitals RRC MDH RRC SCH AK 0 0 3 AL 8 8 9 AR 5 3 11 AZ 1 0 6 CA 6 1 14 CO 0 1 11 CT 2 0 1 DE 1 0 0 FL 5 3 6 GA 12 6 10 HI 0 0 5 IA 2 6 2 ID 1 0 1 IL 5 9 7 IN 9 3 1 KS 1 5 11 KY 16 10 3 LA 5 10 5 MA 0 1 1 ME 1 4 4 MI 5 3 13 MN 0 3 8 MO 5 6 10 MS MT NC ND NE NH NM NV NY OH OK OR PA SC SD TN TX UT VA VT WA WI WV WY MDH 13 2 8 0 1 1 1 0 4 8 6 2 9 3 0 6 7 0 3 2 6 0 SCH 11 0 10 0 1 0 0 0 8 5 8 0 9 1 0 24 17 0 7 1 0 4 4 0 10 4 2 1 2 0 12 4 13 5 15 1 9 5 4 6 45 7 11 1 3 7 4 10

Big Plan vs. Little Plan • $2. 4 trillion - $4 trillion • SGR fix? • Rural Extenders

The costly Doc Fix • Congress consistently blocks scheduled cuts from taking effect, and has to come up with new offsets each time. • According to the AMA, a permanent SGR repeal would have cost $48 billion in 2005 — compared with a price tag of nearly $300 billion to block the cuts that are scheduled for January. • "An agreement on the debt ceiling legislation provides the best — and perhaps only — opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner, " the AMA and other organizations said Monday in a letter to President Obama.

Rural Provisions set to expire at same time as SGR • Positive adjustments in the GPCI • Outpatient hospital hold harmless provisions • Extension of the Medicare Dependent Hospital Program • Section 508 Hospital Payments (reclassification) • Rural Ambulance Super bonus • Technical component cost for certain pathology services • Low volume/high quality adjustment

The Message • Don’t support debt ceiling proposal that contains devastating cuts to rural health care. • $16 billion in Medicare cuts to rural providers will decimate the delivery of health care to the 62 million who live in rural American. • Rural hospitals are critical to the patients they serve and to the rural economy.