Attendees

John Kotson—IBM Retiree; RMAC Chairman

Hazel Floyd—AUSWR CO/WY President; RMAC Member

Barbara Wilcox—AUSWR Health Care Specialist; RMAC Member

Pat Finley—AUSWR Retiree; RMAC Webmaster

Helen Domaratz—IBM Retiree; Member Congressman Jared Polis SAGE Council

John Rommelfanger—AUSWR Retiree, SAGE Council Member

Stuart Feinhor—Congressman Jared Polis Staffer; Sage Council Chairman

Emily Boyd—Congressman Jared Polis Intern

Rosemary Rodriguez—Senator Michael Bennet’s State Director

Special Guest, Colorado State Senator Irene Aguilar

Senator Aguilar’s Presentation

Update on Colorado Health Exchanges

1. Composition of the Colorado Health Exchange Board - Grethen Hammer is chair, represents Colorado Coalition for the Underserved; has toured the state getting input from consumers on exchanges.
2. Legislative Oversight Committee -
   Senator Aguilar is a member. Now have definitions of preventative care,
   feedback will be given to HHS.
3. Review of HHS Rules for Exchanges
4. Financing Concerns - huge expansion of Medicaid under the Affordable Care Act (ACA).
5. Exchanges Must be Ready by Oct 2013;Enrollment for 2014

Changes occurring in structure of health care delivery

1. Colorado Health Care Strategy and Management
   (CHSM) - believes days of independent providers are gone; will be replaced by
   bundled payments and integrated delivery systems.
2. Accountable Care Organizations (ACO’s)
3. Colorado Health Symposium in Keystone
   - panel on how hospitals are preparing for health care reform

Senator Aguilar’s personal experiences as a doctor suddenly becoming a state senator

Status of Senator Aguilar’s proposal for a Colorado Health Care Cooperative

1. Review and Explanation of the
   proposal
2. Possible courses of action
3. Seeking others’ inputs
4. Co-ops and Exchanges, how they might
   work together

Update on the number of uninsured in Colorado- dropping under ACA, young adults covered under parent’s plans.

National

Stuart Feinhor - Have no idea what the debt limit committee will do; spending cuts are
over 10 years, little immediate impact. People don’t realize the age for Social
Security is already being slowly raised to 67. Discussion of tax holiday (Obama
plan); won’t it undermine Social Security and Medicare? Stuart will look into it.

Rosemary Rodriguez - Betty Sweeney retired, will be assuming some of her duties. She
recommends reading Senator Bennet’s newsletters.

Action Items from last meeting

1. Health care costs that drive inflation - Barbara Wilcox has researched; will make a list of cost drivers she has found.
2. Revised RMAC agenda to include “Misuse of Medicare residency payments” - Completed
3. Revise Medicare Catastrophic Coverage white paper to include CBO Option 21 with tiered deductibles - John Kotson has done a revision of white paper; Barbara Wilcox wants to reduce it to 2 pages.
4. Determine if Medicare Trust Fund Report includes savings under the ACA-John Rommelfanger has researched; does include savings defined by the ACA.
5. Does ACO charter include enabling Medicare savings through initiatives such as Medicare clinics and bundling of payments - short answer yes; Medicare and ACA have many pilot projects for revised forms of payment. ACO’s would be like clinics, but not Medicare
   specific.

RMAC website
status-in July there were 346 unique visitors, 444 different visits and 1700
pages visited. Numbers have increased since the first of the year, making
website viable.

Colorado

Congresswoman
Dianna DeGette Contacts-John Kotson, Barbara Wilcox and Hazel Floyd met with
DeGette’s Colorado staffers for Medicare and Social Security. A meeting report
was written and is posted on the RMAC website, www.rmac-co.org.

Congressman
Jared Polis contacts - Stuart Feinhor and Emily Boyd attended today’s meeting.

Congressman
Ed Perlmutter contacts - Pat Finley invited Jerry Pifer to today’s meeting but
she couldn’t attend.

Senator Mark
Udall contacts - Hazel Floyd hasn’t been able to get a staffer to attend.
Rosemary Rodriguez will call Paul Sample and urge him to attend our meetings.

Senator
Michael Bennet contacts - Rosemary Rodriguez wants to sit down with Hazel Floyd
and learn more about RMAC.

General

Future of
RMAC - our numbers are dwindling due to deaths and other causes. We haven’t
been able to get people from more companies to replace Lucent, HP and JM
retirees. Barbara will ask for more AUSWR participants. John Kotson is unable
to keep travelling to Denver for meetings. He will investigate getting Skype so
that he can participate via video.

Next Meeting
December 2^nd—suggestion was made to invite Marguerite Salazar,
regional HHS director, to our next meeting. Rosemary Rodriguez will invite her.

John
Kotson—RMAC Chairman