The Changing Political and Policy Landscape in Health Care: 2015 and beyond

Heidi L. Gartland,

Vice President, Government & Community Relations

HFMA Leadership Conference

March 12, 2015

5 Easy Steps to Picking a Health Plan on Exchange

Step1: Decide on the diseases you and your family are going to have in the coming year

Step 2: Find the best doctors and hospitals for those diseases

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5 Easy Steps to Picking a Health Plan on Exchange

Step 3: Identify which plans offer those doctors and hospitals

Step 4: Select the cheapest plan

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5 Easy Steps to Picking a Health Plan on Exchange

Step 5: If there is no affordable plans with all the doctors and hospitals you want, go back to STEP 1 and pick some new diseases

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Federal Update

State Update

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Policy and Fiscal Environments

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Federal Budget Projections

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Surplus

Deficits

Aug 2014 Projections

Feb 2015 Projections

-$1,600

-$1,200

-$800

-$400

$02

01

0

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11

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(in

bill

ion

s)

Source: CBO Health Care and the Federal Budget February 2015

Revenues vs. Expenditures

Revenue$2,775 B

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Interest

Non-Defense

Defense

Social Security

Medicare

Medicaid

Other

Expenditures$3,455 B

FY 2013 Actuals

Federal: 114th Congress

Senate: Republicans lead • 54R – 46D (Net: R+9)

House: Republicans increase majority• 247R – 188D (Net: R+13)

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Federal: Key Committees

Ways & Means Committee

–Rep. Paul Ryan (R-WI),Chair

Rep. Kevin Brady (R-TX), Health Chair

• Ohio members: Reps Jim Renacci (R-Wadsworth); Pat Tiberi (R-Columbus)

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Federal: Key Committees

Senate Finance Committee

–Sen. Orrin Hatch (R-UT),Chair

Sen. Ron Wyden (D-OR), Ranking member

• Ohio members: Sens. Brown & Portman

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Federal: Setting Stage

• Republicans-control agenda

• President-veto power extensively

• Leg. strategies &

reconciliation

• 2016 Presidential

candidates emerge

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Marketplace by the Numbers 2015

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Cumulative Marketplace Enrollment (HHS Report 3-10-15)

Number of individuals who Selected a Marketplace Plan: 11.7 million (234,341OHIO)

+Males who selected a Marketplace Plan 46%

+18-35 year old who selected a Marketplace Plan 28% (24% OHIO)

+Individuals who selected a Silver Plan 69%

+Individuals who selected a Plan with Financial Assistance 87% (84% OHIO)

Federal: Medicaid Expansion

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Federal: 2015 Legislative Landscape

• Tax reform

• Changes to ACA–30 Hour work week

–Employer mandate

–Medical Device tax

– Individual mandate tax penalties

• Entitlement Reform: Social Security, Medicare/Medicaid

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Federal: President’s Budget

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Federal: Key Dates

• February 4-President’s Budget released

• February 27 – Department of Homeland Security funding expires

• March 15 Debt limit reached

• March 31 – Doc fix patch/two mid-nights expires

• Sept. 30 CHIP Authorization expires

• Sept. 30 Community Health Center funding expires

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Federal: Key Dates

• King v. Burwell-SCOTUS

• June/July-Reconciliation?

• September 16 – ―unofficial‖ 2016 Republican debate

• September 30 – Government funding expires

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Federal: King v. Burwell• March 4, 2015 oral arguments

• June ? 2015 ruling

• Are federal subsidies on federal exchanges illegal?

–ACA…..“enrolled through an Exchange established by the State under §1311 of the ACA.”

• 34 federally facilitated exchange

• 3 state based using healthcare.gov

• 14 state based exchange

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Marketplace: Tax Credits

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King v. Burwell: What’s Next?

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Federal: Key Dates

• King v. Burwell-SCOTUS–March oral arguments

–June decision

• GOP ....―ways we can protect the people and not protect the law itself”

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CHIP Legislative ProposalsDemocratic Bills(S. 522, H.R. 919)

Republican Discussion Draft

Extends CHIP through FY 2019

?

Maintains eligibility levels

Maintains 23% CHIP match

Maintains low waiting periods

Extends pediatric quality

Community Benefit: 501r Final Regulations 12-31-14

• Financial assistance policies

• Limit the amounts charged

• Extraordinary collection actions

• Community health needs assessments

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Federal Update

State Update

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State: 2014 Election Review

Statewide Races• Governor: Kasich (R) 64%

State Senate• 23R – 10D

State House• 65R – 34D (Net: +5R, an historic high)

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National: 2014 State Elections

• 25 of 29 Governor’s up for re-election

won

• Governors--31R, 18D, 1 I

• Legislatures—30 R, 11 D, 8 spit, 1 NA

• State control—23 R, 7D, 18 split, 1 NA

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State: 2015 Legislative Landscape

• Medicaid expansion continuation

• Tax Reform–Severance Tax Increase

–Continued reduction of personal income tax

• Charter School Reform

• Continuing to Look for Government Efficiencies

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US State Spending by Major Category

(In billions of current dollars. Source: NASBO) Medicaid

K-12

Corrections

Transportation

Key Issues for UH: State

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Key Issues for UH: State

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Key Issues for UH: State

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Key Issues for UH: State

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Key Issues for UH: State

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State: Key Issues

• Medicaid Expansion

• State budget (2016/2017)–Medicaid reform

–Medicaid State Innovation Model

–Medicaid provider payments

• SCOTUS decision impact on OH

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State Budget 2016/2017

• Medicaid continuation–Monthly premiums

• Medicaid cuts

• Streamline eligibility categories–Pregnant women coverage eliminated

101%-200%

• Elimination of 209b status (spend-down)

• Pop. Health& Hospital Benefit Advisory Workgroup

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Ohio Department of MedicaidEstimated Uncompensated Carew/ Group VIII - 2014

Southeast: Total w/o Expansion:$95.4m

Actual total w/ Expansion:$65.9m

2013-14 Change:-34.66%

Northeast: Total w/o Expansion:$512.8m

Actual total w/ Expansion:$185.2m

2013-14 Change:-62.75%

Northwest:Total w/o Expansion:$152.5m

Actual total w/ Expansion:$57.3m

2013-14 Change:-66.42%

Southwest:Total w/o Expansion:$464.6

Actual total w/ Expansion:$252.1m

2013-14 Change:-50.86% Central:

Total w/o Expansion:$349.4m

Actual total w/ 2013-14 Change:Expansion: -49.95%$176.5m

NW

C

SW

SE

NE

State: Hospital Cuts

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State: Medicaid Enrollment

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SFY 15 SFY 16 SFY 17

CFC 1,646,035 1,691,207 1,663,982

ABD Adult 174,415 171,429 167,961

ABD Children 42,076 41,377 40,540

ABD Duals 213,206 215,063 219,862

CHIP 121,982 120,091 119,834

Adopted/Foster 27,551 27,243 26,958

Group VIII 503,013 622,516 692,500

Premium Assistance 124,722 130,840 136,374

Family Planning 51,469 36,736 38,929

Breast/Cervical Cancer 761 690 627

Presumptive Eligibility 28,413 25,812 25,968

What’s Next……

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2/08/2010 University Hospitals 3/13/2015 University Hospitals 42