AAFP Government Affairs Update

Bob Hall

State Legislative Conference

Dallas, TX

November 3, 2017

AAFP Division of Government RelationsBob Hall * Director, Government Relations

Shelby King Manager, Center for State Policy

Teresa Baker* Senior Government Relations Representative

Andrew Adair* Government Relations Representative

Sonya Clay* Government Relations Representative

Robert Bennett* Manager, Federal Regulatory Affairs (based in Austin)

Mark Cribben* Director, FamMedPAC

Jeanette Contreras Manager, Strategic Advocacy Communications

Rhonda Carter FamMedPAC Administrative Coordinator

Lorlita Alexander Executive Assistant

Tia Johnson Senior Office Executive

*Registered Federal Lobbyists

AAFP Top Issues for 2017

• Promote physician payment reforms that

value primary care.

• Defend gains in health insurance coverage.

• Reduce administrative and regulatory

burdens.

• Improve physician well-being.

• Increase family physician workforce.

• Support population health improvement.

US House

US Senate

194 Dems

46 Dems

239 Reps

52 Reps

+7

+2

-8

-2

115TH CONGRESS

174

11

6

3

1

12

23

25

180

Solid Democrat

Likely Democrat

Lean Democrat

Toss-Up

Lean Republican

Likely Republican

Solid Republican

■ Republican held seats (240) ■ Democrat held seats (194)

2017-2018 House races

Democrats need to pick up over 20 seats to take back the House in 2018

Source: Cook Political Report.

Cook Political Report ratings

Democrats need a three-seat net gain to win a 2018

Senate majority; Republicans are defending fewer seats

Source: The Cook Political Report.

States with Senate elections, 2018

OH

WV

VA

PA

NY

ME

NC

SC

GA

TN

KY

IN

MI

WI

MN

IL

LATX

OK

ID

NV

OR

WA

CA

AZ

NM

CO

WY

MT ND

SD

IA

UT

FL

AR

MO

MS AL

NE

KS

AK

HI

DE

RI

VT

NH

MA

CT

NJ

MD

DC

■ Democrat incumbent ■ Independent incumbent ■ Republican incumbentAnalysis• Democrats will be defending 25 seats in 2018, while

Republicans are defending only nine• Of the nine Republican seats, just Nevada, held by

freshman Sen. Dean Heller, is in a state won by Democrats in the 2012 or 2016 presidential elections

• No other GOP-held seat appears in danger, which means Republicans are likely to hold onto their majority

• Democrats will likely be on defense in North Dakota (a state Romney won by 20 points and Trump won by 36) and West Virginia (a state Romney won by 27 points and Trump won by 42)

7September 25, 2017 | Daniel Stublen

IN SEPTEMBER OF EACH PRESIDENT’S FIRST TERM

Gallup comparative presidential approval ratings

Pres. Trump’s approval numbers are lower than any other modern presidents’ at this point in their respective terms

Source: Gallup, September 13, 2017.

Election Wild-Card

Trump Administration Priorities: Health care

Sources: National Journal Research, 2017

CSR payments

• In October, President Trump announced

that he would be ending CSR payments

• Sens. Lamar Alexander (R-TN) and Patty

Murray (D-WA) announced a bipartisan

proposal that would extend CSR payments

for two years and give states more flexibility

Repeal and replace ACA

• Graham-Cassidy bill did not receive enough

support to be voted on in the Senate

• Congressional leaders are now focused on tax

reform

■ Completed ■ In progress ■ Stalled ■ No action

Trump’s HHS confirmations

• With Tom Price’s resignation, there is still

speculation for next HHS secretary

• Alex Azar, a former HHS and pharmaceutical

industry executive, is currently the front-runner

for the position

The opioid crisis

• President Trump has not yet invoked a specific

act to free up funding to fight the national

emergency

Drug pricing

• Congress passed the FDA Reauthorization Act,

allowing the FDA to continue collecting user fees

AAFP Policy Health Care for All

Current Sources of Health Insurance Coverage

(Millions)

Insurance Evolution

July 28, 2017 The Senate fails to pass the “skinny repeal”Final health ACA repeal proposal, fails 49-51, with McCain (AZ), Murkowski (AK) and Collins (ME) voting against it

Key health care dates and deadlines Other issues with

unspecified timeline

• Legislation reducing the

cost of prescription

drugs is popular with

constituents; however, at

present no such legislation

is set to pass through both

chambers of Congress

• President Trump has

acknowledged the severity

of the opioid crisis, but

he has not yet invoked any

legislation to allocate

funding to fight the

epidemic

Nov. 1, 2017 Beginning of open enrollment periodThe Trump administration cut outreach and enrollment funding and shortened the length of the open enrollment period. It will end on Dec. 15, 2017

Aug. 25, 2017 All counties have at least one on-exchange insurer

Sources: National Journal Research, 2017.

ACA Repeal legislation stalledbut Obamacare markets may still be in trouble

Oct 19, 2017 Alexander Murray CSRs Legislation Introduced

$5.00 $5.00

$10.60

$12.50 $13.50

$15.00

$17.40

$19.10

$21.10

$19.30 $20.40

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CHIP funding peaked in 2015, MACRA extended it for

two years while lowering levels slightly

Children's Health Insurance Program (CHIP) funding, by fiscal year

Values in billions

12

Sources: Jim Hahn and Kirstin B. Blom,”The Medicare Access and CHIP Reauthorization Act of 2015,” Congressional Research Service, November 10, 2015; “Federal ChipFinancing,” Government Publishing Office, September 2011;

Funded through

CHIPRA

Funded through

ACAFunded through

MACRA

CHAMPION Act CHIP funding

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Congress has a bipartisan, bicameral

deal to extend funding for a program

that covers over 9 million children

through 2022

Key Components

• MOE

• 23% FMAP increase

Other Key AAFP Priorities

• Teaching Health Centers

• Community Health Centers

• National Health Service Corps

Offsets

• Redirect money from the ACA’s prevention and public health

• Shorten the grace period for ACA enrollees who don’t pay their marketplace premiums from 90 days to 30 days

• Charge higher Medicare premiums for seniors earning more than $500,000

• Allow states to dis-enroll lump sum awardees from Medicaid

• Make it easier for state programs to avoid medical costs if they’re already covered by private plans or other government programs

Tax Reform

• Top GOP agenda item, goal by January 1, 2018

• Would be first large-scale overhaul of tax code since 1986

• Principal goal: lower rates, simplify code, spur economic growth

• ACA provisions (individual mandate, premium tax credits) unlikely

• Remote possibility for changes to Health Savings Accounts

• Primary Care Enhancement Act (HR 365 / S 1358) would allow patients with HSAs to access direct primary care

Primary Care Benefit

• AAFP White Paper May 2017

• Policy: Individuals with HDHP would have access

to designated primary-care physician, with no cost

sharing.

• Inspired by Covered California

• Harmonizes somewhat with “Value Based Insurance

Design” push on Capitol Hill

Telehealth

• Legislation

– CONNECT for Health Act of 2017 would give CMS flexibility to expand eligible sites for telehealth (now mostly rural, HPSA, etc.)

– CHRONIC Act of 2017 (passed Senate; could pass House this year) would expand telehealth for MA plans and Medicare ACOs

• Regulatory

– Proposed PFS for CY2018: CMS would pay via telehealth for: • G0506 - comprehensive assessment of and care planning for patients

requiring CCM services,

• CPT 96160 / 96161 - reporting for health risk assessments,

• CPT 90839 / 90840 - psychotherapy for crisis (60 minutes / 30 minutes)

Appropriations

• Agency for Healthcare Research and Quality

• HRSA Title VII, Section 747 Primary Care Training and Enhancement

• HRSA Title X, Family Planning

• Prescription Drug Monitoring Program Grants

• Centers for Disease Control and Prevention– Tobacco Prevention

– Chronic Disease Prevention and Health Promotion

– Immunization and Respiratory Diseases

• U.S. Department of Education – Public Service Loan Forgiveness

Teaching Health Center GME• 2010 - Authorized within the Affordable Care Act

– $230 M/five years

• 2015 - Reauthorized within MACRA

– $60 M/two years + $26 M (additional HHS funding)

• 2017 - Disaster Tax Relief and Airport and Airway Extension Act (H.R. 3823)

– Funded the THCGME program until December, 2017

• 2017 - Community Health and Medical Professionals Improve Our Nation (CHAMPION) Act (H.R. 3922)

– Included the THCGME reauthorization bill

– Approved in the E&C Committee (10/4)

– Floor vote: pending this week

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Teaching Health Center GME/CHAMPION Act

• Training the Next Generation of Primary Care Doctors Act

– H.R. 3394 - Reps. Cathy McMorris Rodgers (R-WA) and Niki Tsongas (D-MA)

– S. 1754 - Sens. Susan Collins (R-ME) and Jon Tester (D-MT)

– Bipartisan cosponsors: 75 (House), 19 (Senate)

• Fully funds current residency slots

– $126.5 Million/732 slots = $157K per resident amount (PRA)

– Current PRA = $116K

• Maintains accountability standards

– Number of patient visits

– Residents in primary care and treating rural/underserved patients

• Authorizes new program applicants

19

Public Health Priorities2016

Helping Families in Mental Health Crisis Act - enacted

Opioids/Comprehensive Addiction and Recovery Act - enacted

Safe Drinking Water/Flint recovery funding - approved

Vaccine education – hearings

Concussions - hearings

2017

• Opioids

• Hurricane assistance

• Political footballs: DACA, abortion, gun safety, tobacco regulation

2018

• Farm Bill

• Transportation bill

• Disaster preparedness: Pandemic and All-Hazards Preparedness Act Reauthorization

• USPSTF Defense: Rep. Blackburn’s (R-TN) USPSTF Transparency and Accountability Act (H.R. 539)

20

Prescription Drug Pricing/Spending

21

Prescription Drug Pricing• 2017 – AAFP joined the Campaign for Sustainable Rx Prices

• Bipartisan agreement

– Lower costs = Higher Competition

– No one-size-fits-all solution

– Delivery system = highly complex!

• Major drug pricing proposals

– Reducing costs – Medicare Part D negotiation, value-based contracting, Medicaid generic drug rebate

– Increasing access to generic drugs – REMS, anti-trust practices

– Promoting transparency – drug hikes, pharm benefit managers

22

Prescription Drug Pricing/Impact

23

Regulatory Advocacy• MACRA

– Final 2018 rule put on display 11/2.

– Impacts reporting requirements and policies for the Merit-based Incentive

Payment System (MIPS) and Alternative Payment Models (APMs).

– AAFP comments sent to CMS on August 18, 2017.

• Medicare Physician fee schedule

– Final 2018 put on display 11/2.

– Impacts payment rates and policies for 2018.

– CMS recognized that E/M documentation guidelines are complex and

ambiguous; AAFP called for no E/M documentation guidelines for PCPs.

– Other policies include site-of-service neutrality, appropriate use criteria, value-

based modifier, and misvalued codes.

– AAFP comments sent to CMS on August 30, 2017.

Administrative Simplification:

Why AAFP is Engaged

• Practice burdens have now eclipsed compensation as

the biggest single reported concern of AAFP

membership.

• Burden can shrink the FP workforce by diminishing the

appeal of the specialty.

• Burden can impact patient care if FPs exhibit signs of

“burnout.”

Administrative Simplification:

What AAFP is Doing• Advocacy to the Administration

– Asking CMS to remove / reduce Documentation Guidelines for E/M, CCM, TCM, and other primary-care service codes; streamline and reduce prior authorization requirements; pay physicians for costs such as translation services

– Asking VA to address Authority of Health Care Providers to Practice Telehealth

– AAFP leadership continue meetings with senior Administration and Congress policymakers

• Advocacy to Congress

– Asking Congress to make optional the upcoming Medicare requirement to consult clinical decision support tools for ordering advanced imaging

– Asking Congress to address PAMA cuts to Medicare clinical laboratory fee schedule payments in 2018

• Advocacy to Private Sector

– Asking health plans to adopt uniform set of primary-care quality measures established through multi-stakeholder process

26

Administrative Simplification:

Selected Highlights to Date• Administration

– CMS established “Pick Your Pace” reporting options under MIPS for 2017/2018

– As CMS implements removal of SS#s from Medicare cards, CMS is creating secure tools for providers to look-up new Medicare numbers

– CMS delayed the upcoming Medicare requirement to consult clinical decision support tools for ordering advanced imaging to Jan. 1, 2019

• Congress

– 21st Century Cures Act (Dec. 2016) gives HHS OIG power to investigate and penalize EHR vendors for data blocking

– Ways and Means “Medicare Red Tape Relief Project” is expected to move forward in 2018.

27

Center for State Policy Scope of Work

• AAFP Congress of Delegates Initiatives

• Chapter Advocacy Casework

– State Legislative Conference

– Chapter Advocacy Days

• Model Legislation Library

• Policy Analysis

• State Legislative Tracking

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Chapter Resources

29

Chapter Resources

30

Chapter Resources

31

Chapter Resources

32

Chapter Resources

33

• As issue experts and constituents, your

elected officials want to hear directly

from you.

• Reaching them has never been easier.

• Lobby Days and Hill Visits

• Emails and letters

• Phone calls

• Social Media

• If you have a relationship with your

Congressman we need you to be a Key

Contact

Please Act - Grassroots Impact

On-Line Resources

Unite ● Organize ● Engage

Join the

Family Physician Action Network

Visit www.aafp.com/grassroots to join

Access Network-only content

Coordinate with other family physicians

Lead Social Media campaigns

Engage in Congressional office visits

Gain recognition at AAFP conferences and lobby days

Work With Other Family Physicians to Cut Through The Noise

The ONLY political organization that promotes family medicine.

Elect candidates to the United States Congress who support AAFP’s

legislative goals and objectives.

Since 2005, FamMedPAC raised and contributed over $5 million to more

than 400 candidates.

2016 Election Cycle Campaign Contributions

$1,020,200 To 154 Candidates

(New Record!)

56 % Democrats, 44 % Republicans

(90% won!)

2018 Election Cycle Campaign Contributions

$236,500 To 50 Candidates

65% Democrats, 35% Republicans

2016 Election Cycle Fundraising

$975,000 received from 3,576 AAFP Members

(New Record!)

2018 Election Cycle Fundraising

*$417,174 (as of 10/31/2017)

* Ahead of last year’s pace!

If every AAFP member contributed just $100, we would have more than $10 million –FamMedPAC would be the largest medical PAC in the country.

On-Line Resources

Save the Dates

• Family Medicine Advocacy Summit–

Washington, DC

May 21-22, 2018

• State Legislative Conference –

Ft. Lauderdale, FL

October 25-27, 2018

Questions?

Bob Hall: Rhall@aafp.org

571/438-3137 (cell)