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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
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
2
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
3
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
4
Federal Update
State Update
5
Policy and Fiscal Environments
6
Federal Budget Projections
7
Surplus
Deficits
Aug 2014 Projections
Feb 2015 Projections
-$1,600
-$1,200
-$800
-$400
$02
01
0
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
(in
bill
ion
s)
Source: CBO Health Care and the Federal Budget February 2015
Revenues vs. Expenditures
Revenue$2,775 B
8
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)
10
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)
11
Federal: Key Committees
Senate Finance Committee
–Sen. Orrin Hatch (R-UT),Chair
Sen. Ron Wyden (D-OR), Ranking member
• Ohio members: Sens. Brown & Portman
12
Federal: Setting Stage
• Republicans-control agenda
• President-veto power extensively
• Leg. strategies &
reconciliation
• 2016 Presidential
candidates emerge
13
Marketplace by the Numbers 2015
Page 14
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
15
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
16
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
18
Federal: Key Dates
• King v. Burwell-SCOTUS
• June/July-Reconciliation?
• September 16 – ―unofficial‖ 2016 Republican debate
• September 30 – Government funding expires
19
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
20
Marketplace: Tax Credits
Page 21
King v. Burwell: What’s Next?
Page 22
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”
23
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
25
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
28
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
29
30
US State Spending by Major Category
(In billions of current dollars. Source: NASBO) Medicaid
K-12
Corrections
Transportation
Key Issues for UH: State
31
Key Issues for UH: State
32
Key Issues for UH: State
33
Key Issues for UH: State
34
Key Issues for UH: State
35
State: Key Issues
• Medicaid Expansion
• State budget (2016/2017)–Medicaid reform
–Medicaid State Innovation Model
–Medicaid provider payments
• SCOTUS decision impact on OH
36
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
