SLIDE 1
Rodney Whitlock
Vice President, Health Policy ML Strategies (@RodneyMLS)
2
All Health Is Local: Update on Federal Health Reform Efforts and - - PowerPoint PPT Presentation
All Health Is Local: Update on Federal Health Reform Efforts and - - PowerPoint PPT Presentation
All Health Is Local: Update on Federal Health Reform Efforts and Why It Matters to Counties Rodney Whitlock Vice President, Health Policy ML Strategies (@RodneyMLS) 2 3 Where are we going and why are we in this handbasket? 4
SLIDE 2
SLIDE 3
3
SLIDE 4
4
Where are we going … and why are we in this handbasket?
SLIDE 5
"There are no facts, only interpretations." Friedrich Nietzsche (1844-1900)
5
SLIDE 6
“There are no solutions, only trade-offs” Thomas Sowell (1930 - )
6
SLIDE 7
The Journey from Nietzsche to Sowell
- Seven years where nothing that was said truly
mattered.
- Now every decision results in significant
consequences.
7
SLIDE 8
The American Health Care Act
8
SLIDE 9
9
AHCA Provisions
- Replaced the individual mandate with a continuous
coverage provision
- Repealed Affordable Care Act (ACA) taxes
- Repealed cost sharing reductions
- Replaced subsidies with tax credits
SLIDE 10
10
AHCA Medicaid Provisions
- Repealed state option to expand the Medicaid program
- Shifted Medicaid funding to a per-capita cap system
- State option to block grant Medicaid funding for certain
populations
- Repealed hospital DSH cuts over time and provided non-
expansion states with funding for safety net providers
SLIDE 11
11
Per Capita Caps vs. Block Grants
SLIDE 12
Congressional Budget Office Score
- The CBO score estimated that the AHCA would:
–Reduce the federal deficit by $119 billion over ten years 2017-2026 –Result in 23 million less people having health insurance coverage by 2026 –Result in 14 million less people having Medicaid coverage by 2026 –Reduce federal funding to the Medicaid program by $834 billion from 2017-2026 – 1/6 of the population lives in a state would utilize waivers for essential health benefits (EHBs) and community rating, which allow for underwriting
SLIDE 13
13
AHCA Implications
- Losses in coverage and access to services
- Increased pressures on safety net providers
- Increased pressures on other social programs that serve Medicaid
beneficiaries (i.e., criminal justice)
- Continued instability in the Marketplace
- Shifted costs from federal government to states, providers, and patients
SLIDE 14
14
AHCA Implications for the Taxpayer
Decreases in federal taxes that result in increases in state and county taxes
SLIDE 15
15
Federal State Local
SLIDE 16
1.Health Care will need to be provided. 2.Someone will need to pay for it.
Two Simple Facts about Health Care
16
SLIDE 17
Moving Money from One Pocket to the Other
17
SLIDE 18
18
Why the AHCA Failed on March 24th
SLIDE 19
19
VS.
SLIDE 20
20
The AHCA Returned from the Dead
SLIDE 21
21
MacArthur and Upton Amendments
- MacArthur Amendment
– Waiver for increasing age band ratios – Waiver for Essential Health Benefits – Waiver for underwriting for certain individuals
- Upton Amendment
– $8billion for high-cost risk pools
SLIDE 22
22
The Face of Pre-Existing Conditions
SLIDE 23
23
The Face of Pre-Existing Conditions
SLIDE 24
Next Up: The United States Senate
24
SLIDE 25
- The Marketplace
- The Medicaid Expansion
- Medicaid Per Capita Caps
- Paying for the Changes
Issues for the Senate
25
SLIDE 26
26
SLIDE 27
27
SLIDE 28
28
SLIDE 29
29
Health Care Minibus
- Children’s Health Insurance Program (CHIP)
- Special needs plans (SNP)
- Community health center funding
- Therapy caps
- Maternal, Infant, and Early Childhood Home Visiting
(MIECHV)
- Disproportionate share hospital (DSH)
SLIDE 30
30
SLIDE 31
31
SLIDE 32
32
What to Watch for in 2017
- The Senate on the AHCA
- Cost-sharing reduction payments and the Marketplace
- Changes to the Medicaid program via CMS
- Health care minibus and how it is paid for
- The final spending bill
SLIDE 33
What Can You Do About It?
33
SLIDE 34
Questions?
34
rlwhitlock@mlstrategies.com @RodneyMLS