Patricia Raffaele, Vice President Professional Services Highlights - - PowerPoint PPT Presentation

Patricia Raffaele, Vice President Professional Services

Highlights

 The ACA-What’s Going On?

• CHIP Reauthorization
• Open Enrollment
• Executive Orders

 The ACA-What’s Next?  Other Topics

 Two repeal bills did not pass  The first bill passed the House in July  The Senate had a vote to determine if the

process should go forward to repeal ACA

 The Senate voted “yes”

ACA: What Happened

 Hurried Negotiations  A bill was offered that would repeal parts of

the ACA

 The Senate defeated the proposed bill  Three vote margin: Sen. John McCain (AZ) cast

the decisive vote

 The vote occurred at 1:30 a.m. on July 27th

ACA: What Happened?

 Then the “skinny repeal” bill-called the Health

Care Freedom Act was introduced-did not pass

• Senate could not find a bill that satisfied

moderates and conservatives in the Republican Caucus

• A “vehicle” to negotiate with the House
• Would have ended the “individual mandate”
• No incentives for people to get coverage’

ACA: What Happened?

What’s Next?

 Something Bipartisan?  Smaller pieces of legislation that are

bipartisan

 The “Governor’s Plan” –bipartisan approach

(included PA)

 Major changes in Medical Assistance: block

grant or capitated program

ACA: What’s Next?

The Governors’ Plan:

 Flexibility for states

States include: PA, Ohio, Colorado, Nevada, Alaska, Virginia, Louisiana, Montana

ACA: What’s Happening

The Governors’ Plan

 Fund cost-sharing payments through 2019  Fund for states to create reinsurance

programs

 Tax exemptions for insurance carriers in

underserved counties

 Retention of individual mandate until there is

a new alternative

ACA: What’s Happening

And . . .

Something Magical?

Executive Order on Health Insurance

 Expands association plans-will rewrite federal rules which

govern these plans (Treasury, Labor, HHS)

 Similar program before-called Multiple Employer Welfare

Arrangements-stopped in 1992

 Widespread problems reported by states, more than $123

million in unpaid claims

 “Association” plans-refer to associations such as the Chamber

• f Commerce, etc. buying “group” insurance

What’s Just Happened



Plans will probably not have to comply with the 10 “essential health benefits”



Plans will probably not have to accept all applications at the same rates without regards to preexisting conditions



Individuals will be allowed to buy short term plans up to 364 days (under ACA it is 90 days)



Employers will be able to use pretax dollars in “health reimbursement arrangements” to help workers pay for any medical expenses (not just those related to ACA rules)



May be more expensive for those with serious medical conditions to buy health insurance



More insurers may leave the marketplace



“This is just the beginning” (rules need rewritten, possible court challenges)

Executive Order

What’s Next?

CHIP Reauthorization Didn’t Happen

 Congress needed to act by Sept. 30th  Advocates asked for “clean” reauthorization (no connection to ACA

• r Medicaid cuts)

 PA Bipartisan Support  Covers 176,000 children in PA, 8.6 million children nationwide  PA has funds to cover CHIP until February  Some states already ran out of money-received redistribution of

CHIP funding for a short-term fix

 Program is authorized through Oct. 1, 2019 but legislation is

needed to continue the program and the funding

 There is a bill in both the Senate and the Health

CHIP

Open Enrollment

 November 1, 2017-December 15, 2017  Navigators are still funded, budgets cut  Less Education and Outreach funding from CMS  Certified Navigators throughout western PA  Healthcare Council’s Certified Navigator: Barb McDowell  Funded through CMS Grant given to Consumer Health

Coalition and grants from local foundations

 Still can conduct special enrollments  ACA is still the law: individual mandates, etc.

In the Meantime. .

New Secretary of Health and Human Services

 Formally acting assistant secretary for health since February  Joined the agency in 2017 under President Bush  Board certified in Family Medicine and Preventive Medicine  Also served in the Department of Labor as director of the

Office of Occupational Medicine

 Has a master’s degree in Public Health

And who is Don Wright, M.D.?

340(B) Drug Program



CMS wants to cut reimbursement for this drug program that benefits those on Medicaid and Medicare



Hearing held on October 11 by House Energy and Commerce Subcommittee Subcommittee on Oversight and Investigations



Hospitals and health centers testified in support of the program Opioid Crisis



Hearing held October 11 by House Energy and Commerce Subcommittee

• n Health



Major issue in western PA/West Virginia/Ohio

And more . .

 Executive Order on Regulatory Reform  Telemedicine and Telehealth  Quality Initiatives  Bundled Payments  PA Budget  Changes in Medical Assistance

Other Factors

 Trend in lower operating margins  Region’s hospitals see most admissions from

Medicare and Medicaid covered patients-70 percent

 Already low reimbursement  Any additional funding cuts to those programs

would have a large negative impact on hospitals

Impact on Region’s Hospitals

For Enrollment Information: Healthcare Council of Western PA: www.hcwp.org Consumer Health Coalition: www.chc.org For Daily Policy Updates: Washington Post: Health Daily 202 For Hospital Policy Positions: American Hospital Association: www.aha.org Hospital and Healthsytem Association of PA: www.haponline.org

Resources

Questions

Patricia Raffaele Vice President, Professional Services Healthcare Council of Western PA raffaelp@hcwp.org 724/772-7202 www.hcwp.org

Thank You