4/8/2016

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Federal UpdateNDHA Board of Trustees

April 1, 2016

John W. Flink, Federal Affairs, NDHA

Agenda

• Campaign 2016

• 2016 Advocacy Agenda

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Campaign 2016

Campaign 2016: All Eyes on the Senate

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A Closer Look at the Senate Currently

54 Reps 44 Dems 2 Ind (D)

24 Republican seats up – only 10 Democratic seats

Going into the campaign – safe and continuing 44 Democrats 44 Republicans – including Sen. Hoeven

Keys: Who wins the White House Impact of Supreme Court fight

Most Contested Senate Races

Illinois – Mark Kirk (R)(I) – toss up

Wisconsin – Ron Johnson (R)(I) – toss up

Florida – Marco Rubio (R) – open seat – toss up

New Hampshire – Kelly Ayotte (R)(I) – potential toss up

Pennsylvania – Pat Toomey (R)(I) – leans Republican

Ohio – Rob Portman (R)(I) – leans Republican

North Carolina (R)(I) – leans Republican

Nevada – Harry Reid (D) – open seat – toss up

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House Unlikely to Flip. But…

Currently 188 Democrats

247 Republicans

Safe and continuing 182 Democrats

221 Republicans – including Rep. Cramer

Growing concern that nominee could cost GOP seats

So What? Observations on the Race GOP Trying to Cope with Trump or Cruz nomination

Congressional agenda driven by presidential/Senate races

Senate GOP goal: protect vulnerable Sens. – no politically risky votes

Ryan goal: develop forward-looking GOP vision/policy

Health care initiatives in Ryan platform

Other keys

External developments – e.g. terrorism threat

Economy

Republican presidential primary illustrates two battles within GOP

Personality vs. policy = Trump vs. Ryan

Angry grass roots (Trump, Cruz) vs. establishment (Kasich)

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2016 Federal Advocacy Agenda

2016 is a Challenging Year…

Election year schedule 111 working days in the House of Representatives

Hiatus: July 15 – Labor Day/October

Yet another budget fight looming

New leadership in key committees – still trying to solidify strategy

Limited legislative agenda No cliffs or deadlines – except appropriations

Opportunities: mental health, medical innovation Medicare still an attractive savings target

Expect the unexpected

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Budget: 2015 Deal

Raises the debt ceiling through March 2017

Raises the discretionary spending caps by $80 billion above current levels, split evenly between defense and non-defense spending

Omnibus appropriations (December) allocates funds

As of January 1, 2017, implements site-neutral payments for all services in provider-based hospital outpatient departments

Exemption for those providing services prior to November 2

2016 Budget Fight

House: 2016 Budget Process Stalled Speaker Ryan promised “regular order”: i.e. pass 12 appropriations bills

House Freedom Caucus wants 2015 budget caps cut by $30 billion – without their support no budget

Leadership offer: entitlement savings in return for 2015 cap levels

E&C Committee moving Medicaid, CHIP spending cuts

Senate: Depends on the House 2015 budget deal = a 2016 budget resolution

Democrats

Hold up 12 spending bills if House doesn’t go along with 2015 spending levels

Outcome? With no House budget, 2017 appropriations will come in lame duck

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Our Agenda: Site Neutral Fix Top Priority

AHA amendment grandfathers those already in development on date of enactment

Looking for legislative vehicle

Challenges:

Cost

Calendar

Few legislative days remaining

Other priorities

The Rest of Our Agenda

CAH 96-hour length-of-stay fix

Supervision of therapeutic services in outpatient departments

RAC reforms

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Other Issues on the Horizon

Mental health reforms House and Senate bills

Sharing health information – interoperability House and Senate bills

Expansion of telemedicine payments Six major bills – no consensus on approach

Protecting 340B

New physician payment system

Looking farther into the horizon…

Prescription drug prices

Top issue in 2016 campaign

Medical education and training changes

Future of rural health care

Lots of concern – No consensus on new model

AHA Vulnerable Communities Task Force

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Funding Threats Still in Play

Additional site-neutral payment policies- E&M code/HOPD ($10 billion)

- 66 additional APCs procedures ($9 billion)

- 12 procedures performed in ASCs ($6 billion)

Hospital bad-debt reductions ($20 billion)

GME reductions ($10 billion)

CAH: payment reductions and mileage criteria ($2 billion)

Post-acute care ($70 billion)

Medicaid: - State provider assessments ($22 billion)

- Medicaid per capita caps

Questions/Discussion

John W. Flink

john@jwfconsultingdc.com

(406) 439-1698