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MAHA Fall ConferenceLegislative Political Update

October 13, 2015

Paige FultsDirector, Advocacy

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Political and Healthcare Climate

• New Leaders• 9 months into 98th Legislative Session

Accomplishments • Negative Media Attention • 600,000 in HMP but 2nd Wavier decision by

CMS pending• Failed Roads proposal has lingering effect• 2016 Elections impact policy and politics

Key Elements to Advocacy Success

• MHA and members advocating with unified voice

• Member participation in targeted advocacy days: Healthcare Advocacy Day, Small/Rural Advocacy Day, GME Advocacy Days

• Support from legislative appropriation and policy leaders; Support from Gov. Snyder and MDHHS Director Lyon

• Public recognition of issues under debate and broad grassroots engagement

• Maintaining strong Health PAC contributions to assist with relationship development and access to legislative leaders 3

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Health-related Public Policy Issues: Michigan Legislature

1. Roads, Roads and more Roads2. FY 2017 state budget development/HICA3. Auto No-fault and “D” insurance4. Interstate Medical Licensure Compact5. Pharmacist substitution of Biosimilar Drugs6. Hospital Chargemaster Transparency7. Community College Nursing Programs8. CON Reform 9. Scope of Practice for Advance Practice Nurses 10. CRNA – Independent Practice 11. Energy Regulation

Road Funding – Proposal 1: Epic Fail• Would have increased state revenue by more than $2.1 billion

a year through a 1-cent increase to state sales tax, vehicle registration discount elimination and motor fuel tax rate increase

• Spending− $1.2 billion to roads− $300 million to the school aid fund− $130 million to mass transit− $95 million to local governments − Expansion of the earned income tax credit would provide

$260 million in targeted tax relief for low-income workers• Defeated 80-20 – The most sided loss ever for a proposed

amendment to the state constitution of 1963

Road Funding – Legislative Proposals

• Various levels of existing general fund ($350m-$700m)• Additional taxes and fees (gas tax increase, registration fee

increase, etc.)• Democrats and administration would like to see an

increase/extension of the Health Insurance Claims Assessment– House and Senate Rs not on board, would prefer not to

further complicate things (much like the end result of Prop 1)

• Is there a path to $1.2b annually for roads?• If a large amount of existing general funds are used, how

will that impact health care funding?

Auto No-fault Insurance – SB 248

• Reduces provider payments to 150% of Medicare

• Replaces existing catastrophic insurance with unregulated, unfunded mechanism

• Creates anti-fraud authority in state government

• Places limits on family-provided attendant care

Auto No-fault Insurance – SB 248

• Currently stalled on House floor• Significant opposition among House

Republicans• House Democratic Caucus formally opposed• No reply to MHA correspondence from

House Insurance Committee Chair Leonard• No workgroup or further meetings with auto

insurers• Little appetite for replacing catastrophic

benefit system among House members

D Insurance – SB 288

• Mayor Duggan’s plan to reduce Detroit auto insurance premiums

• Reduces injury benefit to $250,000/accident for “critical care” services

• $25,000 for post-acute services• No catastrophic benefit• Allows for closed provider network• Applies to any community with 35% or greater

rate of uninsured drivers

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• Does not guarantee a reduction in premiums – it simply trusts insurers to lower your rates

• Does nothing to reduce the number of uninsured drivers, who now pay NOTHING. Even opting for D-Insurance would represent an increase in their expenditures

• Any cost savings is quickly offset by the costs of medical care if the driver involved in an accident requiring catastrophic care

• Unlimited necessary medical care, known as Personal Injury Protection or PIP, is not the reason for high premiums in Detroit – yet the only thing D-Insurance does is cut your PIP benefits

• Health insurance does not cover many of the services needed for recovery from an auto accident, such as attendant care or home/vehicle modification needs

D Insurance Opposition – SB 288

MHA Letter of Opposition• Limiting medical care to lower auto

insurance rates is not a sensible approach

• Address overuse, fraud

• Bring frequency and severity in line with outstate claims

• Town halls

D Insurance – SB 288

D Insurance – Senate Bill 288

• Currently stalled on Senate Floor

• 1-2 Senate Democrats supportive

• House Democratic Caucus formally opposed

• Significant opposition among Republicans in both chambers

• SML Meekhof would like to see more support from Detroit lawmakers prior to considering further action

What reforms do hospitals support?

• Reduce hospital fees by 20% (or lower if negotiated)• Freeze those rates until 2019• Future increases limited to rate of medical CPI

(inflation rate)• Full court press to fight fraud• Focus on appropriateness of care for survivors• Control attendant care cost• Pass savings to consumers

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• House Bill 4583, sponsored by Rep. Jim Tedder (R-Waterford), referred to the House Health Policy Committee

• Would allow Michigan to join the Interstate Medical Licensure Compact– State-based legislative proposal, enacted when seven states

adopt into law– Provides a new, expedited pathway to licensure for qualified

physicians to practice in multiple states– Voluntary for both states and physicians, states maintain

control over practice of medicine• Participating states would formally agree to adopt common rules

and procedures for medical licensure• Compact Commission would provide oversight and administration

of the Compact, create and enforce rules 14

Interstate Medical Licensure Compact

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Interstate Medical Licensure Compact

• Rep. Tedder convened first workgroup Sept. 29• Early adopters will have more influence on framework of compact• Overwhelming support of concept across the country

– AARP– American Medical Association– State medical associations– State hospital associations– Mayo Clinic

• No notable opposition• Possible opportunity to engage Partnership for Michigan Health

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Interstate Medical Licensure Compact

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2016 Elections - Nov. 8

• U.S. President• U.S. Congress – 14 seats (9 R, 5 D)• MI House of Representatives – 110 seats (61 R, 46 D)• Special Elections (Dillion, Courser, Gamrat, V. Smith?,)• MI Supreme Court – 2 seats (Justice Viviano, resignation-Mary Beth Kelly)• Ballot Proposals

– Stop Overcharging– Citizens for Fair Taxes– Prevailing Wage– Marijuana Legalization (2)– Voting by Mail– Paid Sick Leave– Banning Fracking

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2016 Elections - President (Dems)

Lincoln ChafeeFormer Governor of

Rhode Island

Hillary ClintonFormer U.S. Secretary of

State

Joe BidenVice President

Martin O’MalleyFormer Governor of

Maryland

Bernie SandersU.S. Senator - VT

Jim WebU.S. Senator - VA

Lawrence LessigHarvard Professor

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2016 Elections - President (GOP)

Jeb BushFormer Governor of

Florida

Ben CarsonDirector of Pediatric Neurosurgery, Johns

Hopkins

Chris ChristieGovernor of New Jersey

Ted CruzU.S. Senator - TX

Carly FiorinaFormer CEO of Hewlett-

Packard

Jim GilmoreFormer Governor of

Virginia

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2016 Elections - President (GOP)

Lindsey GrahamU.S. Senator - SC

Mike HuckabeeFormer Governor of

Arkansas

Bobby JindalGovernor of Louisiana

John KasichGovernor of Ohio

George PatakiFormer Governor of

New York

Rand PaulU.S. Senator - KY

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2016 Elections - President (GOP)

Rick PerryFormer Governor of

Texas

Marco RubioU.S. Senator - FL

Rick SantorumFormer U.S. Senator - PA

Scott WalkerGovernor of Wisconsin

Donald TrumpCEO of Trump Organization

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2016 Elections – President (21 candidates)

Jeb BushFormer Governor of

Florida

Ben CarsonDirector of Pediatric Neurosurgery, Johns

Hopkins

Carly FiorinaFormer CEO of Hewlett-

Packard

Hillary ClintonFormer U.S. Secretary of

State

Bernie SandersU.S. Senator-VT

Donald TrumpCEO of Trump Organization

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Donald Trump continues to lead in the polls

I too, am in the mix!

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Presidential Candidates - Deja Vu

• The more things change, the more they stay the same….