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Michigan Association of Healthcare

Advocates

68th Fall Conference

MHA Election and Legislative Update

October 11, 2016

Chris MitchellSenior Vice President, Advocacy

2016 Elections

US President (Clinton vs. Trump)•US House of Representatives – 14 MI seats (9 R, •5 D)MI House of Representatives – 110 seats (63 R, •45 D)MI Senate – special election to replace V. Smith•MI Supreme Court – two seats (Justice Viviano, •Justice Larsen)

General Election: Nov. 8, 2016•

Shaping the Election

Scandals •Former Rep. Todd Courser: going to trial, perjury and –misconductFormer Rep. Cindy Gamrat: misconduct charges dismissed–Former Sen. Virgil Smith: convicted of multiple felonies, in –jail, resigned from MI Senate

Crises•Flint Water–Detroit Public Schools–Roads–

Presidential Race•Donald Trump–Hillary Clinton– Donald TrumpHillary Clinton

Politics of the Election: Inside Baseball

The “establishment” is dying•Right direction/wrong track ideal does not •define politics anymoreShift in how candidates are targeting votes •Mass shootings and violence•Obama’s positive approval rating•Straight ticket voting is on the ballot for •November

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Trump – Unexpected Nominee

Won the “somewhat conservatives” •Pick up voters from all parts of the GOP •electorateSimple, relatable answers•Exudes confidence •Popular among people who have been •left behind by current economySick of establishment•Stood out from the crowd•Blunt•

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GOP Concerns

Fractioned party •“Down ballot sweep” by Democrats•Trump’s unpredictability •Minimal campaign operations •Cannot connect with minority and women •votersLacks clear ideology with no political record•Hemorrhaging support from the establishment•

Zero living presidents have come out to –support Trump

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Hillary Clinton

Strong experience/credentials•Considered the most “unknown” known candidate•Part of the establishment •Not charismatic (especially compared to Bill)•Not trustworthy •Not likeable •Mind­ful that she will need Sanders’ sup­port­ers in •Novem­berChanging the shape of politics •

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Healthcare – Party Platforms

Republicans (Trump)–Repeal Affordable Care Act�Move to Medicaid Block Grants for states�Allow purchase of health plans across state lines�Defund Planned Parenthood�

Democrats (Clinton)–Support Affordable Care Act (repeal Cadillac Tax)�Control pharmaceutical pricing�Support vaccination �World is interconnected (Zika/Ebola)�Women’s access to contraception�

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Electoral Map

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Electoral Map

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U.S. House of Representatives

District 1 (Benishek)

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Jack Bergman

Lon Johnson

VS

District 10 (Miller)

VSPaul Mitchell

Frank Accavitti

District 7 (Walberg)

Rep. Tim Walberg

Gretchen Driskell

VS

State: Michigan Supreme Court

Justice Vivano Justice Larsen (seeking full 8 year term)

Current “Republican” majority 5-2•

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(seeking to complete 2 years remaining on her current term; she was appointed to replace

Justice Kelly following her resignation)

Who will be the Next Speaker of the House?

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Tom LeonardTim Greimel

State Legislature

House of Representatives – 110 seats •42 open seats–83 lawmakers will have no more than 2 years of –legislative experienceSpeaker of the House Kevin Cotter is term –limited

Term limited Healthcare Champions •Rep. Mike Callton –Rep. Al Pscholka–

14Callton Pscholka

MHA Election Strategy

Support existing health care champions who •are facing competitive primary and general electionsMaintain a conservative majority on the •Supreme CourtImprove the balance of power in the state •legislature

Weaken tea-party influence in state House–Moderate Republicans and Democrats•

Identify and support new health care •champions

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Election 2016 — Call to Action

Meet your candidates for state House and Congress•Use MHA election tools available on the MHA election •web pageHelp re-elect Justices Vivano and Larsen•Support Health PAC; deliver checks to healthcare •championshttp://www.mha.org/mha/elections.htm•

Election Materials (table tent, posters, brochure) –Election Snapshot –Candidate Listing–Non-partisan sources–

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Health PAC Campaign

2016 Health PAC Goal: $375,000Health PAC Raised: $394,000

AHAPAC Goal: $80,900

THANK YOU to all who have contributed to Health PAC!

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Michigan Legislative Big Picture

Flint water crisis: $68 million supplemental in 2016, •federal waiver for Medicaid, $41.3 million for FY 2017Detroit Public Schools: $48.7 million supplemental •appropriation approved in 2016, $617 million “bailout” plan approved for FY 20172017 budgets completed on June 9, planning FY •2018 underwayAuto insurance tax credit repealed, attempts at fee •schedules and caps on benefits failedElection year for Michigan House•

House Republicans maintain majority = 2 weeks of Lame –DuckDemocrats flip House = 3 weeks of Lame Duck–

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Health-related Public Policy Issues: Michigan Legislature

HICA Alternative Package1.Auto No-fault and “D” insurance2.Interstate Medical Licensure Compact3.Med-mal – Greer v. Advantage Health fix4.CRNA – Independent Practice 5.Telehealth6.Michigan Automated Prescription Program 7.(MAPS) Energy Regulation 8.Pyxis Machine Licensing xix9.CCW law revisions - Elimination of gun-free 10.zones 19

Pending Auto No-Fault Bills

SB 248 (Hune)•Fee Schedule, Fraud, Attendant Care, MCCC–Stalled on the House Floor–

SB 288 (V. Smith)•D-Insurance–Stalled on the Senate Floor–

HB 4224 (Barrett)•Assigned Claims reforms–Awaiting concurrence vote on the House –Floor

Auto No-fault Insurance – SB 248

Reduces provider payments to 150% of •MedicareReplaces existing catastrophic •insurance with unregulated, unfunded mechanismCreates anti-fraud authority in state •governmentPlaces limits on family-provided •attendant care

AUTO NO-FAULT INSURANCE—SB 248

Auto No-fault Insurance – SB 248

Currently stalled on House floor•Significant opposition among House •RepublicansHouse Democratic Caucus formally •opposedNo workgroup or further meetings with •auto insurersBoard recommended that the MHA •maintain its current position and refrain from suggesting another proposal

AUTO NO-FAULT INSURANCE—SB 248

D Insurance – SB 288

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

AUTO NO-FAULT INSURANCE—SB 248

D Insurance – Senate Bill 288

Currently stalled on Senate Floor•1 Senate Democrat supportive•House Democratic Caucus formally •opposedSignificant opposition among •Republicans in both chambersSML Meekhof would like to see more •support from Detroit lawmakers prior to considering further action

Interstate Medical Licensure Compact

House Bill 4583, sponsored by Rep. Jim Tedder (R-Waterford), •passed the House, awaiting action in Senate Health Policy Committee.Would allow Michigan to join the Interstate Medical Licensure •Compact

State-based legislative proposal, enacted when seven states –adopt into lawProvides a new, expedited pathway to licensure for qualified –physicians to practice in multiple statesVoluntary 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 licensureCompact Commission would provide oversight and administration –of the Compact, create and enforce rules

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CRNA Physician Supervision Opt-out

MHA Board of Trustees voted to support opt-out•Governor’s letter alone not sufficient in Michigan•

Attorney General opinion #6567 (1989), anesthesia may be �delegated, but only under the supervision of a physician

MHA and Michigan Association of Nurse Anesthetists pursue •legislative fix

Passage of legislation necessary; Michigan Public Health Code �regarding CRNA scope of practice must changeSenate Bill 1019 introduced by Senate Majority Floor Leader Mike �Kowall (R-White Lake), adds administration of anesthesia by a CRNA to practice of nursing definition

Senate Bill 1019 passed Senate in September, referred to •House Health Policy Committee

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CRNA Physician Supervision Opt-out

Long, multi-year process in virtually all states, no indication •that Michigan will be differentMSMS and MSA are strongly opposed to potential changes•

MAJ has raised concerns about liability�Chairman Callton looking for a “soft landing”•

Staff interested in Colorado model�House workgroup established to search for middle ground •on legislationPotential Lame Duck action in Committee, must •demonstrate that the “votes are there” before hard commitment from Rep. Callton

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Democracy is Not a Spectator Sport

Advocacy is necessary and legitimate part of the •democratic processGovernment decisions affect people and •organizations

Information must be provided to produce informed •decisions

Public officials cannot make fair and informed •decisions without considering information from a broad range of interested parties

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