Florida HIV/AIDS Comprehensive Planning Network (FCPN) November 1-3, 2017 Tampa, FL

Transcription

1 Florida HIV/AIDS Comprehensive Planning Network (FCPN) November 1-3, 2017 Tampa, FL

2 An Unstable Healthcare Landscape A Federal and State Policy Update Michael Ruppal, Executive Director

3 We have been on a very scary roller coaster 3

4 Trying to prevent this from happening to us! 4

5 Our President said what?

6 In a politically divided nation.

7 2017 Political typology: Anchored by Core Conservatives, Solid Liberals

8 A year long effort to repeal and replace the ACA. In the Congress

9 A year long effort to repeal and replace the ACA. By the White House and Agencies Sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval. Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an unprecedented level of flexibility to design their Medicaid programs as they see fit. Seema Verma is the Administrator of the Centers for Medicare and Medicaid Services

10 Replacing former Department of Health and Human Services Secretary Tom Price HHS is currently led by Acting Secretary Don Wright Centers for Medicare & Medicaid Services Administrator Seema Verma Television host and cardiothoracic surgeon Mehmet Oz, M.D. Florida Governor Rick Scott Sen. Judd Gregg (R-NH) Rep. Fred Upton (R-MI) Former Rep. Dave Camp (R-MI) Food and Drug Administration Commissioner Scott Gottlieb Veterans Affairs Secretary David Shulkin Rep. Marsha Blackburn (R-TN) Acting Secretary Don Wright Former Louisiana Governor Bobby Jindal (R) Former Sen. Rick Santorum (R-PA) HUD Secretary Ben Carson

11 The People Continue to Speak Up! Democracy in Action

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13 PACHA Presidential Advisory Council on HIV/AIDS Continuance of Certain Federal Advisory Committees Signed September 29, 2017 The order extends certain federal advisory committees until September 30, Trump extended 32 federal advisory committees, including the Invasive Species Advisory Committee, the Trade and Environment Policy Advisory Committee, and the Presidential Advisory Council on HIV/AIDS. Presidents routinely issue similar orders extending the lifetime of federal advisory committees

14 What has been accomplished? Very Unstable Health Care Environment Individual Health Plan Market Carriers Leaving Premiums, Deductibles, Patient Cost-sharing Rising Confusing Open Enrollment Period Number of Uninsured Increasing While Basic Tenets of ACA Remain Medicaid Continued Threats to Repeal Expansion, Cut & Cap Program, and Block Grant

15 What Does President Trump Want? And Most Other Republicans in Congress Publicly Sabotaging ACA Obamacare is Dead Less Central Federal Government Control Increased State Flexibility Fewer Federal Regulations & Requirements Cut Federal Government Spending Fulfill Political Platform What About Increasing Health Care Coverage for People?

16 What is Next? Congress Continued Debate to Repeal & Replace Unsuccessful in the Past, even through Reconciliation Process Fund Cost Sharing Reductions? In turn for State Flexibility Bipartisan Solutions? Medicaid Caps and Cuts

17 Alexander/Murray Legislation ON OCTOBER 25th the Congressional Budget Office (CBO) released its score of the Bipartisan Health Care Stabilization Act, the cross-party effort by two senators, Lamar Alexander of Tennessee and Patty Murray of Washington, to shore up troubled health-insurance markets. The main goal of this bill is to restore, for two years, the payments to insurance companies that President Donald Trump cut off a couple of weeks earlier. The budget experts predict that doing so would in fact end up saving the government money. But would the bill achieve its aim of stabilizing insurance markets?

18 What is Next? Executive Agencies President Trump Executive Orders Cut Costs & Regulations Increase State Flexibility Provide Options Association Health Plans, Short Term Coverage Proposed Regulations Redefine Essential Health Benefits? Benefit and Payment Parameters Proposed Rule for 2019 Pending at OMB for Release New Guidelines for Plans? Fewer Reviews, Oversight & Less Enforcement State Waivers

19 What is Next? In the States Seek Section 1332 Waivers Reinsurance Programs Helpful for High Cost Beneficiaries Redefine Essential Health Benefits Waive the Individual Mandate? State Laws & Regulations Plan Reviews Discrimination Enforcement

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21 How has it impacted our response to HIV? And What Can We Do? Ryan White HIV/AIDS Program Continues to Be Foundation for Much Care & Treatment Must work with other payers: Medicaid, Medicare and Private Insurance Since ACA, some shift in paying for Ryan White Program clients Extent differs state to state Process occurring over several years Largely successful, but still a work in progress At the same time, constant threats to unravel the ACA & future unknown

22 Handouts ABAC Chart ABAC FY 18 Conference Letter Prevention and Treatment Dashboards Opioid Data TAI Federal HCV Update TAI Capital Update

23 Thank you!