Health Reform 2.0. The Issues, People, and Events That Will Define Regulatory Reforms. Repeal. Replace. The issues. Top Issues for 2017

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1 The Issues, People, and Events That Will Define 2017 The issues Health Care Reform 2.0 Health Care Costs Transformation & Risk Consolidation Population and Community Health Social Determinants of Health Top Issues for 2017 Function of Government Dismissal of Science Workforce Pharmaceutical Issues Physician Well-being Administrative & Regulatory Burden Oh, and of course..macra Health Reform 2.0 Health Care Reform - 3 Pronged Approach Health Reform 2.0 Legislative Process Budget Resolution Fiscal Year 2017 Senate (Jan 11) House (Jan 13) Repeal Regulatory Reforms Replace Reconciliation Repeal Replace 5 1

2 Reconciliation Committees of Jurisdiction Must Originate in House of Representatives Committees of jurisdicition develop recommendations Budget Committee compiles recommendations and develops budget reconciliation bill. Consideration by full House of Representatives Privileged Under Senate Rules (51 votes) House of Representatives Energy & Commerce Greg Walden (OR) Chair Frank Pallone (NJ) RM Ways & Means Kevin Brady (TX) Chair Richard Neal (MA) RM Education & The Workforce Virginia Foxx (NC) Chair Robert Scott (VA) RM Senate Health, Education, Labor, and Pensions (HELP) Lamar Alexander (TN) Chair Patty Murray (WA) RM Finance Orrin Hatch (UT) Chair Ron Wyden (OR) RM 7 AAFP Messaging 4 Themes Currently insured individuals should not lose their health care coverage (public or private) as the result of any action or inaction on the part of the United States Congress. Individuals and families benefit from protections against discrimination in all health insurance marketplaces. These patient-centered protections are essential to ensuring that all individuals, regardless of their age, race, gender, or medical history can obtain health insurance. Primary care is and must remain a critical and foundational component of any health care system. Individuals and families should not face immediate/pre-mature discontinuation of Medicaid coverage as a result of any action or inaction on the part of the United States Congress. Furthermore, the basic functions of Medicaid should be universal, meaning regardless of the state of residency; low-income individuals are guaranteed health care coverage that is equitable to coverage in any of the other states. Health Care Costs Uninsured rate is at historic low Health care costs continue to rise Increase in High-Deductible Health Plans (HDHP) Employer-to-employee cost shift Insurers Commercial Medicare Advantage Medicaid Hospitals & Health Systems Hospital2Hospital Physician practices Physicians Corporate primary care Single specialty corporations The role of Wall Street Consolidation Practice Transformation, Payment Reform & Risk Transformation Single practice transformation Clinically Integrated Networks (CIN) Multi-specialty, multi-site integrations Multi-state integrations Payment Reform Value Based Payment Prospective global payment Population-based payment Risk Performance risk Total cost of care 2

3 Population and Community Health Local, state, and national ACA and post-election impacts How does the role of the AAFP adapt? Partnerships Education of trainees and practicing family physicians. Public Health During the 114 th Congress, AAFP supported funding, program improvements, stakeholder engagement, and legislation to support key priorities: Zika virus funding Flint lead poisoning crisis response Prevention Fund 12 percent of the CDC s budget Tobacco Family Smoking Prevention Tobacco Control Act of 2009 Medical Consortium on Climate Change Mental health reform Opioid abuse legislation Title X funding Outlook: (1) Small bipartisan authorization bills, such as new disaster preparedness coordination legislation, (2) CRA/riders rolling back Obama administration priorities, such as the FDA s deeming authority over all tobacco products, (3) public health cuts or restructures (Farm Bill, annual appropriations, reconciliation.) Social Determinants of Health Health equity Diversity Actionable, practical response by AAFP within HOPS and AAFP as a whole. Function of Government What is the future responsibility and role of government? Is government capable of overseeing health care? Can a private market be established and regulated? The Erosion of Science Fake science, fake news Disbelief and dismissal of science by society and even physicians. How does AAFP advocate for science and evidencebased medicine? Impact of Election on Science Risk to AHRQ, USPSTF, PCORI Advocacy to support these entities Explore alternative plans for future methods and standards of evidence 3

4 Trust of Science Anti-Vaccination Movement Workforce Graduate Medical Education Teaching Health Centers National Health Service Corps Other Health Care Workforce Challenges Hospital-based nurses Care managers Technical skilled workers lab, radiology, etc Prescription Drug Abuse Epidemic status in many states Top priority for Congress, and most Governors CDC activity help or hurt? Balance patient needs with public health Pharmaceutical Issues Pharmaceutical Access & Pricing Emerging as priority issue in public opinion polls President-elect testing the waters Value proposition changing from access/cost to quality/cost Family Physician Well-Being Also.. Decrease the burden Organizational improvements Improve the culture Children s Health Insurance Program Direct Primary Care Telemedicine Chronic Care Concussions Hospital Payment System MACRA Extenders UFA s Tax Reform Gun Research 4

5 10 Most Influential People THE PEOPLE Donald J. Trump 2016 Presidential Election Results Donald J. Trump Hillary R. Clinton Party Republican Democratic Running Mate Governor Mike Pence Senator Tim Kaine Electoral College Votes States Carried 30 + Maine 2 nd CD 20 + DC Popular Vote 62,979,879 65,844,954 Percentage of Vote 46% 48% 45 th President of the United States The 2016 Presidential Election by Congressional District State Overview Republican Democratic Independent Governors Governors State Legislatures 2016 State Legislatures (2 undecided) 5

6 115 th Congress AAFP Legislative Priorities Health Care For All Delivery System & Payment Reform Health Care Affordability Primary Care Workforce Promote Prevention & Wellness Trump Agenda Trump Agenda Trade Tax Reform Immigration Reform Regulatory Relief Energy & Natural Resources Health Care Drain the Swamp Crime Infrastructure Education Reform Trade Tax Reform Immigration Reform Regulatory Relief Energy & Natural Resources Health Care Drain the Swamp Crime Infrastructure Education Reform 6

7 Tom Price, MD Cabinet Nominations HHS Secretary Tom Price, MD Member of Congress Georgia Chairman, House Budget Committee Georgia Senate Orthopedic Surgeon Department of Health & Human Services HHS Office of the Secretary Secretary Secretary Deputy Secretary Chief of Staff Tom Price, MD Office of Health Reform Office of Intergovernmental & External Affairs Administration for Children & Families Administration for Community Living Center for Disease Control & Prevention Centers for Medicare & Medicaid Services Seema Verma Health Resources & Services Administration Substance Abuse & Mental Health Services Administration Agency for Research & Quality National Institutes of Health Indian Health Services Food & Drug Administration Agency for Toxic Substances & Disease Registry AS for Administration AS for Health AS for Planning & Evaluation AS for Public Affairs Office of General Counsel Office of Inspector General Office of the National Coordinator of HIT AS for Financial Resource AS for Legislation AS for Preparedness & Response Office for Civil Rights Office of Global Affairs Office of Medicare Hearings & Appeals Departmental Appeals Board CMS Administrator-Designee Seema Verma Health Policy Consultant Specializes in Medicaid Architect of Healthy Indiana Plan (HIP) Consulted on Kentucky, Iowa waivers Centers for Medicare & Medicaid Services (CMS) Principal Deputy Administrator Chief of Staff Center for Medicare & Medicaid Innovation Administrator Seema Verma Chief Operating Officer Deputy Administrator for Innovation & Quality - CMO Center for Clinical Standards & Quality Center for Medicare Center for Medicaid & CHIP Center for Program Integrity Center for Consumer Information & Insurance Oversight 7

8 10 Influencers 115 th Congress 115 th Congress Reince Priebus Governors Senate Parliamentarian Congressional Budget Office Economy Media Fact Checkers The Calendar Supreme Court Speaker Paul Ryan Nancy Pelosi Greg Walden Kevin Brady Freedom Caucus Progressive Caucus Mitch McConnell Charles Schumer Lamar Alexander Patty Murray Bernie Sanders The Most Important Influencer I've always said that in politics, your enemies can't hurt you, but your friends will kill you. Governor Ann Richards R. Shawn Martin Senior Vice President Advocacy, Practice Advancement, & 8