Washington, D.C. Update 2016 AMGA CMO Council March 9, 2016 Chester Speed, J.D., LL.M, Vice-President, Public Policy Presentation Outline AMGA Priority Issues Risk Survey Legislative Agenda Elections 1
AMGA Priority Issues Risk Biggest policy issue for next 5 Years Post-SGR/Medicare Access and CHIP Reauthorization Act (MACRA) Alternative Payment Models (APMs) Revenue thresholds Timing Nominal downside risk definition Republicans: MACRA as ACA, but Want APMs to Work Merit-Based Incentive Payment System (MIPS) AMGA Priority Issues Medicare Advantage 2017 last year of ACA cuts, but CMS exercises regulatory authority Advance Notice and Call Letter issued on 2/19 ACOs Operational/Financial refinements 2
AMGA Priority Issues Imaging Oppose efforts to eliminate medical group referrals for advanced diagnostic imaging President s 2017 Budget proposal Graduate Medical Education (GME) Support funding for medical education Regulations MACRA rule, Outpatient, Inpatient and Physician Fee Schedule, etc. Expanded Public Policy Department to address MACRA implementation and prepare for the transition to value-based payment Introduction: Risk Survey Context Why Did AMGA Conduct the Survey? The SGR repeal law and pronouncements from the federal government indicate that federal policymakers are moving providers away from fee-for-service and into risk based arrangements. Policymakers may not appreciate the issues related to taking risk. Survey demonstrated that shift to risk is already underway. Also identified impediments to risk and tools policymakers could offer to help providers succeed in a value based payment system. U.S. Capitol Copyright 2015 AMGA Inc. All rights reserved. HHS HQ 6 3
Revenue Sources: Overall Federal Commercial Bundled Payment Medicare Advantage Bundled Payment Full Capitation Partial Capitation Shared Risk Medicaid Managed Care Shared Savings/ACO MSSP/Pioneer/NextGen Medicaid FFS Fee for Service Fee for Service (Original Medicare) Copyright 2015 AMGA Inc. All rights reserved. 7 Percentage of insurers offering risk based arrangements? 40% 30-39% 20-29% 1-19% None Copyright 2015 AMGA Inc. All rights reserved. 8 4
Length of time before we can accept downside risk? 6+ yrs. 3-5 yrs. 1-2 yrs. < 1 year Copyright 2015 AMGA Inc. All rights reserved. 9 Impediments and tools needed to take on risk: Commercial Copyright 2015 AMGA Inc. All rights reserved. 10 5
Impediments and tools needed to take on risk: Federal Copyright 2015 AMGA Inc. All rights reserved. 11 2016 Legislative Agenda Senate McConnell Agenda Appropriations Regular Order, But Elections Supreme Court Battle House Speaker Ryan Agenda Policy Building Year 6
Legislative Agenda Congressional Budget Office Projections for Federal Healthcare Programs Federal Healthcare programs will increase from 5.6% to 6.6% of gross domestic product by 2026 Resulting in more spending in Healthcare programs than Social Security by 2026 Number of people over 65 has doubled in 50 years Medicare Part A Trust fund insolvent in 2026 Meaning 2017 Legislative Agenda Focus on Entitlement Reform Speaker Ryan Priority Premium Support Part C and D walls breached Provider cuts in play Cuts > political pain calculus Vehicles Debt Limit/budget bill 7
Legislative Agenda Affordable Care Act Changes White House dependent Republican: can pass reconciliation bill Democrat: Tinkering but Hillary Clinton supports public option Increasingly Polarizing Ideologies Six Dynamics Affecting 2016 Race Culture Wars Economic Anxiety Strong Sense of Populism Anger at Washington and Career Politicians America s Place in the World 8
Who Will Win the Democratic Nomination? Hillary Clinton holds commanding delegate lead after Super Tuesday and weekend primaries 2,383 Delegates Needed to Win the Democratic Nomination Clinton Needs 1,253 delegates Total 4,763 Delegates Sanders Needs 1,884 delegates Allocated Delegates Remaining Delegates 9
Hillary Clinton is likely nominee, unless Who Will Win the Republican Nomination? 10
Donald Trump still leads after Super Tuesday and weekend primaries 1,237 Delegates Needed to Win the Republican Nomination Trump Needs 853 delegates Total 2,472 Delegates Cruz Needs 937 delegates Rubio Needs 1,086 delegates Kasich Needs 1,200 delegates Allocated Delegates Remaining Delegates Brokered convention? Republicans Cleveland 11
Who Will Win the White House? Kasich Clinton Cruz Sanders Rubio Trump Will Republicans Keep The Senate? Republicans Face More Elections in 2016 Democrat Seeking Re-Election Democrat Not Seeking Re-Election WA Republican Seeking Re-Election Republican Not Seeking Re-Election States with Senate Elections, 2016 MT ND ME OR MN ID SD WI NY WY MI CA NV UT CO NE KS IA MO IL OH IN KY WV PA VA AZ NM OK AR TN NC SC MS AL GA AK TX LA FL 12
Republicans Currently Hold the Five Senate Seats Most Likely to Flip in 2016 GOP Incumbent Running for Reelection Previously GOP-Held Open Seat WA ME MT ND VT OR MN NH ID SD WI NY MA WY MI RI CT IA PA NE NJ NV UT OH DC IL IN DE WV CO CA VA MD KS MO KY NC AZ TN OK NM AR SC MS AL GA AK TX LA HI FL Analysis Illinois: Incumbent Sen. Mark Kirk (R) has distanced himself from the national GOP. He voted against defunding Planned Parenthood and in favor of gun-sale restriction. Wisconsin: Incumbent Sen. Ron Johnson (R) is fighting his challenger on national security issues. New Hampshire: Incumbent Sen. Kelly Ayotte (R) has moderated her stance by supporting Obama s Clean Power Plan. Florida: Senate seat left open by Sen. Marco Rubio. However, Democratic candidate Rep. Alan Grayson is currently facing ethical scrutiny. Pennsylvania: While incumbent Pat Toomey (R) has dropped his reputation as a conservative hard-liner, no clear Democratic nominee has emerged. Will Republicans Keep The House? 13
As Few as 33 House Races Could Be Close in 2016 Competitive 2016 House Races, by Region Lean Democratic Toss Up Lean Republican West WA MT Midwest ND MN-08 IL-10 IA-01 MN-02 NE-02 IA-03 MI-01 MI-07 VT ME Northeast AZ-02 CA-10 CA-21 CA-25 UT-04 CA-07 NV-04 AZ-01 CO-06 NV-03 CA OR NV ID UT WY CO SD NE KS MN IA MO WI IL IN MI OH NH NY MA RI CT PA NJ DE DC MD NJ-05 NY-01 NY-24 NY-03 ME-02 NH-01 NY-19 NY-22 PA-08 WV AZ NM OK AR KY TN VA NC SC Southeast MS AL GA AK TX LA FL-13 VA-05 FL-18 FL-26 FL-07 TX-23 HI FL Questions/Comments Thank You Chester Speed, J.D., LL.M, Vice-President, Public Policy cspeed@amga.org 14