Federal Policy Update
Great Basin Primary Care
Association – Annual Meeting
Joe Gallegos, MBA
SVP for Western Operations
National Association of Community Health Centers
September 10, 2013
America’s Voice for Community Health Care
The NACHC Mission
To promote the provision of high quality,
comprehensive and affordable health care that is
coordinated, culturally and linguistically competent,
and community directed for all medically
underserved people.
THE AFFORDABLE CARE ACT
- A QUICK REFRESHER -
Health Center Funding and the Affordable Care Act
• The Affordable Care Act (ACA) provided $11
billion in Mandatory funding for health center
operations and capital for FY 2011 thru FY 2015.
–$9.5 billion to support health center operations.
–$1.5 billion for capital needs.
• Mandatory funding provided through the ACA
Health Center Trust Fund ends after FY2015.
ACA Planned Funding for Health Centers
& Estimated New Patients*
45
Patients in Millions
Funding in Billions
40
40.0
35
26.0
26.5
$2.5
27.7
25
20
$3.5
$3.0
31.6
30
$4.0
$2.0
19.4
18.8
$1.5
17.0
15
$1.0
Health Reform
Implementation Begins
10
$0.5
5
$0.0
2008
2009
2010
2011
2012
2013
2014
2015
Sources: Data for federally-funded health centers only. FY00-08 are from HRSA’s Uniform Data System. FY09 -15 are NACHC projected estimates based on new
federal funding. NACHC estimates future health center patients as a function of new federal funding.
Note: Other factors are difficult to predict and include payer mix, growth in non-federal grant sources, and the costs of care, which may be related to new patients
having unmet health needs. Patient growth will be contingent on continuation of federal, state, and local support over the period.
* Prior to FY2011 $600 million reduction,
Health Center Funding Under Current Law
Community Health Center Funding:
FY 2010 – FY 2016
Other Key Provisions for Health Centers
• Medicaid Expansion to 133% FPL: The
elimination of categories of eligibility will greatly
expand insurance for health center patients
• Menendez Amendment: Guaranteed Medicaid
PPS Payment Level for FQHCs from Qualified
Health Plans under Exchanges/Marketplaces
• Medicare: Modified Medicare PPS for FQHCs,
Inclusion of all preventive benefits and Elimination
of current provider productivity caps and screens
Some Key Features of the ACA
• Prohibits insurance companies from denying coverage
because of an individual’s pre-existing condition.
• Prohibits new health plans and existing group plans from
imposing dollar limits on the amount of coverage an
individual may receive.
• Extends coverage for Young Adults under parents’ plan until
they turn 26 years of age.
• Paying Physicians Based on “Value” not “Volume”.
• Small Business Health Options Program (SHOP) simplifies
and makes health insurance coverage for employees of small
business more affordable.
Some Key Features of the ACA
2010: Patient Bill of Rights and Cost-free Preventive Services
2011: People on Medicare receive key preventive services for free and
50% discount on brand-name drugs “donut hole”
2012: ACOs and other programs help health care providers work together
to deliver better care—higher quality and lower cost
2013: Open enrollment in Health Insurance Marketplace begins October 1,
2013
2014: Effective January 1, 2014, 30 million low to moderate income
Americans will gain coverage through Medicaid expansion or through
premium subsidies. Millions will gain coverage for the very first time.
NOTE: Who is left out of Coverage? Undocumented Immigrants.
Undocumented Immigrants who arrived in U.S. as Children – Deferred
Action for Childhood Arrivals (DACA) (estimated 900,000)
Status of State Medicaid Expansion for 2014
FY 2013 APPROPRIATIONS
President’s 2013 Budget Proposal
• Budget included $3.1 billion for Health Centers, a $300
million increase over FY 2012:
$1.6 billion discretionary, $1.5 billion mandatory (ACA)
• BUT, proposed to “hold back” $280 million of the $300
million increase as a way to avert the funding cliff
Result would be: only 25 New Access Points (NAPs), no
other expansion or base adjustments
Result: Needed Congress to legislatively compel the
Administration to spend the full increase ($300 million)
in FY 2013.
FY 2013 Appropriation/Spending Plan
FY 2013 Spending Plan ($300 Million)
• $115 +/- million sequester - “backfill”
• $48 million – Base Grant Adjustments (to be announced
mid-September)
• $19 million – New Access Points (20-25 NAPs) (to be
announced mid-September)
• $118 million – Outreach & Enrollment Assistance for
health centers and S/RPCAs*
*Note: Total O&E grant was $156 million---not all from CHC funds
A LOOK AHEAD:
CONGRESS
AND
APPROPRIATIONS
Legal Analysis
16
Major Flash Points
– Debt limit: Expect to reach the $16.7 Trillion limit by MidOctober. Some Congressional leaders are demanding a
budget agreement – potential threat to entitlement programs
– Sequester resumption: $110 Billion in automatic cuts, ½ from
non-defense effective October 1, 2013 unless alternate cuts
are approved (For CHCs = $115 million/900,000 patients not
served)
– Grand or Petite bargain on Federal Budget: bipartisan groups
continue to search for compromise
– Defund Obama Care or shut down Federal government
operations
– Immigration Reform: S. 744 passed the Senate, now debate
moves to the House
NACHC PRIORITIES FOR
FY 2014
NACHC’s 2014 Overarching Priorities
–Avoid further cuts in Section 330 funding
• Secure full use of ACA funds to offset any sequester/
deficit reductions & to support growth where
possible in FY 2014
• Get key members of Congress to commit to address
2015 CHC funding cliff (when ACA funding expires)
–Limit impact to Medicaid (& Medicare & ACA) to avoid
cuts in eligibility, benefits, & payment (esp. PPS)
–Preserve CHCs as open to ALL individuals (including
immigrants)
The Health Center FY2014 Request
Total Funding of $3.8 billion, breaks down to:
• $1.6 billion in discretionary funding
• $2.2 billion in mandatory ACA funding
= increase of $700 million over FY 2013
What $700 million Can Do…
• $95 million in Base Grant Adjustments
• $350 million for New Access Points – potential
to serve an additional 3 million new patients
• $255 million for Expanded Medical Capacity
(EMC) and Service Expansion (medical, dental,
behavioral health, pharmacy and vision
services and enabling services)
Congressional Support Letters
• House: Pallone/ Bilirakis Letter:
–194 Bipartisan Cosigners
• Senate: Wicker/ Stabenow Letter:
–54 Bipartisan Cosigners
• BUT we know of an additional 7 Senators who sent
in their individual support letters for the CHC
program.
• 61 Senators or the majority of the Senate supports
funding for the CHC Program in FY14
Highest level of Congressional support in 3 years!!!
July 2013: The Senate FY 2014 LHHS Bill –
VICTORY!
What is in the bill for CHCs:
Full funding- $3.8 billion/ $700 million increase
Legislative text requiring the Administration to spend
the full $700 million increase by Sep.30th, 2014 on:
• New Health Center Sites
• Expanded Medical Capacity
• Service Expansion
 $142 million in Outreach & Enrollment funds rolled into
base grant adjustments- -making them permanent
$95 million in the Federal Tort Claims Fund
Where is the House???
Too Much Gridlock
– Scheduled and then Cancelled House FY14 LHHS Bill Markup
• The dueling Budgets and lack of sequester repeal are stalling
the LHHS Bill.
• House Allocation is 25.9% less or $142 billion lower than the
Senate
• Too soon to tell how the House will proceed– expect that
many programs will face steep reductions
• Most likely we will face another Continuing Resolution.
FTCA Malpractice Coverage for
Volunteers
• Sen. John Thune (R-SD) and Sen. Bob Casey (D-PA)
introduced S. 955, the Family Health Care Accessibility
Act of 2013.
• Extends Federal Tort Claims Act (FTCA) malpractice
coverage to health practitioners volunteering at Section
330-funded health centers.
• Rep. Tim Murphy and Rep. Gene Green introduced the
Family Healthy Care Accessibility Act (H.R. 2703)—
companion bill to S.955.
Outreach and Enrollment
Outreach and Enrollment Grants for CHCs
• On May 9, 2013, HRSA distributed grants to Health Centers
and S/RPCAs in the amount of $150 million to help uninsured
individuals gain affordable health insurance coverage.
• Last month, CMS awarded a total of $67 million to 105
Navigator grant applicants in Federally-facilitated and State
Partnership Marketplaces to assist individuals who are eligible
for marketplace coverage to select a plan that best meets their
needs.
• This year (2013) is the time to get ready and prepare for
January 1, 2014 when 30 million Americans gain coverage,
many who will gain coverage for the first time. Get ready by
conducting “in-reach” and “community outreach” to assist
individuals in getting enrolled.
What should health centers be doing?
• Recruit Outreach and Enrollment Assistance Workers
• Train Outreach and Enrollment Assistance Workers
• Plan for and conduct outreach and enrollment activities
• Take advantage of PCA, HRSA and CMS resources, training
and technical assistance (i.e., in-reach and outreach)
• Report on progress: # of staff trained; # of individuals
assisted; # of individuals determined to be eligible and # of
individuals enrolled
Important ACA websites
http://www.healthcare.gov
http://marketplace.cms.gov/
http://hrsa.gov/affordablecareact/
What is the Outlook?
202-457-6267
Outlook
Have confidence that, whatever the battles
ahead may be --- we can win.
• Few can match our record --- and few
programs can deliver what we offer:
• Value in the quality care we deliver;
• Value in expanding access and improving
health;
• Value in delivering cost savings PLUS
some $20 billion dollars in jobs and
economic activity for communities.
Where Can I Get More Information?
•Website:
–NACHC.org > Policy Issues > Federal
–Talking points, newest research and data,
webcasts and trainings
•Blog:
–Health Centers on the Hill
•Washington Update:
–Sign up to be a Health Center Advocate
Thank You!
Any
Questions?