MAHA Fall Conference
Legislative Political Update
October 13, 2015
Paige Fults
Director, Advocacy
1
Political and Healthcare Climate
• New Leaders
• 9 months into 98th Legislative Session
Accomplishments
• Negative Media Attention
• 600,000 in HMP but 2nd Wavier decision by
CMS pending
• Failed Roads proposal has lingering effect
• 2016 Elections impact policy and politics
2
Key Elements to Advocacy Success
• MHA and members advocating with unified voice
• Member participation in targeted advocacy days:
Healthcare Advocacy Day, Small/Rural Advocacy Day, GME
Advocacy Days
• Support from legislative appropriation and policy leaders;
Support from Gov. Snyder and MDHHS Director Lyon
• Public recognition of issues under debate and broad
grassroots engagement
• Maintaining strong Health PAC contributions to assist with
relationship development and access to legislative leaders 3
Health-related Public Policy Issues:
Michigan Legislature
1. Roads, Roads and more Roads
2. FY 2017 state budget development/HICA
3. Auto No-fault and “D” insurance
4. Interstate Medical Licensure Compact
5. Pharmacist substitution of Biosimilar Drugs
6. Hospital Chargemaster Transparency
7. Community College Nursing Programs
8. CON Reform
9. Scope of Practice for Advance Practice Nurses
10. CRNA – Independent Practice
11. Energy Regulation
4
Road Funding – Proposal 1: Epic Fail
• Would have increased state revenue by more than $2.1 billion
a year through a 1-cent increase to state sales tax, vehicle
registration discount elimination and motor fuel tax rate
increase
• Spending
− $1.2 billion to roads
− $300 million to the school aid fund
− $130 million to mass transit
− $95 million to local governments
− Expansion of the earned income tax credit would provide
$260 million in targeted tax relief for low-income workers
• Defeated 80-20 – The most sided loss ever for a proposed
amendment to the state constitution of 1963
Road Funding – Legislative Proposals
• Various levels of existing general fund ($350m-$700m)
• Additional taxes and fees (gas tax increase, registration
fee increase, etc.)
• Democrats and administration would like to see an
increase/extension of the Health Insurance Claims
Assessment
– House and Senate Rs not on board, would prefer not to
further complicate things (much like the end result of
Prop 1)
• Is there a path to $1.2b annually for roads?
• If a large amount of existing general funds are used, how
will that impact health care funding?
Auto No-fault Insurance – SB 248
• Reduces provider payments to 150% of
Medicare
• Replaces existing catastrophic insurance
with unregulated, unfunded mechanism
• Creates anti-fraud authority in state
government
• Places limits on family-provided attendant
care
Auto No-fault Insurance – SB 248
• Currently stalled on House floor
• Significant opposition among House
Republicans
• House Democratic Caucus formally opposed
• No reply to MHA correspondence from
House Insurance Committee Chair Leonard
• No workgroup or further meetings with auto
insurers
• Little appetite for replacing catastrophic
benefit system among House members
D Insurance – SB 288
• Mayor Duggan’s plan to reduce Detroit auto
insurance premiums
• Reduces 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
D Insurance Opposition – SB 288
• Does not guarantee a reduction in premiums – it simply trusts
insurers to lower your rates
• Does nothing to reduce the number of uninsured drivers, who
now pay NOTHING. Even opting for D-Insurance would
represent an increase in their expenditures
• Any cost savings is quickly offset by the costs of medical care if
the driver involved in an accident requiring catastrophic care
• Unlimited necessary medical care, known as Personal Injury
Protection or PIP, is not the reason for high premiums in
Detroit – yet the only thing D-Insurance does is cut your PIP
benefits
• Health insurance does not cover many of the services needed
for recovery from an auto accident, such as attendant care or
10
home/vehicle modification needs
D Insurance – SB 288
MHA Letter of Opposition
• Limiting medical care to lower auto
insurance rates is not a sensible approach
• Address overuse, fraud
• Bring frequency and severity in line with
outstate claims
• Town halls
D Insurance – Senate Bill 288
• Currently stalled on Senate Floor
• 1-2 Senate Democrats supportive
• House Democratic Caucus formally opposed
• Significant opposition among Republicans in
both chambers
• SML Meekhof would like to see more support
from Detroit lawmakers prior to considering
further action
What reforms do hospitals support?
• Reduce hospital fees by 20% (or lower if negotiated)
• Freeze those rates until 2019
• Future increases limited to rate of medical CPI
(inflation rate)
• Full court press to fight fraud
• Focus on appropriateness of care for survivors
• Control attendant care cost
• Pass savings to consumers
13
Interstate Medical Licensure Compact
• House Bill 4583, sponsored by Rep. Jim Tedder (R-Waterford),
referred to the House Health Policy Committee
• Would allow Michigan to join the Interstate Medical Licensure
Compact
– State-based legislative proposal, enacted when seven states
adopt into law
– Provides a new, expedited pathway to licensure for qualified
physicians to practice in multiple states
– Voluntary 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 licensure
• Compact Commission would provide oversight and administration
14
of the Compact, create and enforce rules
Interstate Medical Licensure Compact
15
Interstate Medical Licensure Compact
• Rep. Tedder convened first workgroup Sept. 29
• Early adopters will have more influence on framework of
compact
• Overwhelming support of concept across the country
– AARP
– American Medical Association
– State medical associations
– State hospital associations
– Mayo Clinic
• No notable opposition
• Possible opportunity to engage Partnership for Michigan Health
16
2016 Elections - Nov. 8
•
•
•
•
•
•
U.S. President
U.S. Congress – 14 seats (9 R, 5 D)
MI House of Representatives – 110 seats (61 R, 46 D)
Special Elections (Dillion, Courser, Gamrat, V. Smith?,)
MI Supreme Court – 2 seats (Justice Viviano, resignation-Mary Beth Kelly)
Ballot Proposals
– Stop Overcharging
– Citizens for Fair Taxes
– Prevailing Wage
– Marijuana Legalization (2)
– Voting by Mail
– Paid Sick Leave
– Banning Fracking
17
2016 Elections - President (Dems)
Hillary Clinton
Former U.S. Secretary of
State
Martin O’Malley Bernie Sanders
Former Governor of
Maryland
Lincoln Chafee
Former Governor of
Rhode Island
U.S. Senator - VT
Joe Biden
Vice President
Lawrence Lessig
Harvard Professor
Jim Web
U.S. Senator - VA
18
2016 Elections - President (GOP)
Jeb Bush
Former Governor of
Florida
Ted Cruz
U.S. Senator - TX
Ben Carson
Chris Christie
Director of Pediatric
Neurosurgery, Johns
Hopkins
Governor of New Jersey
Carly Fiorina
Former CEO of HewlettPackard
Jim Gilmore
Former Governor of
Virginia
19
2016 Elections - President (GOP)
Lindsey Graham
U.S. Senator - SC
John Kasich
Governor of Ohio
Mike Huckabee
Bobby Jindal
Former Governor of
Arkansas
Governor of Louisiana
George Pataki
Former Governor of
New York
Rand Paul
U.S. Senator - KY
20
2016 Elections - President (GOP)
Rick Perry
Former Governor of
Texas
Marco Rubio
Rick Santorum
U.S. Senator - FL
Former U.S. Senator - PA
Scott Walker
Governor of Wisconsin
Donald Trump
CEO of Trump
Organization
21
2016 Elections – President (21 candidates)
Jeb Bush
Former Governor of
Florida
Ben Carson
Carly Fiorina
Donald Trump
Director of Pediatric
Neurosurgery, Johns
Hopkins
Former CEO of HewlettPackard
CEO of Trump
Organization
Hillary Clinton
Bernie Sanders
Former U.S. Secretary of
State
U.S. Senator-VT
22
Donald Trump continues to lead in the polls
I too, am in the mix!
23
Presidential Candidates - Deja Vu
• The more things change, the more they stay the
same….
24