Policy Briefing 02-14-13

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Policy Briefing 02-14-13

  1. 1. Policy Briefing Philadelphia EMA Ryan White Part A Planning Council February 14, 2013 Presented by Matthew McClain
  2. 2. Topics  ACA milestones through January 1  Plan for Ryan White Program post- expiration  Appropriations 2014  Impact on Planning Council work  Advocacy activities and resourcesFebruary 14, 2013 2
  3. 3. ACA: New as of January 1, 2013  New funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.  States must pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services (fully funded by the federal government).  National payment bundling pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.February 14, 2013 3
  4. 4. ACA: Milestones on October 1, 2013  Health Insurance Exchange marketing begins  Health Insurance Exchange enrollment begins  States will receive 2 more years of CHIP funding to continue coverage for children not eligible for MedicaidFebruary 14, 2013 4
  5. 5. ACA: January 1, 2014 Milestones  Individuals, small businesses, and Members of Congress can compare and buy qualified health benefit plans through Health Insurance Marketplace.  Individual mandate takes effect for all but undocumented and extremely low income.  Americans who earn less than 133% of FPL will be eligible to enroll in Medicaid.  Tax credits and reduced cost sharing will become available for those with income between 100% and 400% FPL.February 14, 2013 5
  6. 6. Insurer Prohibitions EffectiveJanuary 1, 2014  Prohibits dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Prohibits imposing annual dollar limits on the amount of coverage an individual may receive.  Prohibits refusing to sell coverage or renew policies because of an individual’s pre-existing conditions.  Prohibits higher rates in the individual and small group market due to gender or health.February 14, 2013 6
  7. 7. Small Business/Small Nonprofit TaxCredit Effective January 1, 2014  The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations.  Up to 50% credit on taxes on the small employer’s contribution to provide health insurance for employees.  Up to a 35% credit for small non-profit organizations.February 14, 2013 7
  8. 8. February 14, 2013 8
  9. 9. Medicaid Expansion (not)  Pennsylvania: Governor Corbett recommended not expanding Medicaid in the Commonwealth (2/5/13)  New Jersey: Governor Christie is leaning against expansion  NJ partly expanded to non-disabled adults with children through ACA-enabled Medicaid waiver in 2011February 14, 2013 9
  10. 10. If a State Does Not Expand: Uninsured adults  Uninsured adults below 100% FPL in above 100% FPL will that state will not be eligible for gain new affordable subsidies to coverage options, purchase exchange are not eligible for coverage, but many subsidies, and they will likely remain will likely remain uninsured due to uninsured. lack of money.February 14, 2013 10
  11. 11. Ryan White Program 2014  Current legislation expires September 30, 2013  Appropriations can legally continue without authorizing legislation  Absence of appetite on the Hill to legislate any more health laws  Strong policy argument to delay while administrative fixes occurFebruary 14, 2013 11
  12. 12. Federal FY 2013 Budget  $1.043 Trillion Continuing Resolution, currently expires March 27, 2013  Latest scheme: House enacts in March a CR at the current level, keeping sequester unless Congress acts separately, with Senate-passed DOD and VA appropriations bills includedFebruary 14, 2013 12
  13. 13. Sequester  Across-the-board percentage cuts per 2011 law, now effective March 1, 2013  $85 billion in automatic cuts using variable rates for defense and non- defense discretionary (with exceptions)  Effective percentage reduction for non- defense discretionary programs: ~9%  Community health centers mandatory funding limited to 2% cutFebruary 14, 2013 13
  14. 14. White House Press Release:Public Health Sequester Impacts* Mental health and substance abuse services AIDS and HIV treatment and prevention  7,400 fewer ADAP clients  420,000 fewer HIV tests Tribal services* Office of the White House Press Secretary, February 8, 2013February 14, 2013 14
  15. 15. States That Are Most Affected by Across-the-Board Cutsto ADAP Funding Also Disproportionately Impact Peopleof ColorFebruary 14, 2013 15
  16. 16. Key Appropriations Requests 2014,increases above 2012 in millions Part A: +$67 Prevention: +$180 Part B: +$42 DASH: +$20 ADAP: +$133 Hepatitis: +$5 Part C: +$22 Research: +$440 Part D: +$14 HOPWA: +$33 AETC: +$10 Dental: +$3 MAI: +$184February 14, 2013 16
  17. 17. Sample Impacts on the PlanningCouncil’s Responsibilities Needs assessment and planning  To what extent do the Medicaid programs in PA and NJ in 2014-2019 affect needs and what within RW can be brought to bear on new gaps? Priority setting and resource allocations  To what extent does the evidence justify changes in priorities and resource allocations?February 14, 2013 17
  18. 18. Communities Advocating EmergencyAIDS Relief (CAEAR) Coalition Covers authorization and appropriations for Part A, ADAP, Part C, Dental, AETC  Pat Bass, Mid-Atlantic Regional Representative  Kevin Burns, At-Large Member, Board of DirectorsFebruary 14, 2013 18
  19. 19. Federal AIDS Policy Partnership AIDS Budget and Appropriations Coalition  Donna Crews, AIDS United  Emily McCloskey, NASTAD  Carl Schmid, AIDS Institute Healthcare Access Work Group  Robert Greenwald, Treatment Access Expansion Project  Amy Killelea, NASTAD  Andrea Weddle, Infectious Disease SocietyFebruary 14, 2013 19
  20. 20. Advocacy and Upcoming Events Ramp up existing  AIDS Watch mechanisms for February 25-26 information  CAEAR Coalition gathering, analysis, February 25-26 response: PA, NJ,  FAPP Meeting Federal February 27 Advocacy is legal, costs money, and takes timeFebruary 14, 2013 20
  21. 21. Resources hab.hrsa.gov  mahealthconnector.org healthcare.gov  exchange.utah.gov healthreform.gov  ehealthinsurance.com statehealthfacts.org  John E. McDonough, Inside National Health Reform, kff.org 2011. AIDSunited.org  International AIDS Society nastad.org and the Scientific Working Group, Towards an HIV caear.org Cure, July 2012 February 14, 2013 21
  22. 22. Thank you! Matthew McClain AIDSpolicy@aol.comFebruary 14, 2013 22

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