The document summarizes advocacy updates regarding the American Health Care Act (AHCA) and the Health Care Safety Net Enhancement Act. It outlines key provisions of the AHCA, including eliminating the individual mandate and replacing subsidies with tax credits. It notes the CBO score estimated 24 million fewer would be insured by 2026 under the AHCA. The document also states ACEP's stances in support of maintaining certain patient protections and against proposed Medicaid cuts. Additionally, it briefly describes the Safety Net Enhancement Act, which provides liability protections to physicians providing EMTALA services.

1. Advocacy Update
MICHAEL GRATSON MD

2. Objectives
 To have a basic understanding of National and
State Issues in EM
 To understand the potential effects of political
issues on EM
 To understand the value of organized
emergency medicine

3. One Big Fish and One Small Fish

4. The Big Fish
 American Health Care Act H.R. 1628
Introduced into the House of Representatives on
March 6th
Passed through the House Energy and Commerce
Committee and the House Ways and Means
Committee on March 9th
Passed Budget Committee on March 16th
Currently awaiting vote on the House floor today

5. AHCA
 Individual Mandate
 Cadillac Tax
 Replace tax subsidies with tax credits
 Insurance Lapse
 Age band rating increase
 Increase HSAs
 Medicaid Expansion
 Rescind the Prevention and Public Health Fund
 Eliminates Disproportionate Share Hospital payment cuts from ACA

6. AHCA CBO
 Congressional Budget Office released its score on March 13th.
 Reduction in number of insured by 14 million by 2018, 21 million by 2020,
and 24 million by 2026
 Would reduce the deficit by $337 Billion over 10 years
 Estimates that initially insurance premiums would rise then be reduced in
the future moderately
 Insurance premiums would go down substantially for the young but
increase for the elderly
 Increased Medicaid costs due to decreased access to birth control

7. AHCA Recent Updates
 3/20 New amendment was added to change
Medicaid
New addition of work requirement for able-bodied
Medicaid recipients
Change Medicaid funding to block grants versus
per capita
 3/22 Freedom Caucus now saying that bill does
not go far enough to reduce cost

8. ACEP Stance
 Stands against
 Cuts in Medicaid
 Elimination of the tax subsidies
 Institution of 30% penalty
 Lack of mechanisms to increase insurance market share
 Any change in the Prudent Layperson Standard
 Stands for
 Maintaining pre-existing conditions and family plans until 26 years of age
 Elimination of Cadillac Plan Tax

9. The Small Fish
 Health Care Safety Net Enhancement Act H.R. 548/S.
527
 Introduced by Representative Charlie Dent (R-PA)
and Senator Roy Blunt (R-MO)
 Liability reform bill supported by ACEP
 Provides physicians who provide EMTALA related
services temporary protections under the Federal Tort
Claims Act

10. What you can do
 Sen Gary Peters
 LA Greg Mathis Jr – Greg_Mathis@peters.senate.gov
 Sen Debbie Stabenow
 LA Alex Graf – Alex_Graf@Stabenow.senate.gov
 Rep David Trott
 LD Bridget Dobyan – bridget.dobyan@mail.house.gov
 Rep Sander Levin
 LA Daniel Foster – Daniel.Foster@mail.house.gov