This document summarizes key points from a policy briefing about the Affordable Care Act and Ryan White program. It discusses ACA milestones including Medicaid expansion and health insurance exchanges. It notes that some states like Pennsylvania may not expand Medicaid. The briefing also covers the potential impacts of sequestration cuts and upcoming advocacy events regarding appropriations for HIV/AIDS programs.

1. Policy Briefing
Philadelphia EMA Ryan White Part A
Planning Council
February 14, 2013
Presented by Matthew McClain

2. Topics
 ACA milestones through January 1
 Plan for Ryan White Program post-
expiration
 Appropriations 2014
 Impact on Planning Council work
 Advocacy activities and resources
February 14, 2013 2

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. 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
Medicaid
February 14, 2013 4

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. Insurer Prohibitions Effective
January 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. Small Business/Small Nonprofit Tax
Credit 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. February 14, 2013 8

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 2011
February 14, 2013 9

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. 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 occur
February 14, 2013 11

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 included
February 14, 2013 12

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% cut
February 14, 2013 13

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, 2013
February 14, 2013 14

15. States That Are Most Affected by Across-the-Board Cuts
to ADAP Funding Also Disproportionately Impact People
of Color
February 14, 2013 15

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: +$184
February 14, 2013 16

17. Sample Impacts on the Planning
Council’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. Communities Advocating Emergency
AIDS 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
Directors
February 14, 2013 18

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 Society
February 14, 2013 19

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 time
February 14, 2013 20

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. Thank you!
Matthew McClain
AIDSpolicy@aol.com
February 14, 2013 22