policy briefing 02-14-13

Policy Briefing

Philadelphia EMA Ryan White Part A Planning CouncilFebruary 14, 2013

Presented by Matthew McClain

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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

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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

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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

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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

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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

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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

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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

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If a State Does Not Expand: Uninsured adults

below 100% FPL in that state will not gain new affordable coverage options, are not eligible for subsidies, and they will likely remain uninsured.

February 14, 2013

Uninsured adults above 100% FPL will be eligible for subsidies to purchase exchange coverage, but many will likely remain uninsured due to lack of money.

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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

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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

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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

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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

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States That Are Most Affected by Across-the-Board Cuts to ADAP Funding Also Disproportionately Impact People of Color

February 14, 2013

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Key Appropriations Requests 2014, increases above 2012 in millionsPart A: +$67 Part B: +$42 ADAP: +$133 Part C: +$22 Part D: +$14AETC: +$10 Dental: +$3 MAI: +$184

Prevention: +$180DASH: +$20Hepatitis: +$5Research: +$440HOPWA: +$33

February 14, 2013

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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

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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

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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

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Advocacy and Upcoming Events Ramp up existing

mechanisms for information gathering, analysis, response: PA, NJ, Federal

Advocacy is legal, costs money, and takes time

AIDS Watch February 25-26

CAEAR Coalition February 25-26

FAPP Meeting February 27

February 14, 2013

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Resources hab.hrsa.gov healthcare.gov healthreform.gov statehealthfacts.or

g kff.org AIDSunited.org nastad.org caear.org

mahealthconnector.org

exchange.utah.gov ehealthinsurance.co

m John E. McDonough,

Inside National Health Reform, 2011.

International AIDS Society and the Scientific Working Group, Towards an HIV Cure, July 2012

February 14, 2013

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Thank you!

Matthew McClainAIDSpolicy@aol.com

February 14, 2013