what you need to know about politics and policy€¦ · what you need to know about politics and...
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What You Need to Know About Politics and Policy in Olympia and D.C.
Chelene Whiteaker, Senior Vice President, Government AffairsLisa Thatcher, WSHA state lobbyistJohn Flink, WSHA federal lobbyistOctober 11, 2018
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Objectives
• Recognize the political dynamics in Olympia and how they will shape WSHA’s legislative agenda
• Understand the major hospital policy issues at the federal level from 2018
• Identify the most impactful federal and state issues facing hospitals for 2019
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What to Expect in the 2019 State Legislative Session
4
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State Policy & Budget Process
WSHA’s Work
• In 2017-2018 WSHA/AWPHD
reviewed 450 bills
• 2018 Supplemental budget year
• Senate flipped to Democratic
control
• Actively worked on dozens and
dozens of bills in 2018
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WSHA Successes: 2018 Policy
• Reasonable charity care law
• Individual insurance market stability
• Stopped many onerous bills:
• Nurse staffing: meals/rest breaks, on-call and restrictions on mandatory overtime
• Mergers/affiliations
• Restrictions on health care entities
• Expansion of liability for wrongful death
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WSHA Successes
• 2018 Supplemental Budget• No cuts to hospitals/
health systems
• Rate increase for pediatric care
• Some new funding for mental health and opioids
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2019 Legislative Session
2018 elections• All of House up for re-election• Half the Senate up for re-election
Long session• 105 days• Budget year
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Current Make Up of House & Senate
Mid-term elections in November!
5048
House
Ds Rs
2523
1Senate
Ds Rs D
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State Leadership: 2019
Governor Jay Inslee (D) – 2nd term
Senate Majority Leader Sharon Nelson (D) – Narrow majority (25-24) *retiring, replacement not known
House Speaker Frank Chopp (D) – Narrow majority (50-48)
Senate Minority Leader Mark Schoesler (R) – 4th term
House Majority Leader Pat Sullivan (D) – 5th term
House Minority Leader J.T. Wilcox (R) – 4th term
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2019: A Big Budget Year
McCleary (K-12)
Health Care
Higher Education
Capital gains tax?
Culverts?
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WSHA Budget Priorities
• Difficult to discharge patients (patients living in the hospital)
• Behavioral health: funding the continuum of care
• Outpatient Medicaid rate increase for physicians
• Increasing the health care work force
• Rural health transformation
• Renewal of safety net assessment program
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Policy Priorities
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2019 Policy Issues
Improving Access and Helping Patients
(WSHA bills)
Streamlining advance directives
Continue CON exemption for mental
health
Expanding surrogate decision makers
Maintain flexibility and maintain/lower
costs
Restrictions on health care entities
Notice requirements on mergers and
affiliations
Expansion of Ambulatory Surgical Centers without CON
Maintain flexibility and maintain/lower
costs
Nurse staffing: meal & Rest breaks,
prohibiting on-call
Balance billing prohibitions
Expansion of wrongful death
Maintain flexibility and maintain/lower
costs
Restriction on medical debt
Improving Access and Helping Patients
(WSHA bills)
Pharmacy regulations
Sexual assault evidence kits
Opioids
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Nurse Staffing
• HB 1715 would have:• Mandated uninterrupted meal and
rest breaks• Prohibited the use of pre-scheduled
on call• Expanded mandatory overtime
prohibitions
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Partnerships and Affiliations
HB 1811 would have placed significant new requirements on hospitals:
Burdensome reporting to the Attorney General of almost all transactions –
even simple arrangements, such as contracted services
Require health care entities to divulge sensitive,
proprietary transaction details
Treble damages under the Consumer Protection Act
Singles out the health care industry
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Wrongful Death
• The Ride the Ducks accident illustrated limitations of our state’s wrongful death statute
• WSHA and WSMA did not oppose expansion to non-US residents, but strongly opposed:
• Significant expansion of damages
• Exposure for “deep pocket” defendants under state joint and several liability standard
• Removal of economic tie
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Medical Decision Makers
• WA law limits who can make decisions when a patient lacks capacity
• Most other states allow more family members or a close friend to make decisions
• Bill ran out of time in 2018
• Will be back in 2019
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Opioid Epidemic
• WSHA has worked to advocate andimplement state opioid legislation
• New alert system: Alerts providersof a non-fatal overdose
• Provider reports of opioid prescribing: Helps educate providers of prescribing compared to peers.
• Action: Hospitals need to sign up with WSHA!
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Medical Billing
• Bill is expected to significantly limit the ability to collect medical debt
• Concern: medical debt would become a second-tier debt to be paid after all other debts
• WSHA is surveying member hospitals to determine potential impact and inform our position
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The View from the Other Washington
John W. FlinkFederal Affairs, WSHA
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2018: The Year in Review
• The State of the ACA’s Individual Markets
• Taxes, Budget, Appropriations
• 340B
• Opioids
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The ACA’s Individual Markets
• Trump Strategy: Weaken coverage administratively• Ended CSRs• Expanded access to association health plans
• Expanded availability of short-term, limited duration health plans• Reduced funding for navigator program/outreach•New exemptions to individual mandate
• Texas lawsuit against ACA
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Taxes, Budget, Appropriations
• Bipartisan Budget Act of 2018 (Feb) & Omnibus Appropriations Act (March) raised spending caps – funded government through 10/1/18
• HHS appropriations funded health care in FY 2019 (Sept)
• Lots of health care activity early in the year
• CHIP funded 10 years• Low-volume, MDH, rural ambulance, home health payment
add-ons extended 5 years• NHSC, CHC, Teaching Health Center programs extended 2 years• Medicaid DSH payment cuts delayed 2 years• Tax exemption for private-activity bonds preserved
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Wait…there’s more…
• Significant boost in funding for HHS rural health programs
• Funding to fight opioid abuse, including rural grants, funds for workforce development programs that address opioid abuse
• Funds to improve the nation’s broadband infrastructure, including rural
• Enforcement of rules governing supervision of outpatient therapeutic services suspended for CY 2017 – 2019
• CAH length-of-stay audits low priority
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Opioids Crisis: SUPPORT For Patients and Communities Act
• Would expand and create prevention, treatment and recovery programs.• Authorizes grants to rural hospitals and communities
• Allows federal Medicaid payments for substance use disorder treatment in IMDs for 5 years
• Did not address 42 CFR Part 2 confidentiality rules
for SUDs patients
• Bipartisan, bicameral bill recently passed House/Senate
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340B Drug Pricing Program
• Key Questions: How much are hospitals saving and spending?
• House Energy & Commerce Committee (Rep. McMorris Rodgers)
• Series of oversight hearings and reports on status of program
• Several proposals to restrict participation by hospitals
• Senate HELP Committee (Sen. Murray)
• Three oversight hearings
• Litigation
• AHA Pledge
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Calendar for the Rest of the Year
• House recessed September 28 until after election
• Senate expected to recess in mid-October or later
• Lame duck session after election
• Continuing resolution funds government through December 7
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Unfinished Business: Site Neutral/OPPS
• Proposed CY 2019 OPPS Rule would: • Reduce payment for clinic visits in grandfathered PBDs
• Reduce payment for expanding certain services
• $30 million loss in 2019; $440 million over 10 years
• Our Advocacy• Comments – Deadline September 24
• “Dear Colleagues” opposing rule
• Possible litigation or legislation
• Final Rule November 1
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Election 2018: Down to the Wire
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A Blue Wave in 2018? What to Look For…
• Historical patterns – first mid-term a referendum on President
• 35 of 38 first-term presidents lost seats in the House; 19 of 26 lost seats in Senate
• President’s job approval
• Voter Intensity
• Generic Ballot – Democrats need margin of 7
• Swing groups: younger voters, college-educated women,
suburban voters
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President’s Approval Rating
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Is 2018 the Year of the Woman?1998: 1311978: 48
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2018: Record Number of Woman Running
256
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Preference for Control of Congress
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“The GOP’s endangered incumbents this fall – most of whom represent suburban districts where Mr. Trump has turned off voters –must find supporters who will vote for them even though they disapprove of the president.” – Wall Street Journal (9/4/18)
“If you look at our battlefield, 55 districts, the president is underwater in every one of those…across America” – Ben Ray Lujan, Chair, DCCC
“People think the economy is doing well, but that’s not what they’re voting on – they’re voting on the chaos of the guy in the White House” – Glen Bolger, Republican pollster
Commentary…
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The Race for the House
• Control of the House fought in suburban areas that voted for Obama in 2012 and Trump in 2016
• Democrats need 23 seats – roughly 60 in play• 24 seats held by GOP that went for Clinton
• Cook Political Report Projections (9/26)• Solid seats: D = 182; R = 147
• Likely/lean: D= 10; R = 51
• Toss-up: D=3; R = 42
• Trend (this week): • House: Democrats gaining momentum
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Washington’s Tightest Races – WA 3
• Jaime Herrera Beutler (I) (R)• First elected in 2010
• Active on health care issues, on health funding subcommittee
• Carolyn Long (D)• Taught at WSU – Vancouver for 23 years
• Ph.D. in political science
• Primary vote: 51% Republican to 49% Democratic
• Primary votes: JHB = 68,961; Long = 57,798
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Washington’s Tightest Races – WA 5• Cathy McMorris Rodgers (I) (R)
• First elected in 2004
• 4th highest ranking Republican in House – highest ranking GOP woman
• Lisa Brown (D)• Fmr state Representative/Senator • First woman Democratic Senate Majority Leader• Chancellor, WSU - Spokane
• Primary vote: 54% Republican to 45% Democratic
• Primary votes: CMR = 99,689 votes; Brown = 91,738
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Washington’s Tightest Races – WA 8
• Kim Schrier, MD (D)• Pediatrician with Virginia Mason in Issaquah for 16 years
• “Health care is my passion”
• Dino Rossi (R)• Long-time GOP activist, state senator, previously ran for Governor, U.S. Senate
• Career in commercial real estate in Seattle area
• Primary vote: 50% Democratic to 44.3% Republican
• Primary votes: Rossi = 73,288; Schrier = 31,837
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Battle for the Senate…
• Fight for control in “red” states with Democratic incumbents
• Current margin: 51 – 49 Republican
• Seats up in 2018: 26 Democrat vs 9 Republican
• 10 of 26 Democratic seats in states that went for Trump
• Five went for Trump by 19 points or more
• Possible Dem pickups: Arizona, Nevada, Tennessee
• Cantwell safe
• “Arizona, Nevada, Tennessee, Montana, North Dakota, Missouri, Indiana, West Virginia and Florida…All of them too close to call, and everyone of them like a knife fight in an alley.” – Majority Leader Mitch McConnell
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How the Election Affects Health Care
• If GOP holds House and Senate
• Repeal and replace in 2019
• Effort to restrict 340B
• Major deficit reduction initiative – proposals for major changes in Medicare and Medicaid
• If Democrats regain control of the House and/or Senate
• Repeal and replace unlikely
• Protect/strengthen ACA, expand coverage
• Debate about Medicare-for-all
• Deficit reduction effort
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What CanYou Do?
Respond to requests for action
Come to Olympia or D.C. to testify or meet with your legislators
Schedule an in-district meeting – consider including your neighbors
Highlight your care improvements
Advocacy Efforts
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2018Building Bipartisan RelationshipsUnifying Hospitals’ Political Voice
Electing Champions for Health Carewww.wshaweb.com/whpac
Passcode: WHPAC
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Thank You!
Questions? Comments?
Chelene Whiteaker, SVP Government [email protected] 206-216-2545
John W. Flink, Federal Affairs, [email protected] 406.439.1698
Lisa Thatcher, Lobbyist, [email protected]