1. Camila Knowles Friday, May 3, 2013 Washington Update Georgia Academy of Healthcare Attorneys

3. 1. Issues 2. Challenges 3. Trust & Hope

4. Fiscal Cliff Fiscal Cliff Marketplace Fairness Act Marketplace Fairness Act Fiscal Cliff Fiscal Cliff Marketplace Fairness Act Marketplace Fairness Act

5. 24-hour news cycle 24-hour news cycle Fundraising requirement Fundraising requirement Politics back home Politics back home Partisanship Partisanship

6. Lack of trust Lack of trust Efforts to build trust Efforts to build trust Trust v. political self-interest Trust v. political self-interest

7. Immigration Reform On April 15, S. 744, the “Border Security, Economic Opportunity, and Immigration Modernization Act,” was introduced by Senator Rubio and the Gang of 8. On April 15, 2013, S. 744 was marked up for the first time and will likely begin the amendment process is likely to begin on May 9.

8. The Affordable Care Act (Obamacare) We cannot afford trillions of dollars in new spending and debt while diminishing our care. The government option is the wrong option. It will eliminate competition between providers, eventually leading to a takeover that would result in delayed, denied, and rationed care. Bureaucrats in Washington cannot stand between patients and doctors.

9. Supreme Court Ruling On June 28, after three months of reviewing the constitutionality of the Patient Protection and Affordable Care Act (P.L. 111-148; ACA), the U.S. Supreme Court ruled a majority of the health care law to be constitutional by a vote of 5–4. The most controversial provision within the law, the individual mandate requiring all Americans to purchase health insurance the federal government deems appropriate, was affirmed by the court as a legal exercise of Congress's power to tax. However, the court ruled that the law's Medicaid expansion could not be implemented, and each state has the opportunity to decide on whether to expand its Medicaid program without fear of retribution from the federal government. The court's ruling does not change the fact that there have been major complications trying to implement this problem filled law.

10. Medicaid Expansion and Georgia An expansion of Medicaid coverage up to 133% of the federal poverty level (FPL) would be devastating to state budgets. Countless governors have spoken out against this mandate upon their states. If Georgia had opted for the expansion, it is estimated to have added $970 million to its budget over ten years.

11. ACA impact on DSH Payments For FY 2014 through 2020, DSH payments will be reduced by 50 percent once the rate of uninsurance in a state decreases by 45 percent. As the rate of uninsurance continues to decline, the states’ DSH allotments will be reduced by a corresponding amount. Payment reductions must be considered an overpayment to the state to be disallowed against the states’ regular quarterly draw for spending.

12. Graduate Medical Education (GME) Approximately one-third of the country’s doctors are 55 or older, and nearing retirement Experts estimate that 130,000 new physicians would be necessary to eliminate the current physician workforce shortage Georgia has 17 residency sponsoring institutions with 174 programs and 2,241 approved positions. Georgia’s institutions train 1,177 residents in primary care. They host 26 core residencies and 68 fellowships, numbers that would be devastated by cuts to GME.

13. GME Cont. On April 18, Senator Chambliss joined Senator Isakson and other colleagues in sending a letter to the LHHS Appropriations Chairman and Ranking Member requesting full funding for Children’s Hospitals Graduate Medical Education (CHGME). Hospitals participating in the CHGME program train one half of the nation’s entire pediatric workforce.

14. Fiscal Effort Sequestration hit Medicare with an across-the-board 2% cut, which began in January 2013, This equals more than $11 billion in cuts annually to Medicare payments for doctors, hospitals and other healthcare providers.