1 MAHA Fall Conference Legislative Political Update October 13, 2015 Paige Fults Director, Advocacy

Political and Healthcare Climate New Leaders 9 months into 98 th Legislative Session Accomplishments Negative Media Attention 600,000 in HMP but 2 nd Wavier decision by CMS pending Failed Roads proposal has lingering effect 2016 Elections impact policy and politics 2

Key Elements to Advocacy Success MHA and members advocating with unified voice Member participation in targeted advocacy days: Healthcare Advocacy Day, Small/Rural Advocacy Day, GME Advocacy Days Support from legislative appropriation and policy leaders; Support from Gov. Snyder and MDHHS Director Lyon Public recognition of issues under debate and broad grassroots engagement Maintaining strong Health PAC contributions to assist with relationship development and access to legislative leaders 3

Health-related Public Policy Issues: Michigan Legislature 1.Roads, Roads and more Roads 2.FY 2017 state budget development/HICA 3.Auto No-fault and “D” insurance 4.Interstate Medical Licensure Compact 5.Pharmacist substitution of Biosimilar Drugs 6.Hospital Chargemaster Transparency 7.Community College Nursing Programs 8.CON Reform 9.Scope of Practice for Advance Practice Nurses 10.CRNA – Independent Practice 11.Energy Regulation 4

Road Funding – Proposal 1: Epic Fail Would have increased state revenue by more than $2.1 billion a year through a 1-cent increase to state sales tax, vehicle registration discount elimination and motor fuel tax rate increase Spending −$1.2 billion to roads −$300 million to the school aid fund −$130 million to mass transit −$95 million to local governments −Expansion of the earned income tax credit would provide $260 million in targeted tax relief for low- income workers Defeated – The most sided loss ever for a proposed amendment to the state constitution of 1963

Road Funding – Legislative Proposals Various levels of existing general fund ($350m-$700m) Additional taxes and fees (gas tax increase, registration fee increase, etc.) Democrats and administration would like to see an increase/extension of the Health Insurance Claims Assessment –House and Senate Rs not on board, would prefer not to further complicate things (much like the end result of Prop 1) Is there a path to $1.2b annually for roads? If a large amount of existing general funds are used, how will that impact health care funding?

Auto No-fault Insurance – SB 248 Reduces provider payments to 150% of Medicare Replaces existing catastrophic insurance with unregulated, unfunded mechanism Creates anti-fraud authority in state government Places limits on family-provided attendant care

Auto No-fault Insurance – SB 248 Currently stalled on House floor Significant opposition among House Republicans House Democratic Caucus formally opposed No reply to MHA correspondence from House Insurance Committee Chair Leonard No workgroup or further meetings with auto insurers Little appetite for replacing catastrophic benefit system among House members

D Insurance – SB 288 Mayor Duggan’s plan to reduce Detroit auto insurance premiums Reduces injury benefit to $250,000/accident for “critical care” services $25,000 for post-acute services No catastrophic benefit Allows for closed provider network Applies to any community with 35% or greater rate of uninsured drivers

10 Does not guarantee a reduction in premiums – it simply trusts insurers to lower your rates Does nothing to reduce the number of uninsured drivers, who now pay NOTHING. Even opting for D-Insurance would represent an increase in their expenditures Any cost savings is quickly offset by the costs of medical care if the driver involved in an accident requiring catastrophic care Unlimited necessary medical care, known as Personal Injury Protection or PIP, is not the reason for high premiums in Detroit – yet the only thing D-Insurance does is cut your PIP benefits Health insurance does not cover many of the services needed for recovery from an auto accident, such as attendant care or home/vehicle modification needs D Insurance Opposition – SB 288

MHA Letter of Opposition Limiting medical care to lower auto insurance rates is not a sensible approach Address overuse, fraud Bring frequency and severity in line with outstate claims Town halls D Insurance – SB 288

D Insurance – Senate Bill 288 Currently stalled on Senate Floor 1-2 Senate Democrats supportive House Democratic Caucus formally opposed Significant opposition among Republicans in both chambers SML Meekhof would like to see more support from Detroit lawmakers prior to considering further action

What reforms do hospitals support? Reduce hospital fees by 20% (or lower if negotiated) Freeze those rates until 2019 Future increases limited to rate of medical CPI (inflation rate) Full court press to fight fraud Focus on appropriateness of care for survivors Control attendant care cost Pass savings to consumers 13

House Bill 4583, sponsored by Rep. Jim Tedder (R-Waterford), referred to the House Health Policy Committee Would allow Michigan to join the Interstate Medical Licensure Compact –State-based legislative proposal, enacted when seven states adopt into law –Provides a new, expedited pathway to licensure for qualified physicians to practice in multiple states –Voluntary for both states and physicians, states maintain control over practice of medicine Participating states would formally agree to adopt common rules and procedures for medical licensure Compact Commission would provide oversight and administration of the Compact, create and enforce rules 14 Interstate Medical Licensure Compact

15 Interstate Medical Licensure Compact

Rep. Tedder convened first workgroup Sept. 29 Early adopters will have more influence on framework of compact Overwhelming support of concept across the country –AARP –American Medical Association –State medical associations –State hospital associations –Mayo Clinic No notable opposition Possible opportunity to engage Partnership for Michigan Health 16 Interstate Medical Licensure Compact

2016 Elections - Nov. 8 U.S. President U.S. Congress – 14 seats (9 R, 5 D) MI House of Representatives – 110 seats (61 R, 46 D) Special Elections (Dillion, Courser, Gamrat, V. Smith?,) MI Supreme Court – 2 seats (Justice Viviano, resignation-Mary Beth Kelly) Ballot Proposals –Stop Overcharging –Citizens for Fair Taxes –Prevailing Wage –Marijuana Legalization (2) –Voting by Mail –Paid Sick Leave –Banning Fracking 17

2016 Elections - President (Dems) 18 Lincoln Chafee Former Governor of Rhode Island Hillary Clinton Former U.S. Secretary of State Joe Biden Vice President Martin O’Malley Former Governor of Maryland Bernie Sanders U.S. Senator - VT Jim Web U.S. Senator - VA Lawrence Lessig Harvard Professor

2016 Elections - President (GOP) 19 Jeb Bush Former Governor of Florida Ben Carson Director of Pediatric Neurosurgery, Johns Hopkins Chris Christie Governor of New Jersey Ted Cruz U.S. Senator - TX Carly Fiorina Former CEO of Hewlett- Packard Jim Gilmore Former Governor of Virginia

2016 Elections - President (GOP) 20 Lindsey Graham U.S. Senator - SC Mike Huckabee Former Governor of Arkansas Bobby Jindal Governor of Louisiana John Kasich Governor of Ohio George Pataki Former Governor of New York Rand Paul U.S. Senator - KY

2016 Elections - President (GOP) 21 Rick Perry Former Governor of Texas Marco Rubio U.S. Senator - FL Rick Santorum Former U.S. Senator - PA Scott Walker Governor of Wisconsin Donald Trump CEO of Trump Organization

2016 Elections – President (21 candidates) 22 Jeb Bush Former Governor of Florida Ben Carson Director of Pediatric Neurosurgery, Johns Hopkins Carly Fiorina Former CEO of Hewlett- Packard Hillary Clinton Former U.S. Secretary of State Bernie Sanders U.S. Senator-VT Donald Trump CEO of Trump Organization

Donald Trump continues to lead in the polls 23 I too, am in the mix!

Presidential Candidates - Deja Vu 24 The more things change, the more they stay the same….