1. Health Perspective in the New Administrations
Paul Vick Associate Vice President

2. U.S. Senate 52 46 NC Senators: 2 Independents: Richard Burr (R)
Thom Tillis (R)
2 Independents:
Angus King, Maine
Bernie Sanders, Vermont

3. U.S. House of Representatives
193
238
North Carolina Democrat Representatives
1st District: George “G.K.” Butterfield Jr.
4th District: David Price
12th District: Alma Adams
North Carolina Republican Representatives
2nd District: George Holding
3rd District: Walter Jones
5th District: Virginia Foxx
6th District: Mark Walker
7th District: David Rouzer
8th District: Richard Hudson
9th District: Robert Pittenger
10th District: Patrick McHenry
11th District: Mark Meadows
13th District: Ted Budd
WILL UPDATE NIGHT & MORNING OF

4. Affordable Care Act – What Goes?
Tax credits
Exchange subsidies
Presumptive eligibility
Individual and employer mandates
Medicaid expansion
Small business tax credit
Disproportionate Share Hospital (DSH) allotment reductions
Medical device and “Cadillac” taxes

5. Affordable Care Act – What Stays?
Coverage for pre-existing conditions
Allowing children to stay on parents’ plans until age 26
Lifetime caps

6. Repeal and Replace – New Provisions in Replacement Package
Tax credits to purchase insurance
High risk pools
Expand Health Savings Accounts (HSAs)
Purchase of plans across state lines
Limitation on Employer-provided health care coverage

7. Repeal and Replace - NC Impact
545,354 people in North Carolina have coverage through the Marketplace as of end of 2016.
Within this number are 499,178 moderate- and middle-income North Carolinians who receive tax credits averaging $401 per month to help with coverage through HealthCare.gov.

8. Repeal and Replace - Timeline
2 or 3-year transition period
Freedom caucus wants change now
Senate wants to take as long as possible
What additional ways might the government fund coverage?
High risk pools
State grants
Individual health pools

9. Medicaid - New Options for Payment
Block grants or per capita
Block grants impose national cap on federal Medicaid funding and an aggregate cap for each state
Per capita cap, federal funding is on a per person basis

10. Medicare Under Majority Leader Ryan’s Plan
Possible privatization
Moving from paying set share of costs (through premiums, deductibles and co-pays) to premium support with no guarantee and defined set of benefits
What happens to add-on payments?
Graduate Medical Education (GME)
Indirect Medical Education (IME)

11. NIH Funding and Awards Total NIH Funding (billions)*
Duke School of Nursing
NIH Funding and Awards
Total NIH Funding (billions)*
Duke NIH Awards (millions)
$350.7M
$362.9M
$416.9M
$33.1B
$32.3B
$30.3B
*not including 21st Century Cures

12. NIH Funding and Awards – Duke University School of Nursing
Duke School of Nursing
NIH Funding and Awards – Duke University School of Nursing
$4.2M
$4.8M
$6.4M
Ranked 4th in 2016 for nursing schools with NIH funding!

13. 21st Century Cures
$1.8B
$1.5B
$1.4B
$1B
$500M
$500M
$300M
$40M
$10M
$2M
$30M
$20M
21st Century Cures was passed in the Lame Duck session of Congress in December 2016, authorizing $6.3B (mostly for NIH) in funding over 10 years to accelerate the discovery, development and delivery of cures.

14. North Carolina

15. Governor Roy Cooper

16. NC - Medicaid Reform
Current proposed reform in NC moves to managed care model with competition in insurance space.
Who receives Medicaid in NC?
Who pays for Medicaid in NC?
How much does Medicaid cover? Claims payments from Medicaid to hospitals only cover about 65% of the cost to provide care.
Source: Data compiled by the North Carolina Hospital Association.

17. 2017 Legislative Priorities
Sales Tax
Behavioral Health
Graduate Medical Education
Medicaid
Certificate of Need
Private Property Rights

18. QUESTIONS?