1. Mid-Year Federal Legislative Update Andrew MacPherson Senior Policy Adviser Washington, DC August 2, 2018

2. Outline
Update on Public Sector HealthCare Roundtable Policy Activities
Policy and Political Issues Impacting Public Sector Purchasers
Legislative
Regulatory
Future Issues, the Election, and Roundtable Engagement
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3. UPDATE on Roundtable Policy Activities

4. Public sector healthCare Roundtable Priorities
What We Believe
The members of the Public Sector HealthCare Roundtable have a long-term commitment to maintaining programs that enable public workers, retirees, and their families to obtain high-quality health benefits at a cost that is affordable and sustainable for the workers, their families, and their employers. It is our belief that national health care policies should advance innovative proposals to constrain costs, increase value, and improve quality and efficiency in the health care delivery system.
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5. Roundtable Policy Priorities We support…
Health System Innovation and Sustainability
We support that constrain health care cost growth and ensure the sustainability of public programs, including the movement to innovative payment models based on value and quality, rather than volume.
Pharmaceutical Cost Containment Issues
We support congressional and the regulatory efforts to establish and sustain greater competition in the pharmaceutical – and especially the biopharmaceutical -- marketplace.
Health Care Quality and Improved Outcomes
We support the further development of quality measures, and particularly those in high-impact areas such as the complex chronically ill and those individuals that are functionally limited.
Innovation in Care Delivery
We support innovative care delivery models, such as Independence at Home, that allow those with complex needs and those individuals nearing the end of life to receive care in the home setting.

6. Roundtable Policy activities mid-year 2018
Monitoring Legislative Activity
Monitor, provide analysis, and inform Roundtable members of key federal legislation
Supporting/Opposing Key Legislation and Regulatory Actions
Take positions on consensus-based issues and publicly support/oppose if/when necessary
Engaging/Collaborating with Allied Stakeholders
Work alongside and in collaboration with allied stakeholders, including consumers and other health care purchasers
Engaging/Collaborating with Roundtable Members
Engage members and promote innovative purchasing initiatives as well as data
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7. Roundtable Policy activities mid-year 2018
May Legislative Forum
Washington, DC
“Health Care at a Crossroads:
Policy Options to Address Soaring Drug Costs
and Ensure Better Care for Seniors”
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8. Policy and Political Update
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9. Health care Policy in Washington today…
THE WALL!
Migrant Families
Affordable Care Act Reforms
Premiums
Instability + Anxiety
Short-Term Plans/AHPs
Reinsurance Payments
Drug Industry Scrutiny
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10. policy/political Update and context AND angling for…
— Insurers are still anxious about the seemingly non-stop rule changes being implemented by the Trump administration. Last month's decision to halt risk adjustment payments in response to a legal challenge — even though it was reversed within weeks — was the latest cause for heartburn.
"The detour on risk adjustment spooked a lot of people in the market," said Ceci Connolly, CEO of the Alliance of Community Health Plans. "That just reminded them of all of the uncertainty and all of the unpredictability in this line of business."
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11. policy/political Update and context
ACA Popularity Reaches Record High A recent poll by the Kaiser Family Foundation shows that 54 percent of Americans approve of the Affordable Care Act, the highest rating since the group began its monthly poll in Individuals Satisfied with their Plans Most people who have purchased their health plan on the Affordable Care Act exchange like their insurance coverage percent of marketplace enrollees are satisfied with their insurance choice.
— Insurers are still anxious about the seemingly non-stop rule changes being implemented by the Trump administration. Last month's decision to halt risk adjustment payments in response to a legal challenge — even though it was reversed within weeks — was the latest cause for heartburn.
"The detour on risk adjustment spooked a lot of people in the market," said Ceci Connolly, CEO of the Alliance of Community Health Plans. "That just reminded them of all of the uncertainty and all of the unpredictability in this line of business."
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12. policy/political Update and context Congress
U.S. House Action. The House very active approving health care legislation.
On July 24, the House approved the Protect Medical Innovation Act of 2018 (H.R. 184) which would repeal the ACA's tax on medical devices.
The following bills related to expanding access to health savings accounts (HSAs) were approved by the House on July 25:
H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018: Would allow people to use HSAs when purchasing certain over-the-counter medications and other products.
H.R. 6311: Proposes to delay the health insurance tax for 2020 and 2021— the tax is currently suspended for The bill would also expand access to HSAs through various provisions like increasing annual maximum contribution limits.
House Budget Committee FY 2019 Budget Resolution (“A Brighter American Future”) which assumes passage of the American Health Care Act (AHCA), including the associated per-capita caps on Medicaid and Medicare premium support.
U.S. Senate Action. Senate actively developing legislation but approving less health care legislation.
February 2018, Senate passed S Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 as part of the Bipartisan Budget Act
Not for copy or distribution

13. policy/political Update and context Congress
U.S. House Action. The House very active approving health care legislation.
On July 24, the House approved the Protect Medical Innovation Act of 2018 (H.R. 184) which would repeal the ACA's tax on medical devices.
The following bills related to expanding access to health savings accounts (HSAs) were approved by the House on July 25:
H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018: Would allow people to use HSAs when purchasing certain over-the-counter medications and other products.
H.R. 6311: Proposes to delay the health insurance tax for 2020 and 2021— the tax is currently suspended for The bill would also expand access to HSAs through various provisions like increasing annual maximum contribution limits.
House Budget Committee FY 2019 Budget Resolution (“A Brighter American Future”) which assumes passage of the American Health Care Act (AHCA), including the associated per-capita caps on Medicaid and Medicare premium support.
U.S. Senate Action. Senate actively developing legislation but approving less health care legislation.
February 2018, Senate passed S Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 as part of the Bipartisan Budget Act
Focus on health care market stabilization, opioids, and “messaging” bills and hearings
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14. Roundtable policy priorities update “CHRONIC” lEGISLATION
Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act (S.870)
Who?
Sens. Hatch [R-UT] and Wyden [D-OR] and every member of the Senate Finance Committee.
Passed US Senate UNANIMOUSLY
What?
Extends Independence at Home demonstration by 2 years
Includes GAO study on “longitudinal care planning”
Permanently authorizes SNPs
Expands testing of MA Value-Based Insurance Design test model.
Allows MA to provide additional telehealth benefits to enrollees and, to chronically ill enrollees, certain supplemental health care benefits.
Allows prospective, voluntary assignment of Medicare fee-for-service beneficiaries to accountable care organizations (ACOs), and
Allows ACOs to operate beneficiary incentive programs.

15. policy/political Update and context administration
Through CMS, the Administration is pursuing actions to change the ACA marketplaces, such as the finalized rules on Association Health Plans and Short-term Limited Duration Plans.
In addition, through the White House’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs and HHS’s request for information HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs, the Administration is laying out its vision for reforms
HHS announced it will work with the FDA to establish a working group that examines how to import prescription drugs from other countries “in the event of a dramatic price increase for a drug produced by one manufacturer.”
Centers for Medicare & Medicaid Innovation (CMMI)
The Center for Medicare & Medicaid Innovation (the Innovation Center) with CMS supports the development and testing of innovative health care payment and service delivery models that aim to achieve better care for patients, smarter spending and healthier communities.
Led by Director Adam Beohler, Former CEO of Landmark Health; Gary Bacher, Chief Strategy Officer
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16. policy/political Update and context Centers for Medicare and Medicaid Innovation
Accountable Care and Episode-Based Payment
Accountable Care Organizations and similar care models are designed to incentivize health care providers to become accountable for a patient population and to invest in infrastructure and redesigned care processes that provide for coordinated care, high quality and efficient service delivery.
Under these models, health care providers are held accountable for the cost and quality of care beneficiaries receive during an episode of care, which usually begins with a triggering health care event (such as a hospitalization or chemotherapy administration) and extends for a limited period of time thereafter.
Primary Care Transformation
Advanced primary care practices – also called “medical homes” – utilize a team-based approach, while emphasizing prevention, health information technology, care coordination, and shared decision making among patients and their providers.
Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
Many innovations necessary to improve the health care system will come from local communities and health care leaders from across the entire country. By partnering with these local and regional stakeholders, CMS can help accelerate the testing of models today that may be the next breakthrough tomorrow.
Initiatives to Speed the Adoption of Best Practices
The Innovation Center is partnering with a broad range of health care providers, federal agencies professional societies and other experts and stakeholders to test new models for disseminating evidence-based best practices and significantly increasing the speed of adoption.
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17. TIMELINE OF UPCOMING KEY POLITICAL AND LEGISLATIVE EVENTS
August Recess: All but first week of August recess cancelled, potential for health care debates
Early to late Fall: CMS likely posts proposed changes to Medicaid Managed Care Final Rule
September 30: End of the Federal fiscal year
November 6: 2018 Elections
Late 2018: Lame Duck session of Congress

18. Public Sector Priority Issues and Activity
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19. Roundtable policy priorities update Key issues to watch
Affordable Care Act / Repeal-Replace
Budget reconciliation procedures passed
Budget “blueprint” from House Budget Committee includes American Health Care Act
Stabilization to pass in Senate? Bipartisan?
All eyes on mid-term election results
Drug Cost Containment
CREATES Act marked-up
Administrative action to continue, likely more PBM scrutiny and no real downward pressure on drug prices
Other important legislation to get more bipartisan support – again, all eyes on election!
Cadillac and Health Insurance Taxes
Cadillac: NOT yet suspended for 2022
HIT:
2018: Insurers are required to pay for the HIT
2019: HIT suspended
2020: Currently, insurers would be required to pay the HIT in 2020

20. Thank You!
Questions?
Andrew MacPherson
Senior Policy Adviser