2017 Northern Michigan HIV Summit Traverse City, Michigan

Transcription

1 1 Healthcare Reform and its Impact on Persons Living with HIV P. Greg Gulick, JD, MHA, MBA Adjunct Professor Michigan State University College of Law College of Human Medicine, Division of Public Health College of Osteopathic Medicine, Institute for International Health 2017 Northern Michigan HIV Summit Traverse City, Michigan

2 2 Agenda The PPACA What did it do and what has been its impact? The AHCA and the BCRA What are they and what would have been the impact? The AHCA and BCRA Impact on Persons Living with HIV The Future of Healthcare Reform Questions and Discussion

3 3 Healthcare Reform - Generally Free-Market solution versus Government-regulated solution (singlepayer) Healthcare as a Public Good Congressional Intent of the PPACA Health Insurance Reform and Medicaid Expansion

4 4 The PPACA Health Insurance Reform Access to health insurance (and to care) structural changes: Marketplaces = competition (and lower prices); Standardization of products (and advertising); 10 Essential Health Benefits (based on state benchmark plan) Subsidies (towards premiums and towards co-payments); Mandate to purchase/maintain insurance coverage (to create a larger riskpool)

5 5 The PPACA Health Insurance Reform Access to coverage (and care) product changes: Prohibition on rescission; Prohibition on underwriting or restricting coverage based on pre-existing conditions; Guaranteed Access and Renewal; Coverage through the age of 26 (on parents group coverage); Coverage of preventative services (including HIV testing); Elimination of annual, lifetime, and condition-specific limits on coverage; Restrictions on underwriting (age, geography, gender no medical underwriting)

6 6 The PPACA Medicaid Expansion Expanded eligibility of Medicaid program available (extending program to people living up to and including 138% of the federal poverty level This was a state-specific change, but Michigan opted into the expansion Triggered coverage of Alternative Benefit Plans (which were equivalent to EHBs) Michigan used the Section 1115 waiver program to make this change (along with 5 other states)

7 7 The PPACA What didn t it do? Cost Reform 30% of spending in the healthcare industry is wasteful (works out to about 5% of our GDP) Unregulated drug pricing Tort Reform Defensive medicine Administrative Cost Reform (System Simplification) 25% of healthcare spending in the U.S. Versus 15% in England and 12% in Canada

8 8 Agenda The PPACA What did it do and what has been its impact? The AHCA and the BCRA What are they and what would have been the impact? The AHCA and BCRA Impact on Persons Living with HIV The Future of Healthcare Reform Questions and Discussion

9 9 The American Health Care Act of 2017 Health Insurance Changes: Replaces premium subsidies with tax credits (eliminates cost-sharing subsidies) Repeals individual and employer mandate to purchase and maintain coverage Replaced with continued-coverage requirements (with look-back provisions) Changed ability of insurers to vary premiums based on age from a 3:1 ratio to a 5:1 ratio Elimination of metal tiers and generosity-levels Creation of High-Risk Pools (funding mechanism) Allows states to seek waivers of certain ACA-requirements: Implement a new age-rating ratio State-specific EHB packages (or elimination of EHBs altogether) Waive the continuous coverage penalty in favor of reinstating medical underwriting Maintained elimination of pre-ex restrictions Repealed Prevention and Public Health Fund Allocated an additional $422M in funding to Community Health Centers in FY2017 Repeal of various PPACA taxes on health insurers and other parties

10 10 The American Health Care Act of 2017 Medicaid Changes: Repeal of Medicaid expansion (codifying the NFIB v. Sebellus case) although expansion allowed through 2020; Repeals state option to extend coverage to adults at 133% of FPL; Termination of Enhanced Federal Match for ACA Expansion population; Sunsets EHB requirements; Changes Medicaid funding methodology Per Capita Cap on Payments for medical assistance expenditures State-targeted spending amounts (based on historical per enrollee costs), tied to the CPI Penalties for exceeding medical assistance expenditures Repeals cuts to DSHs Allows states to implement work-requirements to qualify for Medicaid Repeals presumptive eligibility determinations for Family Planning services Medical Assistance by a hospital Pregnant Women Repeal of retroactive eligibility Disenrollment for high-dollar lottery winners

11 11 The Better Care Reconciliation Act of 2017 Health Insurance Changes: Less restrictive to a certain extent Tax credits (instead of subsidies) focus on income rather than age (although there is an age-adjustment) Maintains same marketplace rules as AHCA (and ACA) guarantee issue, coverage through age 26 Continued coverage requirement (6 month waiting period) Makes it easy for states to waive EHBs Allows for Association Health Plans

12 12 The Better Care Reconciliation Act of 2017 Medicaid Changes: Very similar to AHCA; primary difference is the timing of the changes to the financing

13 13 Agenda The PPACA What did it do and what has been its impact? The AHCA and the BCRA What are they and what would have been the impact? The AHCA and BCRA Impact on Persons Living with HIV The Future of Healthcare Reform Questions and Discussion

14 14 The ACHA and BCRA Impact of Persons Living with HIV The Senate health care bill will be catastrophic for our nation s health care system. If passed, not only will people living with or at risk of HIV and STDs suffer, but our efforts to end the HIV and STD epidemics will be impeded, stated Jesse Milan Jr., president and CEO of AIDS United. The changes to Medicaid, including the repeal of the expansion and the drastic cuts to funding beginning in 2020 will harm people living with and at risk for HIV and STDs. This proposal guarantees limited access to care and benefits, added David C. Harvey, executive director of the National Coalition of STD Directors. In addition, this bill eliminates funding for vital services provided by the Prevention and Public Health Fund, which funds 12 percent of the Centers for Disease Control and Prevention s budget beginning in FY2018, just over three months away. This will decimate the federal government s response to public health issues, including HIV and other STDs, and exacerbate the cuts proposed in the FY2018 President s Budget, observed Michael Ruppal, executive director of The AIDS Institute. The bill as written threatens our progress in linkage, retention in care and viral load suppression elements of an essential strategy to improve the health outcomes of people with HIV and to reduce transmission of HIV, said CAEAR Coalition chair Graham Harriman. We encourage you to call your senators to tell them they are responsible for addressing the coverage gaps and increased expenses the BCRA creates for persons living with HIV.

15 15 The AHCA and BCRA Impact on Persons Living with HIV Reduction in insurance coverage for people living with HIV Cuts to Medicaid funding, the per-capita cap, phase-out of Medicaid expansion, and defunding of Planned Parenthood Will result in loss of coverage, higher cost-sharing (which may serve to delay or reduce primary or preventative care) and reduced access to the healthcare system Not just healthcare reform, but also budget issues will impact persons living with HIV $59 Million reduction in Ryan White funding, as well as cuts to Hep C and STD prevention programs, other social safety-net programs (such as Meals on Wheels) and Social Security Disability Insurance

16 16 Agenda The PPACA What did it do and what has been its impact? The AHCA and the BCRA What are they and what would have been the impact? The AHCA and BCRA Impact on Persons Living with HIV The Future of Healthcare Reform Questions and Discussion

17 17 The Future of Healthcare Reform Bipartisan measures versus dismantle PPACA? Maintaining federal subsidies for people purchasing coverage on the exchange Single-payer system? Systemic reform? Need to decide what we want to be. Public Health and Prevention

18 18 Agenda The PPACA What did it do and what has been its impact? The AHCA and the BCRA What are they and what would have been the impact? The AHCA and BCRA Impact on Persons Living with HIV The Future of Healthcare Reform Questions and Discussion

19 19 P. Greg Gulick, JD, MHA, MBA Michigan State University 2017 Northern Michigan HIV Summit Traverse City, MI