It Ain t All Good, but It Ain t All Bad

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2 It Ain t All Good, but It Ain t All Bad

3 President Donald J. Trump Likes golf and block granting Medicaid Hates Hillary Clinton, the Terminator & the ACA

4 Secretary Tom Price CMS Director Seema Verma

5 House Speaker Paul Ryan Senator Majority Leader Mitch McConnell

6 House Minority Leader Nancy Pelosi Senate Minority Leader Chuck Schumer Cousin of Amy Schumer

7 Mick Mulvaney From South Carolina

8 Health Care Reform Aka Repeal and Replace Section 330 Funding Aka Funding Cliff

9 * Our Section 330 funding is set to expire on October 1 * This accounts for 70 percent of federal funding for SC community health centers * If this funding isn t reauthorized, then SC CHCs stand to lose..

10 $44.7 Million and. 53,790 Patients will lose access to care

11 Without this money, SC CHCs will be forced to * layoff employees * close sites in places where we are the only outlet for care * remove funding streams for critical workforce programs like National Health Service Corps & Teaching Health Centers * Most importantly, we won t able to provide care for thousands of our patients

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14 The GOP s plan to repeal and replace the Affordable Care Act, aka Obamacare Currently, this legislation is set to go before the full House for a vote. Last week, it passed the House Budget Committee.

15 * Replaces income subsidies to purchase insurance with age-adjusted tax credits * Phases out Medicaid expansion by 2020 (South Carolina is not an expansion state) * Eliminates the ACA s individual and employer mandates * Allows states instead of the feds to determine the essential benefits for insurance plans

16 * Allocates states money to establish high risk pools * Eliminates the ACA s taxes, i.e. penalty for not having insurance, medical device tax * Expands Health Savings Accounts * Defunds Planned Parenthood (more on this later)

17 * Keeps coverage for those with pre-existing conditions & allows young adults up to age 26 to stay on their parents insurance plans * Does not propose any change to the FQHC Prospective Payment System (more on this later) * $422 million more for community health centers!!!!!!

18 * It DOES NOT address the funding cliff * Per Capita Cap for Medicaid * The Congressional Budget Office says 14 million people will lose coverage under AHCA * The support in form of subsidies and Medicaid expansion provided by the ACA to add millions among the insured will be gone * This could potentially have an untold catastrophic impact on our patient population in terms of coverage and access to care

19 Let s talk about Medicaid * Currently, FQHCs have payment protection with Medicaid reimbursement * This system, called the Prospective Payment System or PPS, pays CHCs a fixed amount for different services * This is critical to CHCs financial stability as it allows administers to make confident financial decisions regarding their centers

20 States anticipating changes to the Medicaid system could get proactive by using Section 1115 waivers * These waivers granted by HHS allow states to experiment with different Medicaid service delivery and payment methods * There s nothing stopping South Carolina for applying for a Section 1115 waiver which eliminates the PPS system for FQHCs (I m just saying this could happen.) * It could actually be granted given the political climate (The RGA wants to reform PPS) * We need language in our state law which protects FQHC s PPS system

21 Finally, dispersing Medicaid dollars using a per capita cap or block grants will have several damaging consequences for CHCs. Last year, Medicaid with our current PPS reimbursed CHCs $65.5M Our internal estimates suggest that, under a system which eliminates our PPS, CHCs stand to lose around $35.8M in reimbursements

22 Different pockets of Opposition within Congress Democrats House Freedom Caucus Senate Republicans

23 * CHCs have received bipartisan support for more than 50 years because we treat underserved populations in an effective and cost conscience manner which saves lives and money. We should be part of any discussion regarding health care reform. Work with us to develop solutions. * To protect our time-tested model, we need our two pillars to stand tall. Those pillars are our Section 330 funding and maintaining a strong Medicaid program with PPS protections

24 * Don t put our patients coverage at risk. We re concerned about potential changes to patients coverage without a clear plan for continuity of both coverage and access for those we serve.

25 * SC CHCs are incredibly effective stewards of Medicaid dollars. We treat 14% of all the state s Medicaid patients; however, we only account for slightly more than 1% of the state s Medicaid expenditures * We are the safety net. Our presence in the health care space reduces costly ER visits, extended hospitalizations, prevents chronic illness through our preventative care, and closes the gap on health disparities

26 * We serve medically underserved areas and populations which would otherwise go untreated. In some areas, CHCs are the only outlet for care nearby. * We serve the needs of our communities and are governed by the people who live in them. At least 51 percent of our boards are made up of patients and the rest are community members.

27 We re the Walmart of Health Care A One Stop Shop Medical, Dental, Behavioral & Pharmacy Services under one roof Primary & preventative care Patient-centered Home Model we treat the whole patient

28 Our economic impact (2015 UDS & EIA Report) * $473M total economic impact * Saved health care system $460M * Produced $58M in tax revenue * Provided nearly 4,400 jobs * Served more than 364,000 patients Play up our role as the safety net provider * 91 percent of our patient population is under 200 % of federal poverty line * 65% of our patient population is on Medicaid or uninsured

29 * NACHC P&I * Meet with MOC or staffers at home * Get know to your state lawmakers * Invite them to your CHC! * Spearhead advocacy efforts at your CHC * Use social media as an advocacy tool

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