Public Health & The Legislature: Looking Back & Looking Forward. David Patton, PhD Executive Director Utah Department of Health

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1 Public Health & The Legislature: Looking Back & Looking Forward David Patton, PhD Executive Director Utah Department of Health

2 Key Legislative Issues Medicaid Expansion Suicide Prevention Health Data Student Privacy Tobacco/E-Cigarettes CO/Radon Testing Autism Air Quality Plant Extract Child Care Birth/Adoption Records

3 Key Legislative Issues Medicaid Expansion Digital Health Services Commission Tobacco/E-Cigarettes Plant Extract Child Care Birth/Adoption Records

4 2014 Medicaid Expansion HB 401, Rep. Dunnigan Health Reform Task Force to evaluate all proposals SB 251, Sen. Shiozawa (did not pass) Expansion to 100% FPL, Governor to negotiate with Federal Government SB 272, Sen. Davis (did not pass) Full expansion to 138% fpl under traditional Medicaid Program 2015 Governor s Healthy Utah Plan Potential for other proposals

5 Health Data 2014 HB 35, Rep. Dunnigan Reauthorizes the Health Data Committee HB 141, Rep. Dunnigan 2015 Arranges for sharing benefit/payment information through third party data center Cost and quality measures from health databases Reauthorization of the Digital Health Services Commission

6 Tobacco & E-cigarettes 2014 HB 112, Rep. Ray (did not pass in last seconds) License e-cigarette outlets SB 12. Sen. Reid (did not pass) Raised the age to purchase or possess tobacco products to age Both bills will be back (Rep. Powell to sponsor age restriction bill)

7 Autism 2014 HB 88, Rep. Menlove Extends the Autism pilot program for Medicaid and PEHP SB 57, Sen. Shiozawa Imposes a mandate on insurance companies to cover autism (2-9, $100,000 cap, 2016) 2015 Nothing planned

8 Plant Extract 2014 HB 105, Rep Froerer Allows doctors to provide a letter for parents to obtain and possess hemp extract for the treatment of epileptic seizures in children Have issued 20 permits to date, several more likely in the coming weeks as product becomes available 2015 Sen. Urquhart discussion of selling extract in state liquor stores Potentially expand availability to others with chronic conditions (MS)

9 Child Care 2014 HB 146, Rep. Menlove (did not pass) Requires exempt providers to undergo background checks, register with state, allow state to investigate complaints Submit names of the children receiving care HB 159, Rep Hughes Creates the Child Care Licensing Committee alongside the existing (but renamed) Residential Child Care Licensing Advisory Committee 2015 Sen. Christensen to sponsor bill similar to HB 146

10 Student Privacy 2014 HB 161, Rep. Roberts (did not pass) Requires State agencies to refuse to give federal entities electronic data HB 169, Rep. Anderegg (did not pass) Requires parental consent for releasing student information Prohibits schools from releasing personally identifiable information Prohibits schools from collecting certain information from students HB 397, Rep. Layton Requires parental consent to provide student information 2015 Rep. Anderegg s has already filed another student privacy bill

11 CO Detector & Radon Testing 2014 SB 58, Sen. Dabakis Requires carbon monoxide detectors in schools SB 109, Sen. Osmond UDH to develop Radon awareness campaign 2015 Nothing planned

12 Air Quality 2014 HB 19 electronic vehicle charging station resale of energy HB 31 pollution control incentives HB 38 State sustainability coordinator HB 61 polluting lawn equipment buy-back HB 74 income tax credit for new energy efficient vehicles HB 154 wood burning stove conversion SB 26 air conservation reauthorization SB99 State vehicle fleet must be 50% NGV SB 196 medical waste incineration restrictions 2015 Five bills already filed, would expect more

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14 Supreme Court Decision National Federation of Independent Business v. Sebelius June 2012 Ruled that existing federal Medicaid dollars can t be withheld if state does not expand to new adult population Left intact other ACA provisions, including new taxes Created state option to expand coverage through Medicaid

15 ACA Mandatory Expansion Income Limits for Medicaid, CHIP and Tax Credit Eligibility No Optional Medicaid Expansion Federal Poverty Level % 0% 50% 100% 133% 200% Eligibility Categories: Children 0-5 Children 6-18 Pregnant Women Adults > 65 People w/ Disability Adults w/ Children Adults w/o Children No Medicaid Coverage Available Available to 400% FPL Tax Credit Eligibility Minimum = current Medicaid eligibility = current CHIP eligibility = mandatory ACA changes to Medicaid eligibility = eligible for Medicare = eligible for Tax Credits for use in the Exchange (up to 400% of FPL)

16 ACA Optional Expansion Income Limits for Medicaid, CHIP and Tax Credit Eligibility Optional Medicaid Expansion Federal Poverty Level % 0% 50% 100% 133% 200% Eligibility Categories: Children 0-5 Children 6-18 Pregnant Women Adults > 65 People w/ Disability Adults w/ Children Adults w/o Children Available to 400% FPL = current Medicaid eligibility = current CHIP eligibility = mandatory ACA changes to Medicaid eligibility = optional Medicaid ACA expansion eligibility = eligible for Medicare = eligible for Tax Credits for use in the Exchange (up to 400% of FPL)

17 * National figures ACA Taxes

18 Who is Covered?

19 Utah s Uniques Jobs Low unemployment rate Health Lower prevalence of disease Lower than average healthcare expenditures Insurance Competitive insurance market Higher percentage of population on employer-sponsored insurance Higher percentage of population underinsured Lower percentage of population on Medicaid

20 Principles & Strategies Promote Individual Responsibility Charge premiums for higher income adults Collect co-pays from all adults Require adults that can work to participate in employment training Offer incentives for healthy behaviors

21 Principles & Strategies Support Private Markets Use employer-sponsored insurance when available Provide assistance to buy private market plans

22 Principles & Strategies Maximize Flexibility Use savings achieved from the program to support quality improvement efforts Allow Medicaid children to join parents on private plans Establish three year pilot program that allows the state to evaluate the effectiveness of Healthy Utah

23 Principles & Strategies Respect the Taxpayer Recoup some of the ACA taxes that Utahns are already paying Terminate plan if federal funding fails to be provided as promised

24 Questions?