What You Need to Know About Politics and Policy in Olympia and D.C.

Chelene Whiteaker, Senior Vice President, Government AffairsLisa Thatcher, WSHA state lobbyistJohn Flink, WSHA federal lobbyistOctober 11, 2018

Objectives

• Recognize the political dynamics in Olympia and how they will shape WSHA’s legislative agenda

• Understand the major hospital policy issues at the federal level from 2018

• Identify the most impactful federal and state issues facing hospitals for 2019

What to Expect in the 2019 State Legislative Session

4

State Policy & Budget Process

WSHA’s Work

• In 2017-2018 WSHA/AWPHD

reviewed 450 bills

• 2018 Supplemental budget year

• Senate flipped to Democratic

control

• Actively worked on dozens and

dozens of bills in 2018

WSHA Successes: 2018 Policy

• Reasonable charity care law

• Individual insurance market stability

• Stopped many onerous bills:

• Nurse staffing: meals/rest breaks, on-call and restrictions on mandatory overtime

• Mergers/affiliations

• Restrictions on health care entities

• Expansion of liability for wrongful death

WSHA Successes

• 2018 Supplemental Budget• No cuts to hospitals/

health systems

• Rate increase for pediatric care

• Some new funding for mental health and opioids

2019 Legislative Session

2018 elections• All of House up for re-election• Half the Senate up for re-election

Long session• 105 days• Budget year

Current Make Up of House & Senate

Mid-term elections in November!

5048

House

Ds Rs

2523

1Senate

Ds Rs D

State Leadership: 2019

Governor Jay Inslee (D) – 2nd term

Senate Majority Leader Sharon Nelson (D) – Narrow majority (25-24) *retiring, replacement not known

House Speaker Frank Chopp (D) – Narrow majority (50-48)

Senate Minority Leader Mark Schoesler (R) – 4th term

House Majority Leader Pat Sullivan (D) – 5th term

House Minority Leader J.T. Wilcox (R) – 4th term

2019: A Big Budget Year

McCleary (K-12)

Health Care

Higher Education

Capital gains tax?

Culverts?

WSHA Budget Priorities

• Difficult to discharge patients (patients living in the hospital)

• Behavioral health: funding the continuum of care

• Outpatient Medicaid rate increase for physicians

• Increasing the health care work force

• Rural health transformation

• Renewal of safety net assessment program

Policy Priorities

2019 Policy Issues

Improving Access and Helping Patients

(WSHA bills)

Streamlining advance directives

Continue CON exemption for mental

health

Expanding surrogate decision makers

Maintain flexibility and maintain/lower

costs

Restrictions on health care entities

Notice requirements on mergers and

affiliations

Expansion of Ambulatory Surgical Centers without CON

Maintain flexibility and maintain/lower

costs

Nurse staffing: meal & Rest breaks,

prohibiting on-call

Balance billing prohibitions

Expansion of wrongful death

Maintain flexibility and maintain/lower

costs

Restriction on medical debt

Improving Access and Helping Patients

(WSHA bills)

Pharmacy regulations

Sexual assault evidence kits

Opioids

Nurse Staffing

• HB 1715 would have:• Mandated uninterrupted meal and

rest breaks• Prohibited the use of pre-scheduled

on call• Expanded mandatory overtime

prohibitions

Partnerships and Affiliations

HB 1811 would have placed significant new requirements on hospitals:

Burdensome reporting to the Attorney General of almost all transactions –

even simple arrangements, such as contracted services

Require health care entities to divulge sensitive,

proprietary transaction details

Treble damages under the Consumer Protection Act

Singles out the health care industry

Wrongful Death

• The Ride the Ducks accident illustrated limitations of our state’s wrongful death statute

• WSHA and WSMA did not oppose expansion to non-US residents, but strongly opposed:

• Significant expansion of damages

• Exposure for “deep pocket” defendants under state joint and several liability standard

• Removal of economic tie

Medical Decision Makers

• WA law limits who can make decisions when a patient lacks capacity

• Most other states allow more family members or a close friend to make decisions

• Bill ran out of time in 2018

• Will be back in 2019

Opioid Epidemic

• WSHA has worked to advocate andimplement state opioid legislation

• New alert system: Alerts providersof a non-fatal overdose

• Provider reports of opioid prescribing: Helps educate providers of prescribing compared to peers.

• Action: Hospitals need to sign up with WSHA!

Medical Billing

• Bill is expected to significantly limit the ability to collect medical debt

• Concern: medical debt would become a second-tier debt to be paid after all other debts

• WSHA is surveying member hospitals to determine potential impact and inform our position

The View from the Other Washington

John W. FlinkFederal Affairs, WSHA

2018: The Year in Review

• The State of the ACA’s Individual Markets

• Taxes, Budget, Appropriations

• 340B

• Opioids

The ACA’s Individual Markets

• Trump Strategy: Weaken coverage administratively• Ended CSRs• Expanded access to association health plans

• Expanded availability of short-term, limited duration health plans• Reduced funding for navigator program/outreach•New exemptions to individual mandate

• Texas lawsuit against ACA

Taxes, Budget, Appropriations

• Bipartisan Budget Act of 2018 (Feb) & Omnibus Appropriations Act (March) raised spending caps – funded government through 10/1/18

• HHS appropriations funded health care in FY 2019 (Sept)

• Lots of health care activity early in the year

• CHIP funded 10 years• Low-volume, MDH, rural ambulance, home health payment

add-ons extended 5 years• NHSC, CHC, Teaching Health Center programs extended 2 years• Medicaid DSH payment cuts delayed 2 years• Tax exemption for private-activity bonds preserved

Wait…there’s more…

• Significant boost in funding for HHS rural health programs

• Funding to fight opioid abuse, including rural grants, funds for workforce development programs that address opioid abuse

• Funds to improve the nation’s broadband infrastructure, including rural

• Enforcement of rules governing supervision of outpatient therapeutic services suspended for CY 2017 – 2019

• CAH length-of-stay audits low priority

Opioids Crisis: SUPPORT For Patients and Communities Act

• Would expand and create prevention, treatment and recovery programs.• Authorizes grants to rural hospitals and communities

• Allows federal Medicaid payments for substance use disorder treatment in IMDs for 5 years

• Did not address 42 CFR Part 2 confidentiality rules

for SUDs patients

• Bipartisan, bicameral bill recently passed House/Senate

340B Drug Pricing Program

• Key Questions: How much are hospitals saving and spending?

• House Energy & Commerce Committee (Rep. McMorris Rodgers)

• Series of oversight hearings and reports on status of program

• Several proposals to restrict participation by hospitals

• Senate HELP Committee (Sen. Murray)

• Three oversight hearings

• Litigation

• AHA Pledge

Calendar for the Rest of the Year

• House recessed September 28 until after election

• Senate expected to recess in mid-October or later

• Lame duck session after election

• Continuing resolution funds government through December 7

Unfinished Business: Site Neutral/OPPS

• Proposed CY 2019 OPPS Rule would: • Reduce payment for clinic visits in grandfathered PBDs

• Reduce payment for expanding certain services

• $30 million loss in 2019; $440 million over 10 years

• Our Advocacy• Comments – Deadline September 24

• “Dear Colleagues” opposing rule

• Possible litigation or legislation

• Final Rule November 1

Election 2018: Down to the Wire

A Blue Wave in 2018? What to Look For…

• Historical patterns – first mid-term a referendum on President

• 35 of 38 first-term presidents lost seats in the House; 19 of 26 lost seats in Senate

• President’s job approval

• Voter Intensity

• Generic Ballot – Democrats need margin of 7

• Swing groups: younger voters, college-educated women,

suburban voters

President’s Approval Rating

Is 2018 the Year of the Woman?1998: 1311978: 48

2018: Record Number of Woman Running

256

Preference for Control of Congress

“The GOP’s endangered incumbents this fall – most of whom represent suburban districts where Mr. Trump has turned off voters –must find supporters who will vote for them even though they disapprove of the president.” – Wall Street Journal (9/4/18)

“If you look at our battlefield, 55 districts, the president is underwater in every one of those…across America” – Ben Ray Lujan, Chair, DCCC

“People think the economy is doing well, but that’s not what they’re voting on – they’re voting on the chaos of the guy in the White House” – Glen Bolger, Republican pollster

Commentary…

The Race for the House

• Control of the House fought in suburban areas that voted for Obama in 2012 and Trump in 2016

• Democrats need 23 seats – roughly 60 in play• 24 seats held by GOP that went for Clinton

• Cook Political Report Projections (9/26)• Solid seats: D = 182; R = 147

• Likely/lean: D= 10; R = 51

• Toss-up: D=3; R = 42

• Trend (this week): • House: Democrats gaining momentum

Washington’s Tightest Races – WA 3

• Jaime Herrera Beutler (I) (R)• First elected in 2010

• Active on health care issues, on health funding subcommittee

• Carolyn Long (D)• Taught at WSU – Vancouver for 23 years

• Ph.D. in political science

• Primary vote: 51% Republican to 49% Democratic

• Primary votes: JHB = 68,961; Long = 57,798

Washington’s Tightest Races – WA 5• Cathy McMorris Rodgers (I) (R)

• First elected in 2004

• 4th highest ranking Republican in House – highest ranking GOP woman

• Lisa Brown (D)• Fmr state Representative/Senator • First woman Democratic Senate Majority Leader• Chancellor, WSU - Spokane

• Primary vote: 54% Republican to 45% Democratic

• Primary votes: CMR = 99,689 votes; Brown = 91,738

Washington’s Tightest Races – WA 8

• Kim Schrier, MD (D)• Pediatrician with Virginia Mason in Issaquah for 16 years

• “Health care is my passion”

• Dino Rossi (R)• Long-time GOP activist, state senator, previously ran for Governor, U.S. Senate

• Career in commercial real estate in Seattle area

• Primary vote: 50% Democratic to 44.3% Republican

• Primary votes: Rossi = 73,288; Schrier = 31,837

Battle for the Senate…

• Fight for control in “red” states with Democratic incumbents

• Current margin: 51 – 49 Republican

• Seats up in 2018: 26 Democrat vs 9 Republican

• 10 of 26 Democratic seats in states that went for Trump

• Five went for Trump by 19 points or more

• Possible Dem pickups: Arizona, Nevada, Tennessee

• Cantwell safe

• “Arizona, Nevada, Tennessee, Montana, North Dakota, Missouri, Indiana, West Virginia and Florida…All of them too close to call, and everyone of them like a knife fight in an alley.” – Majority Leader Mitch McConnell

How the Election Affects Health Care

• If GOP holds House and Senate

• Repeal and replace in 2019

• Effort to restrict 340B

• Major deficit reduction initiative – proposals for major changes in Medicare and Medicaid

• If Democrats regain control of the House and/or Senate

• Repeal and replace unlikely

• Protect/strengthen ACA, expand coverage

• Debate about Medicare-for-all

• Deficit reduction effort

What CanYou Do?

Respond to requests for action

Come to Olympia or D.C. to testify or meet with your legislators

Schedule an in-district meeting – consider including your neighbors

Highlight your care improvements

Advocacy Efforts

2018Building Bipartisan RelationshipsUnifying Hospitals’ Political Voice

Electing Champions for Health Carewww.wshaweb.com/whpac

Passcode: WHPAC

Thank You!

Questions? Comments?

Chelene Whiteaker, SVP Government AffairsCheleneW@wsha.org 206-216-2545

John W. Flink, Federal Affairs, WSHAjohn@jwfconsultingdc.com 406.439.1698

Lisa Thatcher, Lobbyist, WSHAlisathatcher@comcast.net