Health Center Funding Cliff Webinar/NACHC Policy Update Elizabeth Kwasnik Manager of Grassroots Advocacy National Association of Community Health Centers April 23, 2015

TODAY’S AGENDA The Environment for Health Centers FUNDING CLIFF/Policy Update Grassroots Advocacy Questions?

THE ENVIRONMENT FOR HEALTH CENTERS The Environment in Washington Bipartisan support for Health Centers’ mission as we celebrate 50 years Both sides are looking for solutions in the health care arena Health Centers are at the center of the conversation There are Health Centers in 98% of Congressional Districts (425/435)

HEALTH CENTERS IN A POST-ACA WORLD Where do we fit? Where do we stand? Access to primary care is vital for cost savings and improved outcomes Unmet need for our services remains enormous – 62 million without primary care We expect increased demand, among newly insured, remaining uninsured and underinsured Federal support, through 330 grant and Medicaid payment, crucial to model of care We will have to advocate louder than ever

FUNDING CLIFF FIX NEXT STEPS – APPROPRIATIONS, MEDICAID, 340B POLICY UPDATE FUNDING CLIFF FIX NEXT STEPS – APPROPRIATIONS, MEDICAID, 340B

HEALTH CENTER FUNDING STREAMS Annual Appropriation Annual, up to Congress to determine amount Prior to ACA, the only funding for CHC program Cut several times, backfilled with mandatory funds Currently $1.5 billion (FY15) “Discretionary” Health Center Trust Fund Required spending, unless Congress changes the law Special 5-year Trust Fund created in ACA to boost Health Center Capacity Currently $3.6 billion (FY15) “Mandatory”

RAISING THE NOISE ON THE HILL Sign-on Letters Bipartisan letters circulated in both Chambers Addressed Appropriations Support and Cliff Issue House: 271 Signers (173 D, 98 R) Senate: 60 Signers (39 D, 19 R, 2 I) Member Contacts Target fly-in with Leadership, Key Committees Hundreds of visits during P&I Hill Day Thousands of calls to Congressional Offices

RAISING THE NOISE IN MICHIGAN Sign-on Letters Cliff sign-on letter (October 2014) 8 Reps. and both Sens. FY16 Approps letter (March 2015) 9 Reps. and both Sens.

Primary Care Cliff Averted! Congress passed, and the President signed into law, H.R. 2, the Medicare and CHIP Reauthorization Act of 2015 Overwhelming support – passed House by a vote of 392-37, and Senate by 92-8! Permanent Medicare SGR “Doc Fix” 2-year extension of CHIP **Two years of additional mandatory funding for Community Health Centers, National Health Service Corps, and THC Program – All extended until October 1, 2017**

Note About H.R. 2 Funds Senate Human Trafficking Legislation Use of Health Center funds set aside in H.R. 2 to cover health care-related services for victims Cost could range from $5mil to $30mil per year (for two years) Press release/statement available on NACHC website, and we will be sure to update you as we know more

Primary Care Cliff Averted! Health Center Funding Chart

HRSA has/will spend this on: FY15 FUNDING $5.1 billion in FY15 - $1.4 billion more than FY14, largest amount ever. HRSA has/will spend this on: $350M - New Access Points and Expanded Services $165 - Base Adjustments $150M – Construction & Capital Improvements $150M - Outreach and Enrollment $51M - Behavioral Health Integration $36M - Quality awards

Where Do We Go From Here? FY16 Appropriations Funding at Risk After big investments in mandatory funding, Congress may cut back on discretionary funding – need to advocate louder than ever to maintain $1.5 billion Medicaid changes included in ACA alternative proposals, budget negotiations and entitlement program discussions, including block grants, per-capita caps, and increased state waiver flexibility

Where Do We Go From Here? King v. Burwell Supreme Court Decision Expected in June Potential to severely undermine insurance exchanges 340B Drug Discount Program Recent Congressional Hearing “Mega Guidance” expected this summer

Importance of advocacy Access is the Answer Campaign What’s next? GRASSROOTS ADVOCACY Importance of advocacy Access is the Answer Campaign What’s next? Key Contact Program

MAKE YOUR VOICE HEARD!

ACCESS IS THE ANSWER CAMPAIGN We did it! H.R. 2 signed into law on April 16th Don’t forget to thank your MOCs! Direct email/call Media templates available Health Center advocates made a HUGE difference BUT, our job isn’t done…

ONGOING ADVOCACY NEEDS Appropriations process– need to protect our discretionary funding! Federal discussion around Medicaid King v. Burwell* Workforce issues Funding past FY17 We need to be able to adequately respond when issues come up, and be on the offensive moving forward! We cannot afford to lose any ground we’ve gained!

Does your Health Center have a Key Contact? KEY CONTACT PROGRAM Does your Health Center have a Key Contact? Leverage your relationship with Members of Congress and their staff Be an advocacy leader; Key Contacts are our grasstops! Can be anyone at a CHC with a relationship with Member or staff- CEO, O&E, clinician, etc.

A WORD ABOUT MICHIGAN MOCs Key Contacts and advocacy in Michigan is especially important, given the delegation! Member Contact 46 emails to Reps. and 68 emails per Senator on H.R. 2 Cliff Call in Day (March 19): 153 calls Senate/H.R. 2 Call in Day (April 13): 66 calls

ADVOCACY: THE BOTTOM LINE HEALTH CENTERS SUCCESS & OUR COLLECTIVE FUTURE DEPEND ON THE STRENGH OF OUR ADVOCACY. Local connection is the key to policy change – build relationships and demonstrate impact over time Advocacy requires ACTION - the key is to develop a sustained culture of advocacy in your center The challenges ahead are huge, as are the opportunities. We have to take them on TOGETHER.

Manager of Grassroots Advocacy CONTACT INFO AND QUESTIONS Elizabeth Kwasnik Manager of Grassroots Advocacy 202-331-4614 ekwasnik@nachc.org QUESTIONS?