1. Arkansas Association of Hospital Trustees Federal Update January 3, 2017
Winding Down 2016 and Ramping Up for 2017
The Things We Know and the Things We Don’t

2. AAHT Federal Update January 3, 2017
The Things We Know ….
Nov. 8, 2016 – Donald J. Trump elected POTUS
Affordable Care Act immediately becomes endangered.
Nov. 11, 2016 – AHA sets priority for LAME-DUCK Congress to support crucial must-pass legislation for hospitals and health systems which would:
Address the consequences of the Bipartisan Budget Act (BiBA) on Medicare outpatient payment to off-campus outpatient clinics that were under development at the time of passage;
Adjust the Centers for Medicare & Medicaid Services’ final rule to allow for greater flexibility for off-campus hospital outpatient departments on relocation and other issues;
Establish a socioeconomic adjustment in the Medicare hospital readmissions program;
Extend the Rural Community Hospital Demonstration Program;
Address “25% Rule” relief for long-term care hospitals; and
Ensure flexibility in physician supervision for critical access hospitals.

3. AAHT Federal Update January 3, 2017
The Things We Know ….
Nov. 30, 2016 – AHA CEO Rick Pollack sends letter to Pres.-Elect Trump, offers to work with him and seeks support from him for:
Reducing the regulatory burden,
Enhancing healthcare affordability and value,
Promoting quality and patient safety,
Ensuring access to care and coverage, and
Advancing health system transformation and innovation.

4. AAHT Federal Update January 3, 2017
The Things We Know ….
Dec. 2, 2016 – Second AHA letter to Pres.-Elect Trump lists 27 specific areas in which regulatory reform for hospitals is needed. Among them:
Suspending hospital star ratings,
Canceling Stage 3 of meaningful use program,
Holding Medicare RACs accountable,
Making future “bundled payment” programs voluntary, and
Expanding Medicare coverage of telehealth services.
(For complete list, go to members/advocacy- issues/initiatives/transition/index.shtml?utm_source=newsletter&utm_mediu m= &utm_campaign=WeeklyUpdate)

5. AAHT Federal Update January 3, 2017
The Things We Know ….
Dec. 7, 2016 – Congress passes the 21st Century Cures Act
Authorizes $4.8 billion for the NIH to fund new initiatives around precision medicine, cancer, neuroscience, and regenerative medicine.
Provides $500 million over 10 years to the FDA to facilitate the development of new drugs and devices, as well as modernizing clinical trials and the development of evidence.
Contains several important hospital-related provisions related to:
exceptions from the outpatient PPS site-neutral payments for certain off-campus hospital outpatient departments that were under construction at the time the site-neutral statutory provisions were passed in November 2015; 
adjustments to the Hospital Readmissions Reduction Program to account for socioeconomic status; 
providing for an additional 12 months of relief from the long-term care hospital 25% Rule; 
prohibitions on enforcement of the “direct supervision” regulations for 2016 for outpatient therapeutic services provided in critical access hospitals and certain small, rural hospitals; 
reforms to the mental health system, including provisions related to mental health parity, integration with physical health services, workforce development, and privacy provisions, among others;
extending the Rural Community Hospital Demonstration Program for five years. 

6. AAHT Federal Update January 3, 2017
The Things We Know ….
Dec. 4, 2016 – House Speaker Paul Ryan said that the incoming GOP Congress' first order of business will be to repeal the Affordable Care Act.
Previously, President-elect Donald Trump and Senate Majority Leader Mitch McConnell had said that repealing and replacing Obamacare is a legislative priority.

7. AAHT Federal Update January 3, 2017
The Things We Know ….
About “Obamacare” ( )
21 million people have gained insurance;
The law relies strongly on Medicare hospital cuts as an offset to the cost of added coverage;
Those cuts will cost Arkansas hospitals an estimated $2.5 billion-plus for the period ;
Medicaid expansion in Arkansas via the state’s Private Option/Arkansas Works has dramatically reduced hospital uncompensated care.

8. AAHT Federal Update January 3, 2017
The Things We Know ….
About repealing “Obamacare”
21 million people nationwide would lose insurance;
A new study from Dobson | DaVanzo found that, if the ACA is repealed without a bill providing simultaneous coverage to accompany it, the net impact to hospitals from 2018 to 2026 would be $165.8 billion from the loss of coverage.
If the ACA is repealed and the Medicare inflation update reductions for inpatient and outpatient hospital services are not restored, funding would be reduced by $289.5 billion between 2018 and 2026.
The combined cost for Arkansas hospitals would be c. $4 billion, absent any replacement bill to maintain coverage at current levels.
State Medicaid expansion efforts will likely be adversely impacted.

9. AAHT Federal Update January 3, 2017
The Things We Know ….
About repealing “Obamacare”
Timing – repeal or repeal and delay? How long
Consequences on insurance market?
The American Academy of Actuaries warns that a repeal of the ACA without replacing it would be dangerous to the long-term health of the insurance market.
Through Obamacare, the government plays a huge role in helping people pay for insurance on the individual market. Many insurance companies are already losing money on those policies, so if they think the government won't keep offering subsidies, insurers may just stop selling individual policies altogether.
If the ACA is repealed and the Medicare inflation update reductions for inpatient and outpatient hospital services are not restored, funding would be reduced by $289.5 billion between 2018 and 2026.
The combined cost for Arkansas hospitals would be c. $4 billion, absent any replacement bill to maintain coverage at current levels.
State Medicaid expansion efforts will likely be adversely impacted.

10. AAHT Federal Update January 3, 2017
The Things We DON’T Know ….
About replacing “Obamacare”
Four bills: Empowering Patients First Act (Tom Price), A Better Way (Paul Ryan), Patient CARE Act (Burr, Upton, Hatch) and Heritage Foundation1 H.R. 3762
All would:
repeal individual and employer mandates,
repeal taxes imposed in ACA,
rely on tax credits and enhanced value/use of HSAs, and
repeal or limit Medicaid expansion.
All are silent on restoring Medicare cuts.

11. AAHT Federal Update January 3, 2017
The Things We DON’T Know ….
About replacing “Obamacare”
The repeal and replace proposals all have similar features, but the final approach and myriad details will be determined through the legislative process and through regulations and other executive guidance. Further, how these proposals would interact with existing state laws remains to be seen.

12. AAHT Federal Update January 3, 2017
The Things We Know ….
About AHA position on replacing “Obamacare”
It is the top priority on AHA’s advocacy agenda for the 115th Congress;
Support for keeping coverage in place for 21 million people until a solid replacement is passed;
If Congress chooses to repeal the ACA without a replacement bill, either put the savings from repeal into a reserve fund to be used for future replacement efforts, or eliminate the payment reductions for hospital services that were part of the ACA.

13. AAHT Federal Update January 3, 2017
The Things You Should Know and DO….
About replacing “Obamacare”
Urge the State’s two Senators and your Congressman to preserve coverage as they consider “Repeal and Replace.”
Remind them of the financial implications on your hospital if they choose to eliminate coverage while keeping the payment cuts in place.
Tell them how losses of this magnitude cannot be sustained and would adversely impact patients’ access to care and hospitals’ and health systems’ ability to continue to provide services, and could potentially result in job losses.