1. 1 MAHA Fall Conference October 14, 2014 Laura Appel, Senior Vice President, Strategic Initiatives

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3. Political and Healthcare Climate - Michigan State economic picture improving Voters remain skeptical about economic future More than 400,000 people enrolled in the Healthy Michigan Plan More than 272,000 enrolled in Federal health exchange Number of uninsured Michigan citizens cut in half Medicaid and Medicare represent nearly half of hospital business - public funds, government regulated 3

4. This Year Voters Will Decide…. U.S. Senate U.S. House of Representatives Governor Attorney General Secretary of State State Supreme Court State Senate State House of Representatives 4

5. Michigan Loses Seniority U.S. Senate –Sen. Carl Levin (36 yrs) U.S. House of Representatives –Rep. John Dingell(59 yrs) –Rep. Dave Camp (23 yrs) –Rep. Mike Rogers(13 yrs) –Rep. Gary Peters (5 yrs) Total experience + seniority lost = 136 years 5

6. Election 2014 – Federal U.S. Senate –U.S. Rep. Gary Peters (D) v. Terri Lynn Land (R) 6

7. Election 2014 - Federal U.S. House of Representatives –District 4 John Moolenaar (R) v. Jeff Holmes (D) –District 8 Mike Bishop (R) v. Eric Schertzing (D) –District 12 Terry Bowman (R) v. Debbie Dingell (D) –District 14 Christina Conyers (R) v. Brenda Lawrence (D) 7 John Moolenaar Mike Bishop Debbie Dingell Brenda Lawrence

8. Election 2014 - State Governor – Incumbent Gov. Rick Snyder (R) v. Mark Schauer (D) 8 Lisa Brown Brian Calley

9. Election 2014 - State Attorney General – Incumbent Bill Schuette (R) v. Mark Totten Secretary of State –Incumbent Ruth Johnson (R) v. Godfrey Dillard (D) 9

10. Election 2014 - State State Supreme Court (2 incumbents, 1 open seat) Justice Zahra Justice VivanoRichard Bernstein 10

11. General Election 2014 - State Legislature Senate – 38 seats –10 open seats –First election since 2011 redistricting –Majority Leader Randy Richardville is term-limited House of Representatives – 110 seats –41 open seats –70 lawmakers will have no more than 2 years of legislative experience –Speaker of the House Jase Bolger is term-limited 11

12. Term limited Healthcare Champions Senate Maj. Leader Randy Richardville Sen. Roger Kahn Sen. John Moolenaar Rep. Matt Lori Rep. Gail Haines 12

13. Primary Election Health PAC Score Card 98% of Health PAC funded candidates won Health care champions defeated in primary –Rudy Hobbs: U.S. House (14 th ) –Frank Foster: Michigan House (107 th ) 13 Rudy HobbsFrank Foster

14. Election 2014 — Call to Action Meet your candidates for state House and Senate, and candidates for Congress Use MHA election tools available on the MHA election web page http://www.mha.org/mha/elections.htm –Election Materials (table tent, posters, brochure) –Election Snapshot –Candidate Listing –Redistricting Information –Non-partisan sources 14

15. Date to Remember 15

16. Lame Duck Session - Issues to Watch 1. Roads 2. Regulation of E-Cigarettes (TBD) 3.Hospital Charge Master Transparency (Neutral) 4.Community College Nursing Programs (Support) 5.Licensure of Genetic Counselors (Support) 6.Dense Breast Awareness/Breast Density Screening (Neutral) 7.Certificate of Need - SB 1073 (Neutral) 8.Auto No-fault (Oppose) 9.Scope of Practice for Advanced Practice Nurses (Neutral) 16

17. ACA – Trading Coverage for Reimbursement Coverage expansion through Healthy Michigan Plan and Health Insurance Exchange Almost 700,000 enrolled, premium payment rates at 80% + Michigan hospitals contribute $7 billion over 10 years $2.4 billion annual Investment to cover Healthy Michigan Plan 17

18. Coverage Not the Single Answer 17 million remain uninsured under best scenario Right place, right time treatment doesn’t reduce cost dramatically – ER fixed cost Preventative care=longer life=more expense “The general consensus among health economists is that growth in real spending on health care was principally the result of the emergence of new medical technologies and services and their adoption and diffusion by the US Health Care System” ---Orszag, 2008 18

19. …at the heart of change 19