Health Center Funding Cliff Webinar/NACHC Policy Update

Elizabeth KwasnikManager 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 in Washington

• Bipartisan support for Health Centers’mission as we celebrate 50 years

• Both sides are looking for solutionsin the health care arena

•Health Centers are at the center of the conversation

• There are Health Centers in 98% of Congressional Districts

(425/435)

THE ENVIRONMENT FOR HEALTH CENTERS

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

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

2010 2011 2012 2013 2014 2015 2016 2017

2.19

1.58 1.58 1.495 1.495 1.495 1.495 1.495

1 1.2 1.5

2.2

3.6 3.6 3.6

Discretionary ACA HR 2

Primary Care Cliff Averted!

Health Center Funding Chart

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 RiskAfter 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

GRASSROOTS ADVOCACY

• Importance of advocacy

•Access is the Answer Campaign

•What’s next?

•Key Contact Program

MAKE YOUR VOICE HEARD!

•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…

ACCESS IS THE ANSWER CAMPAIGN

• 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!

ONGOING ADVOCACY NEEDS

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.

KEY CONTACT PROGRAM

A WORD ABOUT MICHIGAN MOCs

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

Key Contacts and advocacy in Michigan is especially important, given the delegation!

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.

ADVOCACY: THE BOTTOM LINE

Elizabeth KwasnikManager of Grassroots Advocacy

202-331-4614ekwasnik@nachc.org

QUESTIONS?

CONTACT INFO AND QUESTIONS