th Legislature and “Policy Planning for the 86 th th Congress Depends on Who Wins ” 116 th 116 Presentation to Healthcare Financial Management Association November 16, 2018 Rosie Valadez McStay, MPH Assistant Vice President, Government Relations and Community Benefits Texas Children’s Hospital Frederic C. (Freddy) Warner Jr., JD Chief Government Relations Officer Memorial Hermann Health System
Presentation Overview • Civics 101 Quiz • Election Outcomes and Insights from the results • State and Federal Policy Considerations • Questions/Discussion
Civ ivics 101 – How well do you know government? • How many members are elected to the US House of Representatives each election cycle? • 435 • How many members are elected to the US Senate each election cycle? • About a third • How many members are elected to the Texas House of Representatives? • 150 • How many members are elected to the Texas Senate? • 31
Civ ivics 101 – How well do you know government budgets? • What is the total FY 2018 budget for the Federal Government? • $4.4 Trillion • What was the revenue received by the Department of the Treasury? • $3.316 Trillion • What is the biennial FY ‘17 - ’18 budget for the State of Texas? • $216.8 B • How much net revenue did Texas receive over the biennium? • $111.2 B/year
Ele lection outcomes in in the US Congress Photo Credits – CNN.com
Ele lection outcomes in in the US Senate Photo Credits – CNN.com
Take-Aways fr from DC Women Serving in the 115 th vs. 116 th Congress House and Senate Chamber Flips since 1930
Other Election Take-Aways Texas Election Demographic Drivers Governor Election Results National Demographic Trends
Ele lection Outcomes - Texas House Current Make-Up • Republicans: 83 Seats • Democrats 67 Seats • Speaker: Rep. Dennis Bonnen
Ele lection Outcomes - Texas Senate Current Make-Up • Republicans: 19 Seats • Democrats 12 Seats • Senate President: Lt. Gov. Dan Patrick
Texas County Ele lections Election Results by Texas County Harris County Judge-Elect Lina Hidalgo Photo Credit – CNN.com Photo Credit – Linahildalgo.com
State Budget Overv rview 12 Photo Credit: Texas Comptroller’s Office
Some additional facts to consider… Texas Uninsured Rate Current Medicaid Expansion States (age 18-64, [2015]) Photo Credit: Texas Academy of Family Physicians (TAFP); U.S. Census Bureau. (2015, March)
State Policy Priorities for Health Systems Health Systems in Texas legislative priorities will focus on fiscal impacts of policies: -Maintenance of safety net, trauma and rural add-ons from 2015 and 2017 sessions • Despite 2015 and 2017 “add - ons,” rate is only 58% of cost of care • Senate and House included in 2017 base budgets -Preservation of the state Trauma Fund -Local Provider Participation Funds (LPPF) proposals -Continuation of 1115 Medicaid Waiver • CMS granted initial 5-year term in 2011, followed by 15-month extension, which ended 12/31/17 • In December 2017, CMS renewed the waiver for another 5 years, through 2022 • Yields $6 billion per year • Texas could receive $8.5 billion/year in federal Medicaid expansion funding • HHSC/CMS negotiating terms and conditions, rulemaking, continue
1115 Medicaid Waiver – Largest Supplemental Funding Strategy December 2017, CMS approved a new, 5-year, $25 Billion Medicaid waiver • Maintains existing funding levels for Uncompensated Care (UC) and Delivery System Reform Incentive Payment (DSRIP) program • Winds down funding for DSRIP projects to zero, between years 3 and 5; • Mandates transition from the current “UC tool” to S -10 worksheet • Medicaid shortfall no longer allowed • Bad debt costs no longer allowed General waiver renewal terms enumerate timelines for implementation of changes to funding methodologies, and penalties for failing to achieve milestones
116 th Congress – Health Sector Impacts • Lame Duck session (now thru end of the year) • ACE Kids Act • Impact of a split Congress – Math of election voters is on Democrats’ side • Impact on the Affordable Care Act (ACA) • Election cycle created opportunities for several states to consider Medicaid expansion • Congressional Democrats will shore up the ACA; Republican AG lawsuit might weaken it • Drug Pricing Reform • Price Transparency and Consumer Protections • 340 B Discount Drug Program • Stark Law Reform
In summary… Will the 86 th Legislature be a microcosm of 116 th Congress? • New Speakers in both the state and federal Houses – and both march to their own drummer – not going to follow their Senate counterparts • Many spending needs – Education, Infrastructure, Transportation, Health care (e.g. Mental Health and Veterans Care), etc. • How these needs are prioritized largely depends on leadership. • Will partisanship continue to thrive or will pragmatism win?
Thank you! Rosie Valadez McStay, MPH Assistant Vice President, Government Relations and Community Benefits Texas Children’s Hospital Lrmcstay@texaschildrens.org @TXChildrensGR Frederic C. (Freddy) Warner Jr., JD Chief Government Relations Officer Memorial Hermann Health System Frederic.Warner@memorialhermann.org
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