MAHA Fall Conference

October 14, 2014

Laura Appel, Senior Vice President, Strategic Initiatives

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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

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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

Michigan Loses Seniority

• U.S. Senate – Sen. Carl Levin (36 yrs) • U.S. House of Representatives – Rep. John Dingell (59 yrs) – Rep. Dave Camp – Rep. Mike Rogers – Rep. Gary Peters (23 yrs) (13 yrs) (5 yrs)

Total experience + seniority lost = 136 years

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Election 2014 – Federal

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

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) John Moolenaar Mike Bishop Debbie Dingell Brenda Lawrence 7

Election 2014 - State

• Governor – Incumbent Gov. Rick Snyder (R) v. Mark Schauer (D) Brian Calley Lisa Brown 8

Election 2014 - State

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

Election 2014 - State

• State Supreme Court (2 incumbents, 1 open seat) Justice Zahra Justice Vivano Richard Bernstein 10

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

Term limited Healthcare Champions

• Senate Maj. Leader Randy Richardville • Sen. Roger Kahn • Sen. John Moolenaar • Rep. Matt Lori • Rep. Gail Haines

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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 ) Rudy Hobbs Frank Foster 13

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

Date to Remember

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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

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

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

…at the heart of change

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