1. Policy Briefing
Philadelphia EMA Ryan White Part A
Planning Council
February 14, 2013
Presented by Matthew McClain

2. Topics
 ACA milestones through January 1
 Plan for Ryan White Program post-
expiration
 Appropriations 2014
 Impact on Planning Council work
 Advocacy activities and resources
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3. ACA: New as of January 1, 2013
 New funding to state Medicaid programs that
choose to cover preventive services for patients at
little or no cost.
 States must pay primary care physicians no less
than 100% of Medicare payment rates in 2013 and
2014 for primary care services (fully funded by the
federal government).
 National payment bundling pilot program to
encourage hospitals, doctors, and other providers to
work together to improve the coordination and
quality of patient care.
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4. ACA: Milestones on October 1, 2013
 Health Insurance Exchange
marketing begins
 Health Insurance Exchange
enrollment begins
 States will receive 2 more
years of CHIP funding to
continue coverage for
children not eligible for
Medicaid
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5. ACA: January 1, 2014 Milestones
 Individuals, small businesses, and Members of
Congress can compare and buy qualified health
benefit plans through Health Insurance
Marketplace.
 Individual mandate takes effect for all but
undocumented and extremely low income.
 Americans who earn less than 133% of FPL will be
eligible to enroll in Medicaid.
 Tax credits and reduced cost sharing will become
available for those with income between 100% and
400% FPL.
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6. Insurer Prohibitions Effective
January 1, 2014
 Prohibits dropping or limiting coverage because an
individual chooses to participate in a clinical trial.
 Prohibits imposing annual dollar limits on the
amount of coverage an individual may receive.
 Prohibits refusing to sell coverage or renew policies
because of an individual’s pre-existing conditions.
 Prohibits higher rates in the individual and small
group market due to gender or health.
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7. Small Business/Small Nonprofit Tax
Credit Effective January 1, 2014
 The law implements the second phase of the small
business tax credit for qualified small businesses
and small non-profit organizations.
 Up to 50% credit on taxes on the small
employer’s contribution to provide health
insurance for employees.
 Up to a 35% credit for small non-profit
organizations.
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8. February 14, 2013 8

9. Medicaid Expansion (not)
 Pennsylvania: Governor Corbett
recommended not expanding Medicaid
in the Commonwealth (2/5/13)
 New Jersey: Governor Christie is
leaning against expansion
 NJ partly expanded to non-disabled adults
with children through ACA-enabled
Medicaid waiver in 2011
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10. If a State Does Not Expand:
 Uninsured adults  Uninsured adults
below 100% FPL in above 100% FPL will
that state will not be eligible for
gain new affordable subsidies to
coverage options, purchase exchange
are not eligible for coverage, but many
subsidies, and they will likely remain
will likely remain uninsured due to
uninsured. lack of money.
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11. Ryan White Program 2014
 Current legislation expires September
30, 2013
 Appropriations can legally continue
without authorizing legislation
 Absence of appetite on the Hill to
legislate any more health laws
 Strong policy argument to delay while
administrative fixes occur
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12. Federal FY 2013 Budget
 $1.043 Trillion Continuing Resolution,
currently expires March 27, 2013
 Latest scheme: House enacts in March
a CR at the current level, keeping
sequester unless Congress acts
separately, with Senate-passed DOD
and VA appropriations bills included
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13. Sequester
 Across-the-board percentage cuts per
2011 law, now effective March 1, 2013
 $85 billion in automatic cuts using
variable rates for defense and non-
defense discretionary (with exceptions)
 Effective percentage reduction for non-
defense discretionary programs: ~9%
 Community health centers mandatory
funding limited to 2% cut
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14. White House Press Release:
Public Health Sequester Impacts*
 Mental health and substance abuse
services
 AIDS and HIV treatment and prevention
 7,400 fewer ADAP clients
 420,000 fewer HIV tests
 Tribal services
* Office of the White House Press Secretary, February 8, 2013
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15. States That Are Most Affected by Across-the-Board Cuts
to ADAP Funding Also Disproportionately Impact People
of Color
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16. Key Appropriations Requests 2014,
increases above 2012 in millions
Part A: +$67 Prevention: +$180
Part B: +$42 DASH: +$20
ADAP: +$133 Hepatitis: +$5
Part C: +$22 Research: +$440
Part D: +$14 HOPWA: +$33
AETC: +$10
Dental: +$3
MAI: +$184
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17. Sample Impacts on the Planning
Council’s Responsibilities
 Needs assessment and planning
 To what extent do the Medicaid programs
in PA and NJ in 2014-2019 affect needs
and what within RW can be brought to
bear on new gaps?
 Priority setting and resource allocations
 To what extent does the evidence justify
changes in priorities and resource
allocations?
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18. Communities Advocating Emergency
AIDS Relief (CAEAR) Coalition
 Covers authorization and appropriations
for Part A, ADAP, Part C, Dental, AETC
 Pat Bass, Mid-Atlantic Regional
Representative
 Kevin Burns, At-Large Member, Board of
Directors
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19. Federal AIDS Policy Partnership
 AIDS Budget and Appropriations Coalition
 Donna Crews, AIDS United
 Emily McCloskey, NASTAD
 Carl Schmid, AIDS Institute
 Healthcare Access Work Group
 Robert Greenwald, Treatment Access Expansion
Project
 Amy Killelea, NASTAD
 Andrea Weddle, Infectious Disease Society
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20. Advocacy and Upcoming Events
 Ramp up existing  AIDS Watch
mechanisms for February 25-26
information  CAEAR Coalition
gathering, analysis, February 25-26
response: PA, NJ,  FAPP Meeting
Federal February 27
 Advocacy is legal,
costs money, and
takes time
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21. Resources
 hab.hrsa.gov  mahealthconnector.org
 healthcare.gov  exchange.utah.gov
 healthreform.gov  ehealthinsurance.com
 statehealthfacts.org  John E. McDonough, Inside
National Health Reform,
 kff.org 2011.
 AIDSunited.org  International AIDS Society
 nastad.org and the Scientific Working
Group, Towards an HIV
 caear.org Cure, July 2012
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22. Thank you!
Matthew McClain
AIDSpolicy@aol.com
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