Jan. 2019 NADPac Report

NADPac Report

January 2019

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in this issue: Washington Insider

3 Advocacy in Action 4

PAC Contributors

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PAC Committee

Political Action Committee

NADPac Report January 2019

Washington Insider Capital Updates with Lisa Layman

A divided Congress Convenes

The 116th Congress convened in early January with split party control. Democrats lead the House of Representatives for the first time since 2010, having picked up 40 seats in November.

The Senate remains in Republican hands, and with a padded margin – the GOP picked up 2 seats. But, with a 53-47 split in the Senate, Republicans are still well short of the 60 votes they would need to overcome a filibuster and advance most bills.

The relatively narrow Republican margin in the Senate made legislating difficult even when the Republicans held the House in the last Congress. Those difficulties are now amplified, which is one of the reasons we’re, at the time of this writing, experiencing the longest government shutdown in history. The divided Congress makes it extremely unlikely that partisan priorities will advance to the President’s desk over the next 2 years.

Healthcare will be a focus

Getting any significant legislation across the finish line (i.e., to the President’s desk) will be difficult. However, with healthcare outperforming all other issues for voters last November, it will remain a prominent area of focus this year. (According to exit polls, more voters said healthcare was their top issue than any other, including immigration and the economy).

Democrats were returned to office, and dozens newly elected in the House, with a healthcare mandate: more than 70% of voters said pre-existing conditions protections, Medicare, and Medicaid, and other health issues were “very important” to their voting decision.

With that mandate, the Democratic House majority laid out an aggressive health care agenda on the first day of the new Congress.

When the Republicans controlled the House, they held dozens of oversight hearings to bring attention to their view of the failed concept and implementation of the Affordable Care Act (ACA). The House Energy and Commerce Committee alone held 31 oversight hearings; titles included “The ACA on Shaky Ground”, “From Premium Increases to Failing Co-ops: An Obamacare Checkup” and so on.

The Democrats are now gearing up to highlight the effects of Trump Administration actions repealing, restructuring and defunding elements of the ACA, and the gravity of protecting and strengthening the ACA. The Ways and Means Committee is kicking it off with a hearing entitled “Protecting Americans with Pre-Existing Conditions” on January 29th. (It is not a coincidence that the first health care hearing highlights a key election promise.)

Legislative activity

House Democrats have vowed to prioritize ACA market stabilization, and are expected to vote to protect pre-existing condition protections, re-instate reinsurance and cost-sharing subsidies and funding for enrollment and outreach activities, and repeal or limit HHS regulations perceived as weakening the ACA (such as the expansion of association health plans and short-term health plans).

These efforts are viewed as critical to address coverage losses under the Trump Administration: the Gallup National Health and Well-Being Index released last week indicated seven million more Americans are uninsured now than at the end of the Obama Administration, and the rate of uninsured Americans is at its highest since before the implementation of the ACA. The report points to many factors contributing to the decline, including rising premiums (triggered in part by the White House terminating cost-sharing reduction payments to insurers) and the Trump administration’s decision to substantially reduce the funding for outreach and enrollment assistance during the ACA open enrollment period.

Many “pro-ACA” efforts are expected to be approved by the House, and corresponding bills will be introduced by Democrats in the Senate. But broad expansions and significant funding increases will not advance in the Senate, or make it to the President’s desk.

Single Payer? Medicare for All?

Along with defending pre-existing condition protections, some form of “Medicare for All” was embraced by many Democrats in the November election campaigns. We can expect re-introduction of many of the proposals from the last Congress – which ranged from single payer or Medicare-for-All bills, to a Medicare “X” option on the exchanges, to allowing certain groups of people to “buy in” to Medicare or Medicaid – and Speaker Pelosi has announced her support for at least limited congressional hearings on expanding coverage beyond Obamacare. All of these efforts are undertaken with an eye to the 2020 congressional and Presidential election; they will not move beyond the most preliminary steps this year. However, it will be critical for the dental industry to engage in these discussions; it is best to be at the table early.

NADPac Report January 2019 Republican Healthcare Agenda

Many Republicans would prefer to stay away from healthcare altogether — their efforts to repeal and replace the ACA failed and lost them the House. Some, though, aren’t letting go: 17 Republicans introduced two bills in the House on the first day of the session to repeal the ACA. The bills won’t advance with the Democratic majority, however, and while Senator Graham (R-SC) may re-introduce a version of his legislation to restructure and shrink the Medicaid program, Republicans in the Senate don’t have the necessary 60 votes to pass such legislation. Instead, the Administration will take the lead on changes to Medicaid through the regulatory process (including continuing to promote work requirements, and more recently through a proposal in development to allow states to choose block grants in exchange for additional flexibility.)

However, there are Republicans, especially those in swing districts or “purple” states facing re-election in 2020, eager to show support for pre-existing condition protections, and some Democrats are hopeful that HELP Committee Chairman Alexander’s (RTN) decision to retire in two years will allow him to try again to reach a bipartisan compromise with Ranking Member Murray (D-WA) on a discrete package of market stabilization provisions.

In general though, where Republican Senate leaders are headed on health care in the 116th Congress is away from the ACA insurance provisions. In remarks made on the Senate floor in December, Senator Alexander said that rather than ‘arguing over six percent of the insurance market’ Congress should be discussing the high cost of health care. And when Senator Chuck Grassley (R-IA), the new Chairman of the Finance Committee, issued a detailed list of his specific health care priorities, the ACA received barely a mention. Instead, he has identified lowering prescription drug costs, increasing quality of care for seniors and addressing rural health care needs as key priorities.

Potential Bipartisan Action

Although the divided Congress and looming Presidential election mean there won’t be a lot of bill signings over the next two years, we could see agreement on drug pricing measures, surprise medical bills, and additional action addressing the opioid epidemic.

And, bipartisan legislation (S. 172) was introduced last week to delay the health insurance tax until 2022. Sponsors of S.172 are pressing for Congressional action on suspension of the tax early this year.

With the exception of a health insurance tax delay, legislation significantly impacting the dental industry is unlikely to become law this Congress. However, legislative and investigative activity will serve as markers for the 2020 elections and placeholders for a potentially different political dynamic in two years. It will be critical for NADP to continue to actively engage with Members of Congress. NADPac can be a powerful tool; industry-sponsored events provide opportunities for focused, thorough, and thoughtful discussions.

Lisa Layman of Hooper, Lundy & Bookman represents NADP on Capitol Hill and has more than two decades of experience in political and legislative affairs, and a comprehensive knowledge of health policy issues. As a senior policy advisor to several US Senators, Lisa has been involved in drafting, analyzing and negotiating legislation involving private health insurance, Medicare, Medicaid, prescription drugs, managed care, and health information technology.

PAC STATS

Year 2018 NADPac Figures: Beginning cash balance 1/1/18: $25,196.77 Closing cash balance 12/31/2018: $27,596.73 Contributions from individuals: $4,339.96 Contributions from PACs: $17,500 Disbursements to federal candidates: $19,500 Year 2017 NADPac Figures: Beginning cash balance 1/1/17: $25,280.13 Closing cash balance 12/31/17: $25,196.77 Contributions from individuals: $4,916.64 Contributions from PACs: $12,000 Disbursements to federal candidates: $17,000

NADPac Contributors The following individuals and corporate PACs have contributed funds to support NADPac efforts in 2018 and fundraising events in May for Senators Debbie Stabenow (MI) and Tina Smith (MN). NADPac appreciates the support of these contributors: • ACLI PAC • Rick Lantz, Delta Dental of MI, IN and OH • Aetna PAC • Lisa Layman, Hooper, Lundy & Bookman • Stacia Almquist, Sun Life Financial • Joe Lentine, DENCAP Dental Plans • Marty Corry, Hooper, Lundy & Bookman • Michael Lewan • Cigna PAC • Joshua Nace, Dental Health Services • DDPA PAC • Theresa McConeghey, Principal • Bethany Dougherty, Life & Specialty Ventures • Kate McCown, Ameritas • Forrest Flint, Delta Dental of MN • MetLife PAC • Rob Goren, Delta Dental of MO • Principal PAC • Guardian PAC • Renaissance PAC • Suzanne Heckenlaible, Delta Dental of IA • James Slotnick, Sun Life Financial • Highmark PAC • UNUM PAC • Evelyn Ireland, NADP • Sue Wright, Lincoln Financial

NADPac Comittee Contributions to federal candidates are overseen by the NADPac Committee, which meets several times a year. The Committee is appointed by the NADP Board to be representative of NADP membership.

Suzanne Heckenlaible Delta Dental of IA Evelyn Ireland, CAE NADP Executive Director and NADPac Treasurer eireland@nadp.org

Jonathan Renfrew Guardian Life Insurance Company James Slotnick Sun Life Financial

Richard Jones Guardian Life Insurance Company

Irica Solomon MetLife

Bernard LaPine United Concordia

NADP Staff Liaisons: Eme Augustini Director of Government Relations, NADP eaugustini@nadp.org

Michael Lewan The Michael Lewan Company Kate McCown Ameritas

Advisor: Lisa Layman Principal, Government Relations and Public Policy Hooper, Lundy & Bookman

Marty McGuinness UNUM Chris Payne Principal Financial Group

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For more information, please contact Evelyn F. Ireland, CAE • eireland@nadp.org Executive Director & NADPac Treasurer National Association of Dental Plans P 972-458-6998 x101 12700 Park Central Dr, Ste 400 Dallas, TX 75251-1529