State & Federal Advocacy Action

Advocacy Alert: US Senate Contacts June 26, 2017

As you know, the Senate currently is working to try to pass a ACA repeal bill with the vote likely occurring when Congress returns from the Fourth of July recess. Both California Senators will oppose the legislation and are working with health care industry leaders in California on a strategy to reach out to our colleagues and friends/family in targeted states to encourage Senator’s from those states to vote against the bill. This advocacy alert is in line with an alert you will receive from CHA today that encourages you to make contact with colleagues and family in key states to ask them to weigh in with their Senators. Contact information is below. Also attached is a summary of the Senate bill that came from Senators Feinstein and Harris’s office.

Yesterday, as you heard, Congressional Budget Office (CBO) released their score of the Senate bill. The Senate Republicans’ACA repeal-and-replace bill would result in 22 million more uninsured people over 10 years and a $321 billion budget deficit over the same period, according to the score.  The analysis is seen as a hurdle for Republicans as they look to pass their bill next month.

Contact info for target Senators:

Email contact pages to Senators may not let you submit if you’re from outside the state, but if you know anyone in the target states (including perhaps staff of hospitals in neighboring states with whom you coordinate), pass the link along. You can make phone calls and tweet targeted Senators.

Senator Susan Collins (Maine)



Phone: 202-224-2523


Senator Dean Heller (Nevada)



Phone: 202-224-6244


Senator Lisa Murkowski (Alaska)



Phone: 202-224-6665


Senator Rob Portman (Ohio)



Phone: 202-224-3353


Senator Jeff Flake (Arizona)



Phone: 202-224-4521


Senator Shelly Moore Capito (West Virginia)



Phone: 202-224-6472



Additional resources:


Real stories from Covered California:

Georgetown Center for Children and Families

  • Report: Medicaid in Small Towns and Rural America

Commonwealth Fund

  • Report : Medicaid Cuts and Hospital Finances

Kaiser Family Foundation:

  • State by state Medicaid numbers and fact sheets for each state: Link
  • Interactive state-by-state map – what’s at stake with ACA repeal: Link
  • Overall comparison of Senate bill, House bill, and ACA: Link
  • Breakdown of current federal vs. state spending under Medicaid: Link


If you have any questions, please let me know.  And thank you for your ongoing grassroots advocacy.


Federal Advocacy (and Update on ACA Repeal/Replacement) January 10, 2017

While the exact timing of when Congress will consider the repeal of all or part of the ACA remains unclear, a budget resolution for reconciliation in the Senate was introduced last week and could be considered this week. It instructs the three key Committees (Senate HELP and Finance and House Energy and Commerce) to make their recommendations for changes to the ACA by January 27th with the goal of getting something to the President by February 20th.

However, this morning, it was suggested this January date could be pushed back to March sometime given there is a movement in the Senate that some Republicans have joined saying that repeal and replace must occur at the same time. Approximately 9 Republicans in the Senate have indicated they will not support a repeal effort without immediate replacement. This is putting pressure on the leadership to rethink the strategy as it could impact the votes necessary to pass a repeal. As they say, the devil is in the details so more to come as details are shared on what such a package may look like, the timing of repeal, etc.

In the interim, it is important for all Members of the CA Delegation to hear from their district/municipal public hospitals on the importance of the ACA – To that end, we urge you to reach out to your Members of Congress THIS WEEK with the following message:

  • No Repeal Without Immediate Replacement: If the ACA is repealed, there needs to be an immediate replacement. Congress needs to have a replacement bill before them as a repeal is occurring. It is estimated that in 2017-2018, 1.4 million California’s will be enrolled in the ACA (Covered California). A complete repeal of the ACA, without a companion replacement program, would not only affect millions of Californians’ health benefits, but would also disrupt the private insurance market.
  • Keep Medicaid Expansion: Medicaid expansion MUST be protected in the ACA. California stands to lose an estimated $15 billion annually in federal funding for Medicaid expansion and insurance subsidies — more than any other state. The state’s Medi-Cal program now covers about a third of all Californians. Based on the expansion of the Medi‑Cal program, caseload has increased from 7.9 million in 2012‑13 to a projected 14.3 million in 2017‑18. To date, 32 states have Medicaid expansions in place with many additional states considering expansion. Per the CA Governor’s 2017-2018 budget summary, it assumes costs of $20.1 billion ($888 million General Fund) in 2016‑17 and $18.9 billion ($1.6 billion General Fund) in 2017‑18 for the 4.1 million Californians in the optional Medi‑Cal expansion.
  • Protect Hospitals: If policymakers choose to repeal the ACA without ALL current provisions, it is essential that they either put the savings from repeal into a reserve fund to be used for future replacement efforts, or eliminate the payment reductions for hospital services that were part of the ACA.

All CA Delegation Members should be contacted – if you need assistance in identifying your Members of Congress, please reach out to Charity Bracy, DHLF Federal Advocate (

Key Members to reach out to given their leadership or Committee Membership include:

Majority Leader Kevin McCarty

Minority Leader Pelosi

Rep Raul Ruiz (Energy and Commerce Committee)

Rep Doris Matsui  (Energy and Commerce Committee)

Rep Anna Eshoo (Energy and Commerce Committee)

Rep Mimi Walters (Energy and Commerce Committee)

Rep Scott Peters (Energy and Commerce Committee)

Rep Tony Cardenas (Energy and Commerce Committee)

Rep Jerry McNerney (Energy and Commerce Committee)

Rep Devin Nunes (Ways and Means Committee)

Rep Mike Thompson (Ways and Means Committee)

Rep Linda Sanchez  (Ways and Means Committee)

As you make phone calls or send emails, please let DHLF staff now of any feedback or questions you are getting. This will help us with our advocacy efforts.


Federal Hospital Outpatient Site Neutral Payments:

Dear Hospital Colleagues:

As discussed previously, language was included in the signed Federal Budget Act of 2015 that changes the way hospital outpatient clinics, including how District hospital clinics are paid for the services they provide to Medicare patients.  The Forum has been working to address this issue, with CHA and others in the industry, over the last several months. To that end, a letter is being circulated by Reps Nunes and Crowley in the House to the CMS Administrator asking for flexibility when they implement this law. It is critical that we get as many co-signers on this letter as possible; The total number target is 218 so securing as many from the California Congressional Delegation will be critical. Please reach out to your Member of Congress immediately and ask for them to sign onto the letter. The deadline is May 13th. The letter is attached to this email.

Background: Under the change in policy, new off-campus outpatient facilities developed or acquired by a hospital will not be reimbursed under the outpatient prospective payment system. Instead, they will be reimbursed under either the Medicare physician fee schedule or ambulatory surgical center prospective payment system, as applicable. The provision (in Section 603) requires “site-neutral” payment reductions for all new hospital outpatient departments located more than 250 yards from the main hospital campus.

The site-neutral provision means that any outpatient service provided by a hospital in a facility off of the main hospital campus will be reimbursed at the same, lower amount paid to physicians beginning January 1, 2017 if it is located more than 250 yards from the main hospital campus. Only outpatient facilities that were operational and billing Medicare before November 2, 2015, will be “grandfathered” under the old rules and will continue to be paid at the existing hospital reimbursement rate. This very limited grandfather provision means that hospitals that are in various stages of project development of outpatient programs, but have not yet completed them, will now be subject to reduced payment rates. It also means that hospitals that have plans to move existing clinics to another location will be subject to reduced payment rates.

This change in reimbursement will mean hundreds of millions dollars annually to hospitals statewide, including District hospitals, and could impact access to care in local communities.

Please let me know if you have any questions.


Charity Bracy


Support of Waiver Legislation:

The two state bills which will implement Medi-Cal 2020 (and the PRIME program) are set to be heard in the Assembly and Senate Health Committees in late April.  Since PRIME is such an important program to district/municipal hospitals, your advocacy team has requested all district/municipal hospitals to weigh in supporting the two bills.  A sample letter is attached.  If possible, please use the third paragraph as noted to describe the projects (or a sample of the projects if you have several) specific to your hospital.  Please put on your hospital letterhead and otherwise personalize as noted or as you would like. 

If you have any questions, please let me know.  And thank you for taking a moment to put together a letter supporting this program and its associated funding.