Election 2016Predictions and Impact

Candidates for President of the U.S.

ELECTORS OF PRESIDENT AND VICE PRESIDENT

• CLINTON and KAINE, Democratic

• JOHNSON and WELD, Libertarian

• STEIN and BARAKA, Green-Rainbow

• TRUMP and PENCE, Republican

What issues do voters care about? Pew Research Center, July 16

• Economy & Terrorism The economy and terrorism are the top two issues

for voters this fall. Overall, 84% of registered voters

say that the issue of the economy will be very

important to them in making their decision about

who to vote for in the 2016 presidential election;

slightly fewer (80%) say the issue of terrorism will

be very important to their vote.

Other issues that rank highly on voters’ 2016

importance list include foreign policy (75% very

important), health care (74%), gun policy (72%) and

immigration (70%).

With an open seat on the Supreme Court, 65% say

appointments to the nation’s highest court will be a

very important factor in their decision this fall.

Presidential Polls

• National PollsAccording to a recent ABC News and ABC

News/ Washington Post polls, Hillary

Clinton up 12 percentage points over Donald

Trump among likely voters, 50 to 38 percent

Up 7 points since Oct. 13

CNN Poll out this week has a narrower

margin, 5%

• Polling of Massachusetts VotersClinton has an over 24% lead in

Massachusetts

Six Consecutive Presidential Elections

Source: 270towin.com

Electoral College Map

Source: 270towin.com

• Donald Trump• Repeal Obamacare

• Promises no cuts to

Medicaid

• Convert Medicaid to

block grant, ending the

open-ended federal

entitlement and capping

federal funding

• Enforce immigration

laws. Claims U.S.

provides healthcare to

illegal immigrants,

costing $11B annually.

• Hillary Clinton• Expand Medicaid in

the 19 states

• Three years of full

federal funding for 19

states (same as

originally offered

when passed)

• Allow people ages 55-

64 to buy into

Medicare

• Donald Trump

• Repeal

Obamacare

• Promises not to

Cut Medicare

• Support drug

importation

• Hillary Clinton• Authorize Medicare

to negotiate drug

prices with Pharma

• Supports beneficiaries

importing lower-cost

Rx from abroad

• Allow people ages 55-

64 to buy into

Medicare

• Donald Trump

• Nothing in

Health Care Plan

• No response to

NACHC inquiry

on funding cliff

• Answer to ACA is

to increase

funding for more

CHCs

• Hillary Clinton• Double funding for CHCs

and support healthcare.

• Double funding for

primary-care services at

CHCs over the next decade.

• Supports President

Obama’s call for a near

tripling of size of National

Health Service Corps.

• Favors 3.6B Mandatory over

10 years, 36B, plus

additional growth funds

• Donald Trump• Completely Repeal

Obamacare

• Eliminate individual mandate

• Tax deduction for health

insurance premiums. Allow

individuals to fully deduct

insurance premium payments

from their tax returns

• Allow insurance companies to

sell across state lines

• Allow individuals to use

Health Savings Accounts.

• Price transparency from all

healthcare providers,

especially docs and healthcare

organizations like clinics and

hospitals.

• Hillary Clinton• Defend and Strengthen ACA

• Resolve “family glitch” that

denies insurance subsidies to

some dependents

• Sweeten Subsidies for people

buying coverage in marketplace

• Offer a new government-

sponsored insurance plan to

compete with private companies

• Hillary Plan to expand coverage

to 9 million more uninsured

• Repeal tax on high-cost

insurance “Cadillac Tax”

U.S. Senate

Republican

54

Democrat

44 D, 2 Ind.Current Senate

+16 +10

46 46

Seats not up for Reelection 30 34

Solid Party Seats

Competitive U.S. Senate Seats

Republican

Rubio (I)

Portman (I)

Kirk (I)

Johnson (I)

Ayotte (I)

Democrat

Murphy

Strickland

Duckworth

Feingold

Hassan

Florida

Ohio

Illinois

Wisconsin

NH

48 49

Competitive Senate Seats Cont.

Pat Toomey (I)

Todd Young

Richard Burr (I)

Katie McGinty

Evan Bayh

Deb Ross

Pa.

Indiana

NC

48-51 49-52

2018 US Senate ?!

U.S. House of Representatives

Republican

247

Democrat

188Current House

Solid Incumbent Seats

Likely Outcomes

(435)

(378)

(417)

228 189 (+5)

201

+27

177

+12

U.S. House Cont.

18 Seats

• 15 current R (5 open)

• 3 current D (2 open)Toss Ups:

Predictions: • Dems gain 5-20

• Highly unlikely to get 30

• In September 2016, a Kaiser Family Foundation

Conducted a Health Tracking Poll

• Favorable or Generally Unfavorable Opinion

of Health Reform Bill signed into law in

2010 (“Obamacare”)?

47% Unfavorable (down 2% since April)

45% Favorable (up 7% since April)

• New Government Report on ACA likely to

drive up Unfavorability in October

• According to Government Report Released on

Monday, ACA Costs Surge.• Average premium for Benchmark Silver Plan will

rise 22% in 2017 in states that use federal exchange

• Typical bill will be $296 a month for 27-year old

• Last year, Premiums rose only +7.2%

(double pace of inflation)

• However, 75% of Policy Holders will pay less than

$100 per month with Gov’t Subsidies

• 2017, number of Carriers will drop to 228 (down 70) in

Federal Exchanges and selected states

• Insurers narrowing networks to keep costs down

• Enrollees Sicker and More Costly than

Expected

• Lack of Young, Healthy Enrollees

• Insurers Priced Plans Too Low

(Adjusting)

• Fewer Companies Offering Coverage

Dropping Exchanges

State of Play in Massachusetts

• Most lawmakers did not face re-election

challenges and even fewer face opponents in 2

weeks

• 15 of 40 Seats in the Mass Senate Contested

• 42 of 160 Seats in the Mass House Contested

• 7 of 14 Sheriffs Contested

• Legislators on Road for Presidential Candidates

Massachusetts Senate

40 Mass. Senators: 34 D, 6 R

3 Open Seats:

Wolf (D): Cyr (D) vs. Schiavi (R)

Downing (D): Hinds (D) vs. Canning (R)

Joyce (D): Timilty (D)

3 Contested Republican Seats:

O’Connor, Humanson, Ross

All likely to remain

9 Contested Democratic Seats:

L’Italien (D) vs. Laplante (R)

Gobi (D) vs. Erhardt (R)

Lesser vs. Harrington (R)

Massachusetts House of Representatives

160 House Members: 126 D, 34 R

9 Open Seats:

All current Democratic seats

Likely 8/9 will stay D

J. Fernandes (D): Biagetti (R) vs. Murray (D)

15 Contested Republican Seats:

Likely 11/15 will stay R

Wong/Migliore, Decoste/Nyman

Viera/Patrick, Boldyer/Sandlin

8 Contested Democratic Seats:

Likely 5/8 will stay D

Gregoire/Ferro, Mom/Kay

Cutler/Cogliano

• Question 1•

• Question 2•

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•

• Question 3•

• Question 4•

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• State Facing 9c Cuts• $294 million gap between anticipated revenue

collections for fiscal 2017 and budgeted spending

• House Speaker and Senate President calling for Baker

Administration to “pump the breaks”

• Gov. says municipal and school aid, funding for DCF

core services, higher ed, court system, DMH,

pensions, debt service and budgets of other four

constitutional officers off limits

• Mass Medicaid Waiver Approval Pending

• Governor 69% Job Approval Rating, but no

progress on key legislative priorities (e.g., charter schools)

•U.S. House and Senate both

put forward $1.5B for

discretionary funding

•FY2016 levels carry forward

through CR, back in December

to pass budget appropriations

• 30 Programs expire over next 2 years,

largest CHC mandatory funding and CHIP

• $3.6B out there being used by CHCs

• No clear legislative vehicle, nothing like

Medicaid Doc Fix

Fix Options

1. Move $3.6B to discretionary, moves us

beyond cap under discretionary funding

2. 10-year fix, considered permanent

3. Kick forward with shorter multi-year fix

• Only 2/3 of Massachusetts FQHCs are

members of NACHC

• Expect 50% of Congress to turn over in

four years

• must re-educate members

• build new relationships

Questions?