Tennessee Charitable Care Network Annual Conference October 14

Tennessee Charitable Care Network Annual Conference October 14, 2016

The Sycamore Institute is an independent, nonpartisan public policy center for Tennessee. MISSION To provide accessible, reliable data and research in pursuit of sound, sustainable policies that improve the lives of all Tennesseans

HISTORY • Founded in 2015 as a wholly owned subsidiary of The Healing Trust • Two years of planning & preparation • Vision – getting upstream • Organizational planning • Capacity & resources • Independent in 2016

UNWAVERING COMMITMENTS • • • Nonpartisan work, bipartisan stakeholders Focus on data and research Flexibility to engage different audiences Listening and communicating in ways people can hear Transparency, credibility and accountability Agility Collaborative Diverse and inclusive Unifier Iterative

OUR RESEARCH 2016 -2017 STATE BUDGET FOUNDATIONAL KNOWLEDGE-BUILDING HEALTH POLICY RESPONSIVE POLICY ANALYSIS PROACTIVE POLICY ANALYSIS STATE BUDGET PRIMER LEGISLATIVE ANALYSIS STATE HEALTH INDEX TECHNICAL ASSISTANCE PROCESS & DATA ANALYSIS PRIMERS POLICY BRIEFS BLOG POSTS ACCESSIBLE & RELIABLE

STATE BUDGET PRIMER

WHAT IS THE STATE BUDGET? AN ACCOUNTING OF ALL THE MONEY COMING INTO AND GOING OUT OF THE STATE GOVERNMENT A STATEMENT OF PUBLIC POLICY PRIORITIES AND A VISION & DIRECTION FOR THE STATE

WHAT IS THE STATE BUDGET? FY 2016 -2017 RECOMMENDED TENNESSEE STATE BUDGET TOTAL: $34. 8 BILLION REVENUES State Taxes Federal Funds All Other Revenues EXPENDITURES Health & Social Services Education All Other Expenditures Sources: The Sycamore Institute analysis of “Total State Budget: Comparison of Programs and Revenue Sources” and “Comparison Statement of State Revenues” from the FY 2016 -2017 Tennessee State Budget

OUTCOME OF THE BUDGET PROCESS FY 2014 -2015 Sources: “Total State Budget: Comparison of Programs and Revenue Sources” from the FY 2014 -2015, FY 2015 -2016, and FY 2016 -2017 Tennessee State Budgets

STATE TAX REVENUES Sales Tax Other Taxes Corporate Taxes Selective Sales Taxes Income Taxes Sources: The Sycamore Institute analysis of “Comparison Statement of State Revenues” from the FY 2016 -2017 Tennessee State Budget; Cheryl Lee, Edwin Pome, Mara Beleacov, Daniel Pyon, and Matthew Park, “State Government Tax Collections Summary Report: 2014, ” Economy Wide Statistics Brief, U. S. Census, April 16, 2015, Available at http: //www 2. census. gov/govs/statetax/G 14 -STC-Final. pdf.

HEALTH & SOCIAL SERVICES FY 2016 -2017 RECOMMENDED TENNESSEE STATE BUDGET HEALTH & SOCIAL SERVICES TOTAL: $15. 8 BILLION REVENUES Federal Funds State Taxes All Other Revenues EXPENDITURES Tenn. Care Department of Human Services All Other Health & Social Services Source: The Sycamore Institute analysis of “Comparison of Programs” and “Budget by Functional Area” from the FY 2016 -2017 Tennessee State Budget

BUDGET TRENDS CUMULATIVE BUDGET GROWTH 253% Total Budget Federal Funding 185% State Taxes Sources: The Sycamore Institute analysis of “Total State Budget: Comparison of Programs and Revenue Sources” and “Comparison Statement of State Revenues” from the FY 1996 -1997 – FY 2016 -2017 Tennessee State Budgets FY 2014 -2015 FY 1994 -1995 145%

BUDGET TRENDS TENNESSEE HISTORICAL BUDGETS BY REVENUE SOURCE State Taxes Federal Funds All Other Revenues Sources: The Sycamore Institute analysis of “Total State Budget: Comparison of Programs and Revenue Sources” and “Comparison Statement of State Revenues” from the FY 1996 -1997 – FY 2016 -2017 Tennessee State Budgets

BUDGET TRENDS AVERAGE ANNUAL TENNCARE SPENDING GROWTH vs. OTHER HEALTH CARE SPENDING Sources: Tenn. Care information from The Sycamore Institute’s analysis of “Comparison of Programs” from the FY 1996 -1997 – FY 2016 -2017 Tennessee State Budgets; Medicaid, private health insurance, and national health expenditures information from “NHE Historical and Projections, 1960 -2025, ” Centers for Medicare and Medicaid Services, available from https: //www. cms. gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and. Reports/National. Health. Expend. Data/National. Health. Accounts. Projected. html.

HEALTH POLICY

IMPACT OF DIFFERENT FACTORS ON RISK OF PREMATURE DEATH Health Care 10% Social and Environmental Factors 20% Genetics 30% HEALTH & WELL-BEING Individual Behavior 40% Source: Kaiser Family Foundation’s analysis of Schroeder, SA. (2007). We Can Do Better – Improving the Health of the American People. NEJM. 357: 1221 -8.

HEALTH POLICY • Research approach to health policy • Does the policy… • Improve the health status of individuals, families & communities? • Defend the population against what threatens its health? • Protect people against the financial consequence of poor health? • Provide equitable access to people-centered care? • Make it possible for people to participate in decisions affecting their health and health system? • Understand protect against social determinants of health? Source: : World Health Organization’s “Key Components of a Well-Functioning Health System”

FEEDBACK What are the most important health policy issues on the horizon for Tennessee? What issues and research questions do you recommend we explore?

THANK YOU! www. sycamoreinstitute. TN. org @sycamore. TN thesycamoreinstitute MANDY PELLEGRIN Director of Health Policy mpellegrin@sycamoreinstitute. TN. org (629) 888 -9784