Federal Healthcare Issues
AAP Statement on Passage of Funding for Childrens Health Insurance Program
By: Colleen Kraft, MD, FAAP, President, American Academy of Pediatrics
With todays passage of funding for the Childrens Health Insurance Program (CHIP), the families of nearly 9 million children and their doctors can finally take a deep breath. After 114 days of worry, the American Academy of Pediatrics (AAP) welcomes todays bipartisan Congressional action to extend CHIP funding for six years.
Now that Congress has acted on CHIP, we urge a similar bipartisan approach to the other pressing child health issues that remain unresolved, such as the Maternal Infant, and Early Childhood Home Visiting Program (MIECHV), which serves at-risk pregnant women and parents with young children. We also call on lawmakers to find a permanent solution that will allow Dreamers—immigrants brought to the United States as children and who are now young adults—to remain in the United States.
Todays action was an important step forward for children and families. As always, we stand ready to work with elected officials at all levels of government to advance policies that are most supportive of children and their families.
- State-by-state data released today (by Avalere consultants) shows that the Graham-Cassidy proposal would reduce federal funding to states by $215B through 2026 and more than $4T over a 20-year period. All states would lose funding over the 20 year period.
- Yesterday, a bipartisan group of 10 governors issued a letter opposing the Graham-Cassidy proposal and recommending that Congress return to efforts to stabilize the insurance market.
State Healthcare Issues
- The AAP Network Adequacy Advocacy Action Guide provides detailed guidance for AAP leaders working on network adequacy regulation at the state level. The Advocacy Action Guide includes background information as well as advocacy guidance on many facets of this issue, including the documentation of network adequacy, use of objective measures, network directories, and more. AAP State Advocacy staff are also happy to provide targeted assistance to AAP chapters on this issue—dont hesitate to contact us at email@example.com or 847-434-7799 with questions or for targeted consultation.
- Early Intervention Services in Idaho Proposed Rules (pdf - 10/12/2017)
- Raising the Tobacco and ENDS Purchase Age to 21 >> (pdf)
- State Advocacy Planning Resources for AAP Chapters >> (website)
To assist AAP chapters in developing a state advocacy agenda, the AAP hosted a Webinar examining how the Washington, Iowa, and New Jersey chapters have developed agendas to fit their advocacy needs, engage chapter members and other stakeholders, and support AAP priorities.
2017 White Coat Day at the Idaho State Capitol
Click on an issue to read more.
1) Idaho Medicaid Expansion ››
Medicaid Expansion is Killed on the Last Day of the Session
At the beginning of this week, legislation that would have allowed a waiver to provide coverage for individuals under 100 percent of the federal poverty level (FPL) was not allowed to be introduced in the House. Instead, the House passed two alternative bills: HCR 63 require further study of the Gap population, and HB 644 to provide $5 million grants to community health centers to enhance some services to the uninsured. Both HCR 63 and HB 644 were found to be wholly inadequate by healthcare advocates.
When the Senate considered these bills later in the week, the Senate Health & Welfare Committee killed HCR 63, and sent HB 644 to be amended by the full Senate. On the Senate floor, the bill was amended significantly and changed to the waiver proposal quashed earlier by House leadership and supported by Close the Gap proponents. HB 644a, as amended, passed the Senate 27-8.
HB 644a then had to return to the House for a concurrence vote on Friday, the last day of the legislative session. Advocates believed that there were enough votes to pass the amended bill, but unfortunately HB 644a was killed in the House on a straight party-line vote, indicating that political pressure won out over the merits of the bill. And the disheartening result is that 78,000 Idahoans will continue to be without healthcare coverage, unnecessarily costing our state lives and money.
IMA would like to extend our gratitude to all physicians, PAs, NPs, office managers, patients and others who contacted their legislators numerous times, showed up at the Capitol, and otherwise supported efforts to Close the Gap. Your efforts truly made a difference in that the discussion actually advanced further in the Legislature this year than at any point in the past. Thank you!
Status: HB 644a passed the Senate 27-8, but it was killed in the House 55-12.
2) For-Profit DO School in Idaho ››
SPECIAL UPDATE: SURPRISE ANNOUNCEMENT ABOUT FOR-PROFIT DO SCHOOL IN IDAHO
Recently, Governor Otter held a press conference to announce a partnership between Idaho State University and the Burrell Investment Group to launch a for-profit osteopathic medical school, which will be known as the Idaho College of Medicine (ICOM). Construction will begin in early 2017 on land leased from ISU in Meridian, and ICOM will take its first class of 150 students in August of 2018.
As the largest physician organization in the state, the Idaho Medical Association had heard rumors about the potential for a DO school to locate in Idaho, but unfortunately the IMA was deliberately excluded from stakeholder discussions despite our requests to obtain information and participate in the conversation. Therefore, the announcement came as a complete surprise to the IMA and the majority of practicing physicians in Idaho.
At the 2015 House of Delegates, IMA developed criteria to evaluate any proposals for expanding medical education and residency programs in Idaho. Because IMA was prevented from receiving detailed information about the ICOM proposal, we have not had an opportunity to evaluate the ICOM model. However, initial concerns were raised about the large class size of 150, and Idahos ability to accommodate clinical rotations for that number of students since there is currently some difficulty in finding spots now for rotating medical, physician assistant and nurse practitioner students. IMA also has concerns about a lack of residency slots in our state, and the potential for the medical graduates to be forced to go out of state to continue their training.
On the day following the announcement, IMA was finally able to meet with representatives of ICOM. While no justification was given for intentionally excluding IMA from stakeholder discussions, they expressed regret for not reaching out sooner and a desire to work with IMA as the ICOM project moves forward. ICOM Founding Dean Robert Hasty, DO indicated that third and fourth year students will do their rotations in a five state region to include Idaho, Montana, North Dakota, South Dakota and Wyoming. He also indicated that residency slots will be developed in Idaho and throughout the country to accommodate ICOM graduates.
The IMA Board of Trustees will now have the opportunity to hear detailed information about ICOM, and will engage in that process in the coming weeks. Other health care organizations that were able to participate in early stakeholder discussions have come out in support of the ICOM proposal — including the Idaho Hospital Association and the Idaho Osteopathic Physicians Association. The Governor, the Idaho Department of Commerce and many other government and business entities are strongly supportive of this effort as an economic development opportunity for Idaho.
IMA will be reaching out to our physician members early next week with additional information and an opportunity for your input about this proposal. Please watch for those messages.
Here are two articles from the Idaho Statesman regarding ICOM:
3) Medical Education and Residency Program Funding ››
The Idaho State Board of Education has a plan to increase Idaho WWAMI participation by five students per year until we reach a total of 40, and to increase funding to Idahos residency programs to add more training opportunities, many in rural Idaho. IMA strongly supports the Idaho State Board of Education and the Governors Division of Financial Management recommendations to provide funding for five new WWAMI students, two new University of Utah School of Medicine students, and to increase funding for residency programs.
Status: Passed JFAC by a vote of 19-1.
4) Telemedicine Reimbursement ››
IMA supports telemedicine as a care delivery method which upholds and builds upon the Patient Centered Medical Home model of care. Telemedicine plays a critical role in expanding care options by increasing opportunities for specialists to consult with on-site physicians to evaluate and develop a care plan for a patient residing miles away from the specialist. Unfortunately, reimbursement for telemedicine services has not kept up with technology and the expanding uses for telemedicine. IMA supports appropriate reimbursement for telemedicine services and will be introducing legislation to improve current reimbursement.
Status: Held in House Health & Welfare Committee and will NOT proceed in 2016.
5) Increasing Number of Delegates a Prescriber can have to access PMP ››
- HB 374: Increasing How Many Delegates a Prescriber May Have to Access the PMP SUPPORT
The Idaho Board of Pharmacy is proposing legislation that would allow prescribers to authorize up to four (4) supervised staff members to access the Idaho Prescription Monitoring Program (PMP) on their behalf.
Status: Passed and is now LAW.
6) Medical Laboratory Science Act ››
- HB 453: Medical Laboratory Science Practice Act Oppose
The purpose of this bill is to provide licensure for the practice of Medical Laboratory Science. IMA opposes this bill because it does not exempt lab tests performed in physician offices under the direction of a physician.
Status: HB 453 was held in House Health & Welfare Committee and will NOT proceed in 2016.
7) Lowering the age that Pharmacists can Administer Vaccinations ››
- SB 1294: Lowers Pediatric Age for Pharmacists Providing Vaccination From 12 to 6 SUPPORT
Pharmacists can currently prescribe and administer immunizations to persons who are age 12 or older. This legislation changes the age to 6 or older.
Status: Passed and is now LAW.
8) Administration of Epipens without Prescription ››
- SB 1322: Expands Administration of Epinephrine Auto-Injectors Without Prescription SUPPORT
Idaho currently allows schools to stock and administer epinephrine auto-injectors during suspected anaphylaxis without a prescription. This legislation expands the use to camps, churches, daycare centers, amusement parks, sporting arenas and other locations.
Status: Passed the Senate 34-0; Passed the House 65-0; Awaiting Governors signature.
9) Child Friendly Faith Project ››
As Idaho legislators consider a bill that would protect children from egregious faith healing medical neglect, some have a lot to say about religious freedom.
Sen. Lee Heider, who chairs the Sen. Health and Welfare Committee, has repeatedly stated that he opposes a bill that would make it illegal for adults to deny children necessary medical care for religious reasons.
I dont find fault in the fact that, because of their religious beliefs, we should prosecute them if a child dies. You know, its a first amendment right, the freedom of religion.
I think everybody cares about the health of children, Governor C.L. Butch Otter told the media, but we also have to remember the very first amendment to our Constitution. . . . No. 1 was religion. . . . I think its important to remember that they didnt do em alphabetically.
Given this allegiance to protecting peoples right to freedom of religion, one wonders if legislators would also support the legalization of all parenting decisions made in the name of faith, including those that jeopardize childrens health and safety.
10) Vaping Bill ››
The Idaho House Health and Welfare Committee voted Wednesday to require distributors and retailers of e-cigarettes and vaping supplies to obtain a permit from the state.
The permit is identical to that which tobacco distributors must secure before selling cigarettes. Bill sponsor Rep. John Rusche, D-Lewiston, said during testimony the permit would help block youth from accessing e-cigarettes.
Rusche, a retired physician, told his colleagues that though e-cigarettes may have a role to play in helping smokers break their addiction, he believes non-smokers receive no health benefits from taking up vaping.
Vaping and e-cigarettes are new, Rusche said. Theres not enough time to know what the long-term effects is.
There is evidence, he added, that some vaping liquids cause cell damage in the respiratory tract and the lungs.
If the bill finds its way into law, it wouldnt change how Idahoans sell or buy e-cigarettes or vaping supplies, but it would give the state the ability to track businesses that sell such devices.
Erin Bennett, government relations director for the American Heart Association, endorsed the plan. She told the panel that while Idaho law bans e-cigarette sales to minors, youth vaping is on the rise. She also suggested that vaping could serve as a gateway to regular tobacco use.
Rep. Brandon Hixon, R-Caldwell, motioned to approve the bill, calling it a level-headed piece of legislation that could help the state combat future problems with vaping.
These are relatively new in the marketplace, Hixon said. It would be a good idea, in case we have a problem down the road, to have some sort of paper trail leading to the sources of these.
Only Rep. John Vande Woude, R-Nampa, voted against the measure.
The full House will deliberate the bill in the next few legislative days.
The Washington Post wrote earlier this year that e-cigarette and vaping sales are worth about $3 billion a year nationwide.