Help out by coming to Jefferson City for our White Coat Day on February 24, 2015. The more physician visibility we have in the Capitol, the better.
The 2015 legislative session will be upon us in no time. With the general election now behind us, the Republicans will control 117 of 163 seats in the House of Representatives and 25 of 34 seats in the Senate. In other words, they have a supermajority in both chambers, and a supermajority renders the Governor’s veto pen less formidable.
Of the 197 seats in the 98th General Assembly, four will be held by physicians. Senator Rob Schaaf, MD, won re-election to the 34th district encompassing Buchanan and Platte counties. Bob Onder, MD, will be the new Senator representing St. Charles County’s 2nd senatorial district. In the House of Representatives, Reps. Keith Frederick, DO, and Jim Neely, DO, won re-election representing districts in Rolla and Cameron, respectively. Missouri physicians are incredibly lucky to have four doctors in the legislature, protecting the practice of medicine from outside forces. Your MSMA lobby team looks forward to working with them this coming year.
In no particular order, here are some of the issues we anticipate working on/dealing with during the 2015 legislative session:
Tort Reform
Hopefully, the third time will be the charm. Back in 2012, the state Supreme Court overturned our successful $350,000 cap on noneconomic damages. The past two legislative sessions, MSMA has led a large coalition of organizations attempting to reinstate the cap. In both 2013 and 2014, our bill passed the House of Representatives only to get bogged down in the Senate. Opposition has been from Democrats and a few stalwart Republican attorneys. We hope this year will be different. During the summer, we have had courteous discussions with the trial attorneys in an effort to find common ground. Plus, with the Republican gains on election night, the veto option looks much less onerous. The Show-Me Tort Reform Coalition will hold its White Coat Rally on Tuesday, February 24, 2015. We certainly hope you can join us at the Capitol that day to lobby in favor of re-establishing the cap. Go ahead and save the date in your calendar, and look for more information on the rally in upcoming MSMA publications.
Nurse Scope of Practice
For the past few years, the nurse lobby has unsuccessfully lobbied for an expanded practice authority. Sometimes, they have asked for a complete end to physician collaboration in their desire for complete independent practice. Other times, they have asked for a lessening of what they consider overly burdensome restrictions on APRN practice. But make no mistake; in the end the nurses want to practice without any physician involvement. We’ve made efforts to compromise with them in the past, but they seem to want all or nothing. We anticipate this issue to resurface yet again this year. In addition to the nurses themselves, CVS and Walgreens will be champing at the opportunity to allow APRNs to see patients in their pharmacies. So we foresee their involvement, as well as newcomer BJC HealthCare, who also sees nurses as a viable primary care option to physicians.
Board Opinions
A few years ago the state Supreme Court ruled, in part, that any opinion of general applicability issued by a state board was a rule, and needed to be properly promulgated under the law. That’s a problem because promulgating rules can be a time consuming process. It certainly takes longer than the physician seeking the opinion desires. The ruling has hamstrung the Board of Healing Arts’ ability to answer simple licensure questions and interpretive inquiries raised by physicians. Presently, the Board routinely answers physicians’ questions with, “a state agency cannot make a statement of general applicability, including answering general questions or interpreting or clarifying statutes, without going through a formal rulemaking process.” We think it’s silly that the boards can’t answer simple questions from their licensees. The potential legislation to fix this problem will allow the Board of Healing Arts - as well as the other professional boards - to offer non-binding opinions when licensees ask questions. Allowing this would definitely help physicians, and could potentially keep to public safe as well in certain circumstances.
Medicaid Expansion
This will be an interesting topic this coming year. With even more Republicans in Jefferson City in 2015 than in the prior General Assembly, it seems it will be difficult for anything remotely related to the Affordable Care Act (ACA) to pass. Just like 2013 and 2014, we predict a number of different bills that would give the state’s MO HealthNet program a facelift. Some of those bills will propose full expansion under the ACA, and others will attempt to “fix” the program by offering to make things transparent or rein in fraud and wastefulness. As we’ve seen in the past, some of these ideas will benefit physicians and some will make it more difficult for you to practice medicine. We’ll do our best to sort the wheat from the chaff, and if anything looks as though it might pass we’ll do our best to make it beneficial to you and your patients, rather than the government and insurance companies.
Licensing Compact
Here’s a new issue we anticipate for next year. The Federation of State Medical Boards is championing an interstate compact for physician licensure. Many other health professionals have similar licensing compacts. The compact would make it quicker and easier for qualified physicians to apply for licensure in multiple states. It would eliminate the state-specific nuances in licensure while ensuring states retain the ability to discipline independently when necessary. The FSMB indicates that only 6% of physicians hold licenses in multiple states, which hampers the ability of physicians to practice across states lines or on digital platforms. As with all legislation, much is determined once we get to read the actual bill language. If this issue pops up, we’ll be prepared.
Summary
These are just a few of the things we’ll see this year, but it doesn’t come close to being an exhaustive list. We anticipate having our yearly discussions over the worthiness of state’s motorcycle helmet law. We’ll find ourselves advocating for stricter texting-while-operating laws and seat belt enforcement. The insurance companies will probably get an earful over narrow networks and prior authorization. Telemedicine will likely come up; as will the pharmaceutical industry and their numerous endeavors. We’ll have to watch some public health groups who will attempt to offer solutions to their own issues for their select set of patients. We’re the only state without a Prescription Drug Monitoring Program (PDMP), so that will be in play. Plus, the chiropractors, optometrists, midwives, etc., never seem to go away. And on and on and on…
Be sure to read MSMA’s weekly Legislative Report during the 2015 session. It will keep you in the loop on all the above and then some. And don’t forget to volunteer as the MSMA Physician of the Day at the Capitol. It’s not difficult, and the legislators love seeing one their physicians from back home. Look for a sign-up sheet on the MSMA website soon. If you have any questions about our advocacy efforts on your behalf, feel free to give me a call anytime at 573-636-5151, or email jhowell@msma.org.
Biography
Jeff Howell, JD, is MSMA’s General Counsel and Director of Governmental Relations.
Contact: jhowell@msma.org
