March 21, 2022 Advocacy Update
The House and Senate have been on their annual budget break since February 9, with hearings that just ended with state agencies to discuss their performance and how the 2022-2023 budget will impact their constituencies. The General Assembly now is set to return to Harrisburg on March 28, and with breaks for Easter/Passover and the primary election, will be in session through June, with a June 30 deadline for passage of the state’s 2022-2023 state budget.
Governor’s Budget Proposal and Reactions
Gov. Wolf provided his eighth and final budget proposal to the General Assembly and public Feb. 8, a record $43.8 billion plan – an increase from this year’s $38.6 billion plan for state dollars - that calls for spending more federal pandemic relief aid now and demanding a big boost in state aid to education and increasing the minimum wage. The full text of the Governor’s address is online here.
In response, Republican leaders predictably said the Wolf proposal doesn’t reflect reality. Senate President Pro Tempore Jake Corman said, “Harrisburg has become Fantasy Island,” and Senate Majority Leader Kim Ward equated it to Popeye and Wimpy saying, “I’ll gladly pay you Tuesday for a hamburger today.”
Republicans pointed to estimates by the state’s Independent Fiscal Office that indicate that the concluded that by 2023-24, the state could be facing a $2 billion deficit. The IFO projected that despite the substantial surplus this year, the state would face operating deficits later in the decade of between $1 billion to $2 billion. The state is still also looking at a $900 million unemployment compensation debt to the federal government left over from the pandemic, and possibly increased costs for Medical Assistance programs at the end of the Federal Health Emergency.
Health Related Budget Issues
Among the health related increases he spotlighted in his remarks, Wolf proposed using the balance of state fiscal recovery funds to provide $250 million for long-term living programs workforce recruitment and retention and workforce development initiatives, $40 million to support and expand behavioral health programs, and $35 million for health care worker student loan forgiveness,
He proposed a $96 million increase in mental health services, a 31.5% increase ($8.6 million) in funding for local health departments, and a $486 million increase in Medicaid Capitation programs, that reflecting MA MCO costs with expanded Medicaid participation. At the same time, he proposed cuts to Medicaid Fee-for-Service and Physician Practice Plans, and for the eighth straight year, proposed a significant (18.7%) cut of more than $4 million from Medical Assistance funding to Academic Medical Centers.
PA-ACP has worked with leadership in the past to resume at least level funding for Academic Medical Centers, and is working on that again this year.
Meetings and negotiations continue with the Wolf Administration, insurers and integrated delivery systems to identify areas of agreement and compromise and to work through disagreements.
Senate leaders have said we will have a vote on our bill in late March. On your behalf, we have been making the rounds with members, and once final language is developed, we will look to engage grassroots.
This legislation covers individual and group health plans, which comprise about 25% of the total insured Pennsylvanians, as Medicare and Medicaid have their own legislation governing prior auth, and MCO’s are covered by separate legislation.
The Senate is planning to again move SB 25, and it will almost certainly do so with more than 40 votes. The bill is on the tabled calendar after being moved out of committee in June. However, we have a solid commitment from House leadership and the Professional Licensure Committee to move the six year pilot project for Health Professional Shortage Areas that was agreed to by all parties last session.
Act 73 extended the state’s telehealth waivers through March 31, but did not extend the payment parity provisions. Legislative leaders, medical organizations and hospital and health systems are all pushing for legislation to make mandated payment for telemedicine permanent before then. The Senate passed SB 705 with a 46-4 vote and it was referred to the House Insurance Committee. That Committee is looking at moving legislation to extend telehealth services for mental health patients and clinics. Last session, the bill was blocked because of its eventual inclusion of abortion counseling and prescription of mifepristone.
MH and ABC-MAP Information Sharing
The House late last year passed HB 1561 and HB 1563, which are intended to get the state in concert with federal security and privacy laws, including HIPAA on issues relating to mental health and drug treatments. With amendments PA-ACP sought, the bills and are now in the Senate Health and Human Services Committee where we hope to get Senate passage. As now written, the treatment information will be shared only with appropriate covered entities, including health plans, health care clearinghouses, and other health care providers who have an insured patient.
Pharmacists and Waiver Extensions
The state’s pharmacists and the retail chain drug store companies are seeking permanent extension of the waivers for immunizations they received as a result of the Governor’s and Health Department’s emergency orders. PA-ACP, along with other physician groups have raised concerns over this prospect, based on patient safety issues. We are also pushing for permanence of provisions to allow filling 30-day supplies for emergency scripts vs. just 72 hours for nonscheduled drugs and schedule 5 substances.
SB 938 would explicitly state that nothing would preclude the DDAP from implementing the established American Society of Addiction Medicine criteria for drug and alcohol treatment providers. The bill passed out of the HHS Committee on a party line vote, and is now on the tabled Senate Calendar.
SB 471, which PA-ACP opposes, is on the Senate calendar for March 28 consideration. The “Medical Freedom Act” asserts that every resident in this Commonwealth has the inalienable right to bodily integrity and should be free from any threat or compulsion that the individual must receive a vaccination. An individual who exercises the right not to be vaccinated must not be denied any right or privilege. In the House, HB 2013 on the Tabled Calendar is another bill PA-ACP opposes. This would create a constitutional amendment to assert individuals’ right to medical freedom. SB 956, which would establish a constitutional amendment banning the right to abortion, is on the Senate calendar for March 28 consideration. PA-ACP opposes all these bills.
Legislative Medicaid Outreach
PA-ACP has been directly involved with the PA Providers Coalition in developing and delivering two separate educational sessions with members and staff of the General Assembly to explain the state’s Medicaid system, how it works, who it serves and details of needs and participation by providers. The first session, held in late November, was attended by more than 40 members of the General Assembly and Staff. The second educational session, held February 18, included 62 additional attendees from the General Assembly.
A better understanding of the state’s MA programs is critical with the potential for a significant change at the conclusion of the federal COVID-19 health emergency. These sessions are hopefully setting the stage for our efforts to need to ensure continuity of coverage and prevent inappropriate terminations when that happens. It’s been estimated that more than 100,000 Pennsylvanians could be moved out of MA with the end of that health emergency declaration. PA-ACP has also offered its assistance to the Department of Human Services in educating patients about their upcoming need to re-file if they went under Medical Assistance because of the FHE.
The state’s primary elections will be held May 17. If you are not registered at your current address, you can do that now online here or by mail. You can change address or your party affiliation online as well – check the appropriate box on the form. The last day to register is May 2.
Reapportionment, Redistricting Finalized
A host of candidates are running for US Senate, Governor and Lt. Governor for both parties, and of them all, only Attorney General Josh Shapiro is without opposition in his race for the Democratic nomination in the primary. Ten Republicans have filed for Governor and a dozen candidates have filed for the Lt. Governor and US Senate races.
The state’s political landscape for elections from 2022 through 2032 is now set, with significant changes. Losing one Congressional seat resulted in some major changes, and as a result, Congressmen Mike Doyle and Fred Keller have announced their retirements, and Conor Lamb is running for the US Senate.
In the General Assembly, by mid-March four State Senators and 26 members of the House had announced they would not be running for re-election this year, a fact that will have major repercussions in the 2023-2024 General Assembly with new leaders and committee chairs, and potentially a change in the majority in the State House of Representatives.
Political Action – Campaign Finance
Contributing to political candidates is a part of any successful advocacy effort. PA-ACP members can make either a one-time or a recurring contribution using PayPal at Physicians and Patients PAC Donation | ERG Partners (erg-partners.com). Corporate contributions are prohibited, and contributions are not deductible as charitable contributions for federal income tax purposes. This website is not a PA-ACP Services Inc. affiliated Political Action Committee, but donations are used to support ERG’s efforts.
ERG maintains separate accounting of these funds, and uses them exclusively to support state level officials who directly impact medical policies. Reports are filed with the state election commission several times a year.
Moving forward to create a Pennsylvania Political Action Committee for Internal Medicine has been approved by the Board of Directors at the Annual Meeting.