Harrisburg Advocacy Update – February 17, 2021

Submitted by: John Nikoloff, ERG Partners

 

COVID-19 has impacted state government along with other businesses and industries during the last ten months, and that impact is expected to continue through at least the first half of 2021.  The Capitol building is closed to the public, and to all but essential employees for purposes of COVID-19.

As a result, advocacy is in a new state in Harrisburg – dominated by actions and reactions over the pandemic and state efforts to prevent then mitigate the spread.  Changes in processes, procedures and practitioners dealing with the pandemic are raising issues that will extend beyond any “new normal.”

And with the change in sessions, all legislation that didn’t become law last session must start from scratch and pass both chambers and get the Governor’s approval to become law.  Telemedicine regulation and payment, prior authorization, scope of practice issues for nurse practitioners and pharmacists, among other issues, are now in focus beyond COVID-19.

And the continuing economic struggles due to COVID-19 actions has resulted in a greater need to expand programs to ensure health insurance coverage during the pandemic. Legislation supported by PA-ACP in 2019 has resulted in a state program available at Pennie.com that parallels the federal exchange program.

2021 to Date

In its first few weeks of session, the General Assembly focused on Constitutional amendments that could make it to the ballot for the May 18 primary.  They finished work on the constitutional amendments re executive emergency orders only lasting 21 days without the approval of the General Assembly , revising how the state appellate courts are elected, a proposed amendment barring the denial of equal rights based on race or ethnicity, and one that would grant child sexual abuse survivors who timed-out of the legal system a two-year window to pursue justice.  When it was learned that the Department of State had failed to put the latter out for public notice during 2020 as required, Secretary of State Boockvar was forced to resign, and the General Assembly is working to circumvent the public notice provision to get the issue on the May 18 ballot.

The Governor laid out his priorities for 2021, and provided a video instead of the traditional address to a joint session, facing what the Independent Fiscal Office projected as a $2.5 billion structural deficit for the upcoming fiscal year.  To address this, the Governor proposed raising revenues through legalizing adult use marijuana, increasing the minimum wage, imposing a severance tax, and increasing the state personal income tax from 3.07% to 4.49%.

Most of the Governor’s legislative proposals have repeatedly been rejected by the legislature.  Republican response was predictable.  House Majority Leader Kerry Benninghoff, R-Centre, said the proposals were “as disappointing as it was unsurprising,” noting fears that Wolf’s plans would put additional costs on the backs of businesses that are already struggling.

As for the Republicans in the Senate, they have now postponed planned budget hearings until later in the spring.  The House budget hearings are on track for a normal timetable starting in mid-February.

On the Agenda

As noted, legislation that came close to passage in 2020 will have to start all over again in 2021.  PA-ACP is working on legislation to establish telemedicine coverage and parity with office visits, which came close to final passage last October but stalled over federal REMS list drug prescription.  Highmark this week noted that in 2020 utilization of telehealth services by their members increased more than 3,400 percent over 2019 and more than 3.4 million telehealth services were accessed.  Highmark paid local doctors nearly $300 million for telehealth services in 2020, an increase of more than 8,000%.

Similarly, the Chapter will be working to secure passage of a six-year pilot project for Health Professional Shortage Areas and CRNPs this session.  The nurse practitioners had agreed to this proposal last fall, but have now reverted to efforts to secure independent practice with new legislation.  We anticipate similar efforts to expand scope of practice permanently by retail pharmacies after their engagement with state and federal governments in testing and vaccinating patients during the crisis.

We are also working with both Senate and House members to get introduction and passage of legislation reforming the prior authorization processes, which will be SB 225 and HB 225, sponsored by Sen. Kristin Phillips-Hill and Rep. Steve Mentzer.  And we’ll be working on legislation to prohibit noncompete clauses in health care practitioners’ contracts.

Medical Malpractice/Tort Reform remains an issue as well, and PA-ACP has continued to pressure the Wolf Administration to expand the limited civil immunity from liability it granted a few practitioners last spring.  The House and Senate passed legislation last fall that would have given internists such good Samaritan immunity during the COVID-19 crisis, but the Governor vetoed the bill saying it was too expansive and included many businesses that otherwise simply met the standards set for them.  We will continue to work with the insurers, HAP and other physician organizations to seek legislation or administrative action on this during 2021, as well as efforts with the General Assembly to preclude the state Supreme Court from changing the long-standing rules regarding venue in medical malpractice lawsuits.

Non-legislative Advocacy

PA-ACP continues to work with the Wolf Administration and other professional physician organizations to advocate for state actions in the best interest of our patients and the Commonwealth through the COVID-19 pandemic.  Information on state Covid-19 actions and resources is available on the PA-ACP website.  A summary of some of the advocacy the Chapter has been involved with on prevention and mitigation efforts toward COVID-19 is also online.

Most recently, PA-ACP has pressured the Department of Health to include primary care physicians in the vaccine rollouts, and on February 12 and 15, along with the PA Academies of Pediatrics and Family Physicians, expressed disappointment with decisions to forego use of PCPs in the COVID-19 vaccine effort.  More information on this and the College’s call for further discussions with the Wolf Administration are available on the state COVID-19 resources page.

General Assembly Leadership Changes, Notes

None of this takes place in a vacuum.  PA-ACP works on an ongoing basis with the 203 members of the House of Representatives and 50 members of the state Senate, as well as key staff in the Governor’s Office and state agencies from Insurance to Health to Human Services.

The House and Senate begin 2021 with Republicans in control of both chambers.  In the Senate, Republicans control by a 29-20-1 majority, with Sen. John Blake (D, Lackawanna) announcing he will resign March 8.  The Senate has had several significant changes in leadership, with a new President Pro Tempore Jake Corman (R, Centre) and the first-ever female Majority Leader, Sen. Kim Ward (R, Westmoreland.)  Two progressive Democrats unseated two more moderate Democrats for caucus leadership positions as well.

In the House, the GOP has a 110-92 majority with a seat vacant after Westmoreland County Rep. Mike Reese’s untimely death.  House Democrats elected the first minority and female floor leader in the state’s history, with Rep. Joanna McClinton (D, Philadelphia) leading their caucus.  Another three Democrats defeated last session’s caucus leaders in the process of their in-house elections.

New chairs on key committees

Both the House and Senate have had significant changes among the Committees for 2021-22 that affect the practice of internal medicine and your patients.  These committees receive the majority of bills and resolutions that impact your practices and patients.

Among the dozen committees, there are nine new chairs or minority chairs who have been named for 2021-2022.  And the committees themselves have as many as a dozen new members who must be educated on the issues and impacts of actions on their constituents.  In addition to these committees, the House has a Government Oversight Committee, and each caucus in the House and Senate have Policy Committees which hold hearings on issues and legislation across the Commonwealth.

On your behalf, ERG Partners is working and meeting with all these committee leaders to ensure they understand the roles of internists and how various types of legislation can impact their constituents.

Those who are new to their respective chair positions are noted below with an asterisk.  These men and women have significant control over what legislation and regulations are considered relating to health care and health insurance issues, scope of practice issues, and public health.

If you have relationships with these public officials, please consider signing up as a Keystone Contact for PA-ACP, and becoming part of the Chapter’s ongoing advocacy efforts!  As a Keystone Contact, you will receive legislative updates on key policy issues to help you engage in outreach to the General Assembly and the Wolf Administration.