Heidelberger Responds to State Medical Association PAC Survey

Maybe discussing state issues is irrelevant to legislative campaign success. But that didn’t stop me from responding to the South Dakota State Medical Association PAC‘s survey on a variety of healthcare industry issues. Here’s what I wrote to SDSMA PAC about Medicaid expansion, recruitment of doctors to rural areas, midwives, and more (with summaries of the topics/questions offered in italics):

Access to Health Care—Medicaid Expansion:

Medicaid expansion is the single greatest improvement we can make right now in health care policy in South Dakota. We should have expanded Medicaid immediately. By dithering for three years, we have given up hundreds of millions of dollars in federal funding that would have created jobs, stimulated our economy, saved money for hospitals and consumers by alleviating uncompensated care costs, helped thousands of workers recover from or avoid illness and contribute more to our economy, and, last but not least, saved lives. We need to replace every legislator who has resisted or been squishy on this issue with a legislator like me who will vote on Day #1 of the 2017 Session to expand Medicaid under the Affordable Care Act.

Access to Health Care—plan to address shortage of primary care and mental health providers:

We have national and state programs—scholarships, loan repayment, recruitment—to help attract primary care providers to our underserved rural communities. I support such programs.

But there are important community and cultural aspects to recruiting professionals—medical and otherwise—to come work in rural South Dakota. If we want young doctors and nurses to set up practices in our rural communities, we need to make clear to them that we are committed to offering them and their families great opportunities. We need to demonstrate a commitment to giving their kids a top-notch education, and that means supporting our K-12 schools. We need assure the doctors and nurses that their spouses (quite likely professionals themselves) will also be able to find good jobs in our rural communities, and that means supporting economic development that promotes not just agriculture and manufacturing but other knowledge-based, high-tech industries. We need to provide those new professionals business, cultural, and recreational opportunities, and that means supporting universal broadband and cellular service (key to telemedicine), good roads, and more public transportation options. And while this may be beyond the Legislature’s scope, we need to ensure that all professionals can earn wages that compete with what they can earn in other states.

Targeted recruitment programs with tax and financial incentives have their place, but in the long term, the most sustainable healthcare-professional recruitment program is to create healthy, thriving communities that young professionals will want to live and work in.

Public Health—teen tan ban?

Yes, given solid medical data, I will support restricting minors’ use of tanning beds.

Tobacco/e-cigs to age 21?

I hesitate to further restrict the rights of adults. I don’t smoke, and eliminating tobacco use is a good public health goal, but I would prefer to continue our focus on what seem so far to have been successful public education campaigns to deter smoking.

Regulation of out-of-hospital births/midwifery:

I staunchly defend women’s reproductive rights. That includes access to birthing options as surely as access to birth control, abortion, and pre-natal care. All reproduction services require some level of regulation to ensure women’s and babies’ health and safety. I’m open to an evidence-based discussion of the benefits and risks of out-of-hospital birthing alternatives so we can provide a regulatory framework like other states have that maximizes women’s rights and health and healthy births.

Increasing coverage/treatment for opioid use disorder:

I support evidence-based, medically appropriate treatment for all addiction in conjunction with proper educational and regulatory programs to prevent drug abuse.

Expanding Good Samaritan protections:

I support holding people accountable for illegal behavior, but saving lives comes first. If Good Samaritan protections save lives, I support them.

Scope of Practice—independent practice by mid-level practitioners:

Certainly we don’t want anyone providing health care that they are not qualified and certified to provide. That said, if there are basic services that physician assistants and nurse practitioners can safely and effectively provide, such services may help alleviate the healthcare workforce shortage in rural communities that are unable to recruit doctors and meet basic health needs that might otherwise go unaddressed and lead to worse outcomes. I will oppose expansions in scopes of practice that put public health at risk. I may support expansions in scope of practice if evidence shows that the certified healthcare professionals in question can improve public health without doing things they aren’t trained to do.

Medicaid funding, adequate reimbursement rates:

The Governor’s creative IHS/Medicaid swap could free up some dollars in the state budget to increase Medicaid reimbursements. Obviously, that route would be preferable to fighting for a tax increase to provide the revenue necessary to pay doctors fairly for the Medicaid services they provide.

On a medical provider tax, I’d need to read a specific proposal, but on principle, I don’t like the idea of taxing people for getting sick. If we have to raise revenue to increase Medicaid reimbursements, I’d prefer a funding mechanism that spreads the burden out progressively among all South Dakotans, capturing wealth where it is rather than imposing greater burdens on the sick and the poor.

Medical School Funding—additional funding, remain independent and statewide?

Our medical school is a key component to ensuring we can recruit doctors for our rural communities. We must continue to fund our medical school adequately. If the medical school needs additional funding, then like Medicaid reimbursement, we need to look at fair revenue sources and weigh that priority against all others in the budget.

Expansion of medical school class size:

As a teacher, I know that the more students I have in a classroom, the less time I can spend interacting with each student individually, evaluating her work, and coaching her on her specific learning needs. I understand that the state has expanded the number of students admitted to each class to address our workforce needs; however, we must make sure that we are providing our med school teachers and practitioners with the resources they need (and that may mean more teachers) to maintain the quality of education. Cranking out more doctors won’t improve our rural health care situation if our graduates get a worse education.

Professional Liability Statutes—medical malpractice environment

Again, I’ll rely on evidence to guide legislative decisions. I can see an argument that the $500,000 cap on general damages imposed in SDCL 21-3-11 may require some adjustment for inflation. But I also understand that caps on damages help deter frivolous lawsuits in an overly litigious society [CAH, response to SDSMA PAC survey, 2016.09.05].

SDSMA is meeting today to review and discuss responses to its legislative candidate survey. I’ll let you know if I pass their quiz… though if I were scoring the survey, I’d weight the Medicaid expansion question to equal 50% of the total survey score and give each of the other ten questions 5%. I welcome your weightings and evaluations in the comment section!


5 Responses to Heidelberger Responds to State Medical Association PAC Survey

  1. Oddly enough, I found some of your answers, directly in line with mine.

    Of most interest was the rural access to health care. While the state can support some of the needs like roads and telecommunications. Local communities are going to have to step up and do their part.

  2. Interesting, MC! I hope SDSMA PAC will post everyone’s responses so we can compare notes and find common ground. I’d love to see what the vote count looks like right now among candidates on Medicaid expansion.

    I can dig your response on local communities sharing recruitment effort. Some of that effort is just being welcoming to new residents (step #1: don’t hold monthly Klan meetings with Ron Branstner). Part of the effort has to come from providers: whatever recruitment efforts towns and the state offer, the hospitals and clinics still need to offer competitive wages. I check the SDBOR Dashboard and find that average annual pay for healthcare practitioners and technicians in South Dakota is $66,700. National average is $77,800. We rank sixth from the bottom.

  3. I am generally opposed to increasing any government program, including Medicaid. Given the recent changes in the health insurance industry, the need for health care (not insurance), I have to say I cannot support or oppose a plan I haven’t seen.

    Medicaid funding is only slightly more complicated then p=np (Google it) I want to see the entire plan, I want to make sure it covers who it is supposed to cover, and doesn’t cost any more than it is supposed to.
    More often than not the devil is in the details

    I really don’t trust the federal government to pony up their share of the cost. The South Dakota Tax payer will get caught holding the bag. I want to make sure that doesn’t happen.

  4. MC, the Governor’s plan has been available since last December. It’s not that complicated. It saves South Dakota money.

    http://dakotafreepress.com/2016/02/28/feds-say-yes-to-expand-ihs-funding-path-clear-for-sd-medicaid-expansion-or-dirty-k-12-trick/

    Read more from the Governor’s Health Care Solutions panel:

    http://boardsandcommissions.sd.gov/Meetings.aspx?BoardID=145

  5. Darin Larson

    MC, says “I really don’t trust the federal government to pony up their share of the cost. The South Dakota Tax payer will get caught holding the bag. I want to make sure that doesn’t happen.”

    That’s brilliant. South Dakota has lost out on about $1 billion so far in federal funds for healthcare for 50,000 SD citizens and you are still looking for loopholes. The governor negotiates a deal that takes SD’s share down to a net zero for Medicaid expansion and you are still not satisfied. We are going to lose out on another $300 million next year.

    And you say that you don’t want SD taxpayers holding the bag: they already are holding the bag. They are holding the bag for indigent medical costs that the counties have to pay for. They are holding the bag for the high costs of emergency room visits instead of preventative healthcare. The costs are passed on to taxpayers whose own insurance costs rise because of all of the people without insurance. These are the economic costs to taxpayers in SD. Let’s not even mention the benefits of getting proper healthcare for 50,000 low income South Dakotans.

    I also don’t understand how Republicans are wary of relying on the federal government to meet its obligations with regard to Medicaid when SD Republicans in the legislature gladly depend on $1.7 billion in federal funds each year to balance our budget. That’s right, the feds supply roughly 35% of our state budget to the tune of $1.7 billion a year and Republicans are going to turn up their noses at another $300 million from the feds because the feds are undependable? SD is one of the most dependent states on federal funds. The legislature loves federal money, except if it has Obama’s name associated with it.