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!