Legislative Update (Special Edition)

With the Legislature finally closing its books on the 96th Legislature there were many issues that made their way through the process that kept MSMS on its toes. We provided several letters of support or opposition, provides hours of testimony to the House and Senate, and made hundreds of office visits and phone calls and e-mails. All of this truly helped shape the health policy that Michigan gained over the past two years. Now that the session is over we want to take a look at the issues that affected all of us:

Liability Reform:

Drs Elmassian and Chafty Testifying

The largest victory for MSMS this year was the passage of reforms that would bring Michigan's tort climate back toward what was originally passed by the legislature in 1993. Senate Bills 1115 and 1118 were passed by the legislature in, what some would call, a legendary lame duck session of the Michigan Legislature. These reforms did not come without the battles including five committee hearings in the Senate on these bills which lead to huge crowds in the committee rooms. Those who were for and those against the reforms packed the room wanting to make their presence known to the committee and how they felt.

View at tort reform hearing.

After hours and hours of testimony the Senate committee moved the legislation to the floor and from there the legislation had covered it first real hurdle. Deliberations, discussions, amendments, and speeches against and for the legislation lead us to the final day of working session for the legislature where the House finally took up the legislation on the floor and gave it its blessing to send it to the Governor for his signature. It has been almost twenty years since there has been some significant tort reform for medical malpractice in Michigan until the end of this session, these tort reforms will be good for physicians but more importantly good for patients.

Wayne State Medical Students
 lobbying for Tort Reform.

Earlier in the term MSMS worked on legislation that would allow those physicians who are employed to volunteer in clinics and be provided protections that are afforded to those who are retired and work in the clinics (House Bill 4350). There was contention with this legislation since it provided what some classified as blanket immunity has they had in the later tort reform debate. Working with the members of the Senate, MSMS and other parties were able to come to an agreement that would provide the protection to those who are not contractually compelled to work in clinics to receive the liability protections of those who are retired and volunteering. It was a great day for medicine by opening the door to those physicians who wish to give of their time to help those who need the help the most.

Medical Marihuana:

Dr. Newman testifying to the Senate
Judiciary committee on Medical Marihuana

In this term Medical Marihuana left us with the question of what a "bona-fide patient/physician relationship" was in the eyes of the law. In medicine that question can lead to several answers. The face to face relationship all the way to telemedicine can lead to the definition of a patient/physician relationship. The Medical Marihuana statute stated that grey area that required patients to have this relationship with their physician but did not state what that relationship looked like and left law enforcement and the medical community scratching their heads. Insert House Bill 4851 which for the purposes of Medical Marihuana defined what that relationship looked like. Now patients would have to have contact with their physicians regularly rather that a one and done visit as some were seeing for those who were looking to obtain a certification for Medical Marihuana.

Insurance:

Insurance was an issue that started right away in the session with the attempt by the House to change the Michigan Auto No Fault system. House Bill 4936 wanted to provide levels of coverage that a person can obtain that would provide a certain level of financial coverage for any personal injury that occurred in an auto accident. From the state this was an issue that MSMS was against. Legislators were looking to provide choice for those individuals who were looking to save on car insurance and also provide relief to the Michigan Catastrophic Claims Fund, the fund that covers those gravely injured in an auto accident. Proponents of the legislation stated that the changed needed to happen since in its current form it would bankrupt the system. Opponents of the legislation asked to see the numbers and in the end were never given the opportunity to see the hard data. The House Insurance committee did pass a series of reformed and sent it to the House floor for their consideration but were never able to obtain the votes. Expect this issue back again the new session.

It wouldn't be a complete legislative session if Blue Cross/Blue Shield wasn't involved in some way. This term they had the backing of the Governor and finally found a way to get out from under PA 350 or the Nonprofit Health Care Corporation Reform Act. This act provided the tax breaks that the Blues enjoyed but also provided some requirements that the Blues did not enjoy. With the impending implementation of the health insurance exchange in Michigan, the Governor thought it was time to bring a change to the Blues and give them the ability to compete in the insurance exchange among other reasons and push for legislation to reform the Blues. The Legislature responded and created a nonprofit mutual insurer in the state of Michigan and providing a path to those incorporated under PA 350 to convert into this mutual insurer. This legislation did not come without a cost, requiring that the Blues pay to the state $1.56 Billion from now until 2018. This money will be placed in a health fund used to cover health projects and subsides Medigap policies until 2021 at a cost of $120 Million a year. The Governor received his wish and Senate Bills 1293 and 1294 were sent to his desk where they await his eventual signature.

Helmets:

Before the Legislature left for the summer break this past year they decided to take up an issue that has been on the burners of the legislature for years. They finally made a decision on the age old question, should you be required to wear a helmet while operating a motorcycle? In their opinion you should not be required since it was your individual right to determine whether you ride with a helmet or not. Senate Bill 291 made its way through the legislature going through its ups and downs, being amended several time, and at one point being used in the same conversation the changes with Auto No Fault, but in the end it was finally time according to the legislature to act on this measure. MSMS was adamantly opposed to the legislation reasoning that the having helmet on in an accident will give you the greatest chance to walk away from that accident but the Governor and Legislature did not see it that way and now today we have those who cherish their individual freedoms riding without a helmet. Time will tell if this was a wise decision for Michigan.

Graduate Medical Education:

Every year at MSMS we always face small battles when it comes to the budget, whether it’s trying to get more money for Medicaid, trying to stop the cut to public health funding, or trying to keep J-1 visa waivers in the budget we always have some small battles. One that always continued to come up and we feel will continue to, is the funding for Graduate Medical Education. The Governor has presented his last two budgets to the legislature with significant cuts to the program citing that the priority should be funding Medicaid at a higher level so that physicians will service more patients on Medicaid rather than funding the training of new physicians, fresh out of medical school. We see and understand the investment on Graduate Medical Education and what care this provides to those who need to care the most. Through work and education of the legislators we have been able to stay away from the deep cuts proposed by the Governor and only work hard to absorb small cuts from the legislature. In the coming years we will have to continue this fight to keep GME at its current level rather than seeing another cut to the program.

Affordable Care Act:

This is the only federal issue that made out list this year. We all know about the sustainable growth rate (SGR) and how we face looming cuts into Medicare but somehow Congress always finds a way to kick the can down the road. This time we think it will be the same but with the fiscal cliff casting a shadow on other impending issues, it could take some serious lifting by Congress to get this done on time.

US Supreme Court rendering opinion
in Affordable Care Hearings.

But now on to the Affordable Care Act and the decision from United States Supreme Court that some say rocked and other say solidified the nation in the future of its health care. The Supreme Court upheld the law saying that it was in the taxing authority of Congress to mandate insurance for people and was not within the commerce clause of the US Constitution. This left many states that were waiting for a decision under the gun if they were going to start creating their own health insurance exchanges. As for Michigan an attempt was tried with legislation that was sent from the Senate to the House, Senate Bill 693, but failed to gain the proper support from the committee. The state will now have a state/federal partnership exchange in 2014.

Scope of Practice:

This year the Medical Society found itself involved in looking at the future of medicine and how the team approach to care can continue to grow in Michigan. At the start of the term, physician assistants and physicians came together to find ways to grow their partnership in Medicine and came out of those discussions with Senate Bill 384 which brought more clarification on the relationship between PA's and Physicians, strengthening it, providing greater avenues to provides the best care.
Physical Therapists made an attempt this year to provide direct access for patients, bypassing the physician in House Bill 4603. Nurses also were looking for some clarification on their profession and how they fit into the team approach of medicine with Senate Bill 481. Both of these pieces of legislation did not make through the entire legislative process but MSMS is looking forward to continuing discussions with these groups to better strengthen the medical team in Michigan.

Autism:

Dr. Phillip Wise with Lt. Governor
Brian Calley at the signing of the Autism
Legislation.

This legislative term saw the largest advancement in mental health parity in Michigan in decades. MSMS has always had a long standing policy to support mental health parity in the insurance coverage of treatment of mental health conditions. Michigan took a step towards that this term by requiring the coverage of services surrounding the treatment of Autism. This was a priority of the Lieutenant Governor, Brian Calley; an issue that he worked hard for when he was a member of the Michigan House. Senate Bills 414, 415, and 981 started in June of 2011 with 981 adding in March 2012 and by April 18, 2012 it was the law of the land that insurers had to start to cover Autism services and treatment in Michigan. This is one small victory towards the larger goal of mental health parity.

Claims Tax:

Starting in 2011 there were rumblings from the federal government that the use tax that was set up by Michigan to tax the insurers that held Medicaid plans in Michigan was going to be ruled illegal and could penalize the State by holding back funds for Michigan's Medicaid program. A dilemma was presented to the legislature on what to do to replace the revenue needed to obtain the funds needed for Medicaid. Thus the claims tax proposal was created. Senate Bills 347 and 348 eliminated the use tax and created a claims assessment or tax on each of the insurance claims filed at a 1% level in Michigan. This was supposed to solve the revenue shortfall that would come with the elimination of the Use Tax but that as time moved on it proved not to be the case and this year the Medicaid faces a $140 Million shortfall that has to be filled somehow. The Senate tried to move Senate Bill 1359 which would provide an adjustable rate to make the need for revenue but was rejected by the Senate Appropriations committee. The legislature continues to look for solutions for the shortfall.

Abortion:

Abortion was an issue that seemed to be on the forefront this term with the legislature as looked tightens up regulations surrounding this hot button issue. There were several bills introduced and has testimony taken but in the end, these bills were placed into one large bill House Bill 5711. This legislation took a look at four major issues the legislature felt needed to be addressed: the licensing of facilities that perform abortions, the disposal of remains, and the liability protections needed by a physician who performs abortions, and the use of telemedicine in an abortion. Those against this bill called this issue the War on Women and continued to push for its stall in the House and the Senate. Those efforts did fail and in the early morning hours of the last day of session, the House concurred with the Senate and sent the bill to be enrolled and presented to the Governor. It’s currently uncertain if the Governor will sign the legislation.

Abortion found its way into the blue cross mutualization changes mentioned above with amendments that were added by the House to require that coverage for elective abortions be an opt-in coverage rather than an opt-out situation when purchasing coverage. We will have to wait and see the impact it will have on Michiganders.

Impaired Drivers:

Dr. Spanaki testifying with Senator
Schuitmaker on Senate Bills 402 & 403

An issue that MSMS has been working on for several years was finally accomplished this legislative term by providing liability protections for physicians who report to the Michigan Secretary of State that a person may be impaired to operate a motor vehicle. Senate Bills 402 and 403 started in the Senate Transportation committee and made their way through the entire process landing on the Governor's desk at the end of the second week of December. With the Governor's signature on this legislation physicians can report those patients they feel should not be operating a motor vehicle and let the Secretary of State decide whether that individual should be driving.

Bullying:

A major issue for the MSMS Alliance with past term was the creation of regulations for schools on how to handle instances of bullying. House Bill 4163 was created to provide the school districts have plans in place to handle bullying and plans that are specific to their school district but meet certain requirements required in the act. In December of 2011 Michigan joined other states by have the Governor sign Matt's Safe School Law into law.

Concussions  and High School Athletes:

Watching local high school sports over the past several years there continues to be a push to be faster, be stronger, hit harder and just become more physical overall. With this drive the amount of concussions happening in High School athletics was rising sharply leaving physicians, parents, coaches, and school personal concerned for the safety of the students playing athletics. This lead to the introduction of Senate Bill 1122 and House Bill 5697. Both of these pieces of legislation set into motion procedures that needed to be taken by school personal, what clearance was needed to be obtained by the athlete to compete again and what literature was needed to be provided to the athletes and parents on concussions and their treatment. We are hopeful that this will protect those athletes that want to compete at their highest levels.

With a busy legislative term over, MSMS is looking forward to what the next legislative term will bring. Some of the same issues mentioned today could very well make their way back into the legislative picture in the coming term. Stay with MSMS to get the latest information on issues going through the legislature that affect you and your practice at http://www.msms.org.advocacy. We will be taking a break now until the start of the new term, hope you all have a great new year!

 

Legislative Update Week of November 26th

The first week of the legislative lame duck term was off and running right away this week. The House and Senate started working on several issues including some issues important to physicians around Michigan. Wayne State Medical School also made it up to the Capitol this week providing their insight to lawmakers on issues like tort reform and graduate medical education. Let's jump right into it.

House:

The House started their week of long goodbyes from members that will not be returning to Lansing at the end of the year. The House did consider and pass Senate Bills 402 and 403 that would provide protections to physicians to report patients to the Secretary of State, in their opinion, the patient should not be operating a motor vehicle. The package will now make its away to the Governor's desk where all indications are that the legislation will be signed.

The House Health Policy committee met on Thursday with an extensive agenda but ended up only considering Senate Bill 693, a bill that would create a health insurance exchange in Michigan. Testimony was impassioned by those who were against not just the exchange but the entire Affordable Care Act asking the members of the committee not to vote for the bill. The testimony continued and extended the comments that were made about the subject earlier on in the year to the end of committee, where Chairwoman Haines called for a vote on the bill. The bill failed to gain support out of committee with a count of 9 against, 5 in favor, and 2 passing. The Speaker put out the following statement:

“It was my hope the committee would find that a state-run exchange afforded us more control over the unacceptable over-reach by the federal government regarding the health care of Michigan citizens,” Mr. Bolger said in a statement. “After due diligence, however, it is clear that there were too many unanswered questions for the (Health Policy) committee to feel comfortable with a state-run exchange and we will not have one in Michigan.”

The committee adjourned for the day after the vote where rumors were that it would be the last House Health Policy committee for the term. MSMS will continue to monitor the activity of the committee.

The House Insurance committee also came into session on Thursday this week and went to recess right away. The committee did not reconvene once the House session started due to what some say was a lack of a substitute bill for the Blue Cross/Blue Shield conversion. The committee will be scheduled to meet in the coming week.

Senate:

The Senate brought a dogfight to the floor between interest group by working on Senate Bills 1115, 1117, and 1118. These are three out of the four tort reform bills that MSMS has been supporting and working on. After hard work between the groups some compromises were made and placed in the bills. The Michigan Association of Justice was able to get some more amendments placed into the legislation that were not favored by MSMS. With the amendments being added the Senate voted all three bills to the House where the work will continue. MSMS will be working to take out some of the harmful amendments added during the Senate session.

The Senate Appropriations committee met to consider Senate Bill 1359, among others, which provided a fix for the Insurance Claims Tax that was added to replace the Medicaid Use Tax.  The Senate Fiscal Agency along with the Michigan Department of Treasury projected that with the $400 Million that needed to be made up with the repeal of the use tax the state was going to be $144 Million short in funding for the current fiscal year. The committee heard testimony from General Motors being opposed to the legislation since it would be a cost for them since they self insure their employees. At the end of the committee there were pretty strong signs that getting a fix for the Claims tax was going to be difficult.

The Senate Health Policy committee also met this week to consider House Bill 5315 and Senate Bill 975. MSMS commented to the committee that it has concerns with SB 975 but that we were working with the sponsor to find a solution to our differences. Both pieces of legislation were passed to the full Senate on party lines.

Wayne State Lobby Day:

Wayne State students speak with
Senator Smith.

Wayne State brought some of their up and coming physicians to the Capitol to have meetings with legislators and to lobby them on two issues that they felt were important to them, Tort Reform and Graduate Medical Education. With over 65 students invading the Capitol, several groups of students were able to meet with members directly in their offices, while other groups caught them in the lobby of the Senate and House as they made their way out of the chambers.

Drs Bizon and Elmassian addressing
the Wayne Students.

Later in day Dr. Bizon and Dr. Elmassian joined the students to share their thoughts on the future of medicine, why it was important to be lobbying to the legislature, and how they can make a difference in their community. Both were able to join the students later in the afternoon to work with them and support their efforts to lobby the legislature. Dr. Elmassian commented on how he was impressed with the turnout from the students and how we needed to continue to have efforts like this moving forward. "All schools should be thinking of doing this, it would be great for medicine and their future as physicians."

Next week should bring more activity in the legislature, stay with MSMS to get the up to date information including when committee meetings are and what they are considering for the day on the House and Senate floors. Go to http://www.msms.org/advocacy to get all of the information you need.

Legislative Update: Week of November 19th

With elections finally over and the legislature facing its final weeks in Lansing, the chaos of lame duck is about to start. With the House Republicans losing five members, those leaving have agenda items that they would like to see get done in these short weeks. Those members find themselves fighting against the Governor who also has issues that he would like to see completed before the House and Senate head home for the holidays.

Let’s take a look at what we feel will be the top five projects the legislature will be working on in this coming lame duck session:

1.      Blue Cross/Blue Shield Mutualization: With the Senate pushing through their legislation before Election Day, we find that the House has a different story. Hearings have started in the House Insurance committee and have been marathon meetings starting last week and going through this week discussing issues surrounding Medigap and having the Attorney General Bill Schutte testifying that with this package we are pushing Michigan senior towards a cliff, possibly leaving them without the some of the coverage seniors need. MSMS has amendments it will be looking to introduce in the coming weeks to the package protecting some the privileges offered under PA 350.

2.      Personal Property Tax Reform: This is a request and an issue that is important to the Governor and the Lieutenant Governor. This has been an interest to this administration in the past. While LG Calley was a member of the House he was the minority chair for the House Tax Policy committee where eliminating the PPT was an interest to him at that time. A good thing for the LG is that Speaker Bolger is of the same opinion as him, I would imagine that the House will work to get the PPT off the books before they head home.

3.      Health Care Exchanges: With the Senate tackling this issue earlier this year, the House had a wait and see attitude when it came to the exchanges, first waiting for the United States Supreme Court to render its decision then waiting to see the outcome of the elections, the House now faces either federal implementation for work hard over the next few weeks to get a state exchange in place. We'll see what the legislature can accomplish when the majority feels that this isn't the program they wanted to deal with.

4.      Regional Transit Authority: With Detroit dealing with several financial problems, the thought of a regional transit authority would ease those concerns that surround the transit system. This issue has come up time after time and has never been able to make it out of the legislature, maybe this time it could.

5.      PA 4 Replacement: With Michiganders choosing to take the Emergency Financial Manager act off the books we find the state going back to the Emergency Manager act taking away some powers that some would argue were able to get some off the cities and school districts back on better footing. Now some feel there needs to be a replacement that would still provide the authority that the managers need to get these municipal units back on course.

Other items on the horizon could be mining taxes, educational achievement authorities, and the discussion that with the failure of proposition 2 and 4 if that is a signal to the legislature that Michigan is ready to be a Right to Work state.

MSMS will be making our final push for this legislative session on Tort Reform. We still continue to feel positive that we could get some movement on this during lame duck. We also will be working on getting our impaired drivers legislation moved from the House floor and to the Governor's desk and hopefully seeing movement on Expedited Partner Therapy by sine die.

Stay with MSMS throughout this lame duck session to get the latest information affecting you at http://www.msms.org/advocacy.

Legislative Update Week of September 24th

With the legislature winding down for the month of September, the last months of work for the legislators is starting to shape up. The Senate has started to focus on certificate of need reform and allowing for hospital to be built by McLaren in Clarkston. The Governor is focused on the transformation of Blue Cross / Blue Shield into a mutual insurer, and the House focusing on a variety of issues, let’s review the past couple weeks:

House:

Dr. Phillips and Mercantante
testifying in House Health
Policy Committee

The House Health Policy committee met this past week having two items on their agenda. The first was a presentation on the outbreak of the West Nile virus and the effects it’s having on the state. After the presentation they considered House Bill 5934 which would amend the Public Health code to allow for Expedited Partner Therapy in Michigan. Dr. James Phillips, a MD and health officer for Hillsdale, Branch and Hillsdale counties testified for the Medical Society in support of the package. Dr. Annette Mercantante, a MD as well and health officer of St. Clair county testified for the Michigan Association of Local Public Health (MALPH) and for Michigan Association of Public Health and Preventive Medicine Physicians (MAPPP). The Michigan Association of Justice came to the committee to oppose the bills since the legislation sets a gross negligence standard for physicians who utilize EPT and there is an adverse reaction to the antibiotics given for Gonorrhea and Chlamydia. The bill was sent to a work group where hopefully in October, when the House comes back for one day it will be considered by the committee for a vote.

The House Transportation committee continued the work of the Senate and considered Senate Bills 402 and 403. Testimony was taken on these bills similar to what was testified in the Senate and were reported out of committee on Thursday after the committee took a bunch of testimony on regional transit authority issues in Southeast Michigan. Hopefully these bills will be taken up by the House in the coming months and sent to the Governor for his signature. The House Insurance committee started taking testimony on the mutualization of Blue Cross/Blue Shield. This will be a highly contentious issue and one that will on the front burner until the end of the year.

Senate:

The Senate Insurance committee starting taking testimony on Senate Bills 1293 and 1294 that would allow for the mutualization of the Blues. The Attorney General Bill Schuette testified to both the House and Senate committee that he will trust but needs to verify that the conversion will not harm those who depend on the Blues for their insurance. The Senate will continue to take testimony on the legislation but it could be expected for the Senate to take a vote on the legislation in November to push it to the House. Currently the House does not seem interested in pushing this legislation forward so quickly which could push this issue into the New Year.

The Senate Economic Development committee for the past couple weeks has been considering Senate Bill 1269 which would amend the certificate of need statute but also allow McLaren to build a hospital in Clarkston. Testimony was given for and against the bill which lead to a substitute piece of legislation as was reported to the Senate floor on September 12 where the Senate approved the amendment and sent the legislation from second reading to the committee of the whole in the Senate. The timeline is unknown as of now but we could see the bill making its way to the House before Election Day.

Both the House and Senate will now take a break until October 17th when they will both be in for just that day.

If you are looking for more information on who MDPAC is supporting go to http://www.mdpac.org to get the latest election information.

Legislative Update: Week of June 11th

As time winds down on the legislative calendar with the summer break coming at the end of Thursday, the activity in both chambers ramped up with the chambers considering school retiree reform, tax reform, the new bridge to Canada, abortion and more. Let's review the activities of the final week before summer break:

House:

With session times being set to earlier times this week, most House committees did not meet this week.

The full House considered several issues this week but one of the most controversial came from the House Health Policy committee, the abortion omnibus, House Bill 5711. This bill was the main part of the three bill package that addressed several issues that Right to Life Michigan considered important to consider. Debate on the floor was emotional, heated, and provided for several gavels from the speaker for inappropriate remarks. Several members from both sides of the aisle had commented on their desire not to vote on the legislation stating that it went way to far based on the comments of supporters of the package said were a problem. After the debate, the House did vote on 5711 with it passing 70-39 (Roll Call # 448).

Senate:

The Senate did have committees this week but were very limited in the time they had to meet. The Senate Insurance committee continued again to take testimony on the Patient's First Reform package. Many stories were with the committee that said their physician had some if not all of the responsibility in their stories and how the package would not allow the physician and those who were wronged to receive the justice they deserve. At the end of the committee they did not take a vote on the package, with it now moving into the summer months.

The Senate Judiciary committee considered and took testimony on several items concerning Michigan's Medical Marihuana program including the MSMS supported House Bill 4851 which defines the patient/physician relationship when dealing with medical marihuana. It is unknown when the committee is expected to vote out the legislation. The Senate Health Policy committee also met to consider Senate Bill 975 which provides an opportunity for a health professional if they choose not to treat based on religious objections to what treatment is required. The committee just took testimony on the legislation similar to what they did last week on the nursing scope expansion bill. It is unknown when the committee will consider the legislation again.

The Senate floor was less lively than the House's this week but they did move a two pieces of legislation that is supported by MSMS. Senate Bills 402 and 403 that provides protections for physicians to voluntarily report patients to the Secretary of State if they believe in their professional judgment that the patient is impaired and not able to drive. Physicians are not making the decision whether the patient can drive or not, that is the duty of the Secretary of State, but it allows them to report and have liability protections for reporting to the Secretary of State. These bills were voted out of the Senate and sent to the House for their consideration.

Now the legislature goes on break until July 18th where they will meet for one day. The MSMS Legislative blog will be taking a break until the Legislature comes back into session unless there is breaking election news to post. Stay with the MSMS advocacy section of the website at http://www.msms.org/advocacy. Also with elections right around the corner your support of the candidates helps keep things like tort reform intact. Go to http://www.mdpac.org to see how you can help!