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 December 10th

The final week of lame duck came to a close around 4:30am today, signalling the end of the work being done by the 96th legislature of Michigan. This final day did bring a flurry of issues though the House and Senate including money for a new arena for the Detroit Red Wings, replacement for the emergency manager law, repeal of the personal property tax, and the Detroit lighting authority just to name a few, lets take a look at the issues that will effect you:

Tort Reform:

The House Judiciary committee took up the tort reform bills that made their way from the Senate. Senate Bill 1115, 1117, and 1118 were considered in committee. The committee had a litany of legislation that it needed to consider on this past Wednesday. The committee finally was able to support 1115 and 1118 and sent them to the full House for their consideration. On the last day of session the House took up the remaining bills in the package and by 5:10pm, the House was sending to the Governor legislation that would be the most substantial tort reform that Michigan has seen for medical malpractice since the early nineties. Rumors have been floating around that the two other bills that did not make it through the process will be reintroduced in the coming term.

Abortion:

The House and Senate this week traded legislation, House Bill 5711, that addressed several issues surrounding abortion. One would make it illegal to perform an abortion on a woman who has been coerced into receiving one. Secondly there would be licensing requirement for those facilities that would perform abortions and would require reporting to the Department of Community Health. More information on the legislation can been seen at the link above.

Conscientious Objectors:

The House Insurance committee considered Senate Bill 975 which would provide the protection to physicians who chose not to perform a certain procedure due to a religious or moral objection. MSMS submitted a letter to the committee expressing some concerns we had with the legislation but more importantly praised the efforts of the sponsor of the legislation with his willingness to work with the medical community to address those concerns. The legislation did make it out of committee but did not make it out of the House. MSMS expects to work again with the sponsor in the coming term on the legislation.

With the legislative term coming to a close, we will be taking a break for a little bit. Check in next week as we will have a review of the legislative term discussing the issues that MSMS has worked on for the past two years. Comments are always welcome and we want to hear from you. We have a comment section with every article, please feel free to leave one. Keep up with all advocacy efforts at http://www.msms.org/advocacy.

Legislative Update Week of December 3rd

View of the wait into the House gallery.

Week two of the lame duck session of the legislature continued to offer excitement, fireworks, and even an arrest or two around the Capitol. The week started out with not knowing what the House was going to do with the Blue Cross mutualization legislation that was in the House Insurance committee. Rumblings of Right to Work legislation lead to an all out confrontation between union and legislators on Thursday. Lets review the week:

House:

The House Insurance committee finally meet after session on Wednesday to bring the agreement that the House, Senate, and Governor could agree to. The committee passed the legislation to the House Floor where it was amended again with final language that needed to be added. What was added? A fix for those who have medigap policies. The bill now requires the fund set up by the conversion to pay $120 Million yearly to subsidize the medigap policies until 2018. The House also added an elective abortion amendment that would require those who want to have coverage for an elective abortion to "opt in" for that coverage. The package will now head to the governor's desk for his signature.

The House Health Policy committee was scheduled to meet but with the Right to Work legislation being worked on that day, the committee was canceled.

Senate:

The Senate had a couple other items on their agenda that was health related this week, but as it was with the House, it was all about Right to Work. The Senate passed a series of three bills that made it illegal for those in the health insurance exchange to offer coverage for elective abortions unless the patient purchased an "opt in" coverage for the procedure. The package was sent to the House where it could be taken up since the House did consider some other controversial abortion regulations earlier in the year.

The Senate also considered and passed Senate Bill 975 despite some objections from the major medical groups. What this legislation would do, would provide protections for a physician who chooses not to treat a patient based on their religious beliefs. This raised several concerns to Senator , Kahn, a cardiologists, on the Senate floor saying that it goes against the oath that physician's take before entering into practice. The bill will now be sent to the House where with limited time in the legislative year probably will stay.

The House and Senate have one more week to consider items before they leave for the year. Tort Reform is expected to be taken up this week. Stay with MSMS at http://www.msms.org/advocacy to get the latest information on all of the action happening at the Capitol.

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 July 16th

Picture of the Committee Room

The House and Senate reconvened for their one day at the Capitol for July. The Senate concentrated on school teacher retirement reform while the House continued to brush aside calls for the Speaker to resign due to a report published by the Kent County Prosecutor claiming that the Speaker and Rep. Roy Schmidt attempted to defraud the public with the changing of parties that Rep. Schmidt did before the primary filing date. The biggest event of the day though, was the Senate Insurance committee which continued taking testimony on Senate Bill 1115-1118, commonly known as the "Patients First Reform Package."



Dr Gibson-Fountain leading off the
testimony for MSMS Physicians

The Senate Insurance committee started just after 8:00am where four hours of testimony was scheduled for that day. MSMS along with the Trial Bar worked hard to rally their respective memberships to attend the committee meeting. The building and committee room were opened by 6:30 am and by 8:00 am the room was extremely passed capacity. The Trial bar bought white t-shirts that they had handed out to those who came to support their cause to stop the package of bills.
MSMS had six people lined up to testify including:

• Dr. John Bizon, President
• Dr. Steven Newman, Immediate Past President
• Dr. Cheryl Gibson-Fountain, Board Member
• Patrick Haddad, Attorney for MSMS
• Robert Karam, Practice Manager and Immediate Past President of MMGMA
• Justice Cliff Taylor, Former Chief Justice of the Michigan Supreme Court.

Dr. Newman testifying.

Justice Taylor lead off the testimony providing insights counter to the arguments made by the litany of trial attorneys that went in the previous hearings. As for the physician testimony Dr. Gibson-Fountain lead off the testimony providing insights on her experiences and how the package would create greater access for patients. Gibson-Fountain testified:

"Just as is the case in many of the rural areas of Northern Michigan, as a physician who primarily serves Detroit, there is not a long line of young physicians looking to take my place if I were to retire.  As physicians, our services are in demand across the country and the physicians trained in Michigan and elsewhere generally have multiple job offers across the country.  We need your help and support to make Michigan an attractive state to practice by making very reasonable changes to the statutes regarding professional liability."

Dr. Bizon with his daughter Dr. Burturm
testifying on the reform package.

Dr. Gibson-Fountain took a series of questions from the Senate panel and was able to offer direct answers to their questions. Dr. Newman was the second physician to testify stressing that the ability of the patients to obtain relief if there was a negligence was still available with this package. Dr. Newman did take the time to differentiate between the Medical Society and the State Bar association as those on the other side of the issue were blaming the Medical Society for not taking actions to have the licenses of the repeat offenders taken away. MSMS does not have the ability to do that like the State Bar does, that responsibility is left to the Board of Medicine.

Dr. Rose Ramirez interviewing with
local news.

Dr. Bizon finished the round of testimony for MSMS providing a look into what the changes could mean for medicine in Michigan. Bizon went on to testify:

"The bottom line is that tort reform works.  Whether in Michigan or any of the other states that have adopted tort reforms, we repeatedly see the same thing—the insurance market stabilizes and physicians are able, once again, to return to practice.  Michigan has a strong history of being a leader and an innovator in the area of tort reforms."

The committee ended the day without taking any action on the legislation, but was a positive for MSMS. We were able to push our agenda forward and with the help of those who attended the committee it showed the members of the committee that there is support for the package.

 Now both sides will head back to work to find ways to continue to push their messages. Continue staying with MSMS to get updates on the activity of this package of bills along with others at http://www.msms.org/advocacy.

Legislative Update: Spring Wrap Up

Now that the legislature has moved into a summer session calendar it’s time to wrap up on some of the issues that have been on the radar of the Medical Society, let’s review:

Budget:

This year saw another cut scheduled for Graduate Medical Education with the introduction of the Governor's budget recommendation. Governor Snyder wanted to take $17 Million out of the program for other uses, the legislature in some ways disagreed with that recommendations and only took $8.5 Million which was much better than what the Governor has recommended. Primary care physicians will now start to see an increase in Medicaid rates thanks to the Affordable Care Act providing an increase in Medicaid funding to the tune of $281 Million. Included in Medicaid now is payment for services surrounding Autism and OB/GYN's receiving a small bump in their reimbursement rates. We now look to find a way to restore the $8.5 Million that was cut from GME in the coming months.

Helmet Law:

This spring the long battle to keep helmets on motorcyclists was finally lost with the Senate pushing the repeal of the helmet requirement for all motorcyclists in Michigan. As disappointing as this development was MSMS continues to push for the safety of all motorists on the roads, motorcyclists or not and is pushing for the tracking of individuals that were involved in accidents and whether a helmet was used to see if personal freedom is really worth the safety of all.

Medical Marihuana:

MSMS worked with members in the House and the House Judiciary committee to help create a narrow definition of what a patient-physician relationship is when concerning Medical Marihuana. The statute currently in place provided no direction on that relationship leaving many ambiguities when dealing with Marihuana. This definition now provides protections to both patient and physician when dealing with certification for the substance. This bill was sent to the Senate where it is in the Senate Judiciary committee awaiting a vote to the Senate floor.

Abortion:

Before the House left for the summer they attempted to jam a package of bills through the House that dealt with four issues supported by right to life. These issues ranged from the banning of the practice of tele-abortions to requiring increased levels of liability coverage for those who perform a certain amount of abortions. This was a heated issue between those for and against leaving for one interesting committee meeting where then the bills were voted out of committee on the same day as the hearing, which is uncommon for this legislature. This practice left some with a sour taste in their mouths leaving for nothing short of a floor fight which left some members without speaking privileges after the debates on the House floor. The main bill of the package was passed out sent to the Senate, where it is unknown if the Senate even wants to address this hot potato.

Autism:

A small victory but one that could lead to total mental health parity, the legislature finally required that health insurers, private and public, cover the costs associated with Autism. Those who were against providing the coverage were finally able to come to a compromise with the help and encouragement of the Lieutenant Governor. This issue has been close to him since he was a member of the House, so it was fitting that he signed the bill the put this into law. MSMS hopes that this issue will not stop here and the fight will continue until we get total mental health parity.

Tort Reform:

MSMS over the past month has started to push tort reforms for the purposes of finding ways to increase access to patients all over Michigan who need the care. With the Affordable Care Act reforms hanging the balance, the increase of patients who cannot gain access just by the sure numbers of physicians are staying stable while the demand rises sharply, we find that there is simply not enough in the workforce to meet the demand. With the reforms it would make Michigan a more attractive place to practice medicine providing more opportunities for physicians to come and practice here, answering the question of how we address those who need the care and can't find it. The bills started in the Senate and still await a vote from the Senate Insurance committee. MSMS is hopeful that the legislation will be move soon to help those patients who need it the most.

MSMS now looks towards the fall where issues like tort reform, auto insurance reform, and others still linger from the spring session. Once the legislature gets back into session, MSMS will continue to cover all of the activity for you. Just go to http://www.msms.org/advocacy to stay up to date with all that is happening in Lansing and beyond. The Legislative update will be back in July to cover the one session day scheduled for the legislature.

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!

Legislative Update: Week of June 4th

This week saw the Senate concentrating on finishing up the budget, making this two years in a row that the budget for the state has been finished before the annual summer recess. The House concentrated on its income tax relief package at the beginning of the week and passing more education reforms by the end of the week. Lets take a closer look though at items that have an impact on medicine:

House:

The House Health Policy committee met this week to consider House Bill 5711, 5712, and 5713 which amend the public health code to cover several changes concerning abortion. As with abortion, testimony was very emotional, with the Michigan chapter of Right to Life starting out the testimony. 5711 is an omnibus bill that took four pieces of legislation and smashed them together creating a bill that dealt with fetal remain disposal, liability coverage for those preforming a abortion, and two with coercion and being forced into an abortion. Dr.Matthew Allswede, a obstetrician and President of the Michigan chapter of the American Congress of Obstetricians and Gynecologists testified summing up that with the passage of these bills they face threatening further growing the need for obstetricians in the state. Some members of the committee from both sides of the aisle had issues with the legislation but at the end of the day were forced to vote the legislation out of committee. The bills now await action on the House floor which will happen next week.

The House Judiciary committee was scheduled to meet but was canceled due to the impending problems with Detroit lighting. Hopefully the committee will meet this coming Thursday, pending any other reasons to postpone the hearing.

Senate:

The Senate Health Policy committee met this week, although very briefly, considered and took testimony on Senate Bill 481 which would increase the scope of practice for advance practice nurses. MSMS stands adamantly opposed to the expansion and expressed those concerns with the committee. Since the committee was short on time no action was taken on the legislation and it rumored to be reworked in a way that physicians could consider. Once we have more information, we will be sure to share it, as for now we stand ready to work with the committee and fight irresponsible expansion of scope.

The Senate Insurance committee was also short on time this week but continued taking testimony on the Senate version of the Patients First Reform package (SB 1115-1118). It is also rumored that the committee could consider taking a vote next week on the legislation. Stay tuned for updates.

Elections:

The race for congress in Michigan's 11th district just got dicier as the Secretary of State finds that the signatures to get on the primary ballot may have been forged by someone in Rep. McCotter's campaign therefore not making him eligible for the ballot, leaving a virtual unknown running as the Republican front runner. Former Michigan Senator Nancy Cassis as committed to running a write-in campaign to hopefully win the primary ballot. If this happens, it will be the first time that this has been successful in Michigan for that particular office. Things will now heat up in Michigan's 11th.

On a personal note we at MSMS want to offer our condolences to Senator Goeff Hansen and his family with the loss of their son. All of us at MSMS offer our thoughts and prayers through this difficult time.

Continue to stay with MSMS Legislative Update to gain all the information happening at the capitol and more go to http://www.msms.org/advocacy.

MDPAC needs your help to keep Michigan's tort reform intact! Support MDPAC today at http://www.mdpac.org.

Legislative Update: Week of May 28th

This week saw a flurry of budget activity this week with conference committees meeting throughout the Tuesday, Wednesday, Thursday period. The House also took the time to push a cut in the Michigan income tax that was scheduled to come at the beginning of next year ahead of schedule. The House spent most of Thursday night in session, passing all but the education budget, scheduling an unusual Friday session day for the House. Lets review the rest of the week in Lansing:

Senate:

The Senate Insurance committee continued taking testimony on Senate bills 1115-1118, the Patients First Reform package that amends Michigan's tort reform to protect access to Michigan's patients. MSMS testified last week in the committee, coverage on that can be found in last week article. The committee is expected to take a vote on the legislation this coming Tuesday. The Senate Health Policy committee scheduled a hearing for Thursday to take up Senate bill 481 which would expand the scope of practice and provide independence for advance practice nurses. Due to the budget, the committee was cancelled and scheduled for this coming Wednesday at 9:00am.

House:

The House worked long through the week, even into Friday working on the budget. While waiting for the conference committees to come to a conclusion they had the ability to work on some of the other lingering issues. The House did pass House bill 5338 which would amend the public health code to allow the Director of the Department of Community Health to issue orders to place designer substances on the controlled substances list i.e. K2. As mentioned before the House did pass their version of tax relief by upping the time when the rollback of the income tax would take effect.

Budget:

Budget was the main story this week. The Senate passed through all of its individual budget conference reports and the government omnibus that included everything but education funding. The House did the same with the government omnibus but had to wait until Friday's session to pass the education omnibus or "school bus" as it was affectionately called.

The Department of Community Health budget saw some good come out of the conference report. First the legislature rejected the $17 million cut to GME suggested by the governor; rather the legislature funded it with an extra $8.6 million more than what the governor had proposed and a victory from looking at such a substantial cut. Primary care physicians are going to see a rise in their reimbursement rates from Medicaid as $281 Million of federal funding was put into Medicaid to raise the rates for primary care (excluding ER physicians and some OB services) to Medicare rates. This change was a part of the Affordable Care Act. Investments in Health Kids Dental, Medicaid coverage for Autism, and Health Michigan Fund were all positive and more than had expected. The budget now goes to the Governor for his signature.

For the latest legislative news and activity check out http://www.msms.org/advocacy. Help support those who support you, go to http://www.mdpac.org to find out how you can help!

Legislative Update: Week of May 21st

This week has been a busy one for MSMS as the tort reform package supported by MSMS has seen some activity in the Senate with activity upcoming in the House. Budgets were the story of the week as the Governor, Speaker, and Majority Leader came to an agreement on the target numbers for the different budgets. Let's review this week's activity:

Senate:

(From midweek)


Michael Chafty, MD, JD

The Senate Insurance committee took testimony on Senate Bill 1115, 1116, 1117, 1118, affectionately known as the "The Patients First Reform" package. This effort, spearheaded by MSMS and the physician community, is the first significant tort reform package since the early 1990's.

Elmassian and Chafty testify for
the Senate Insurance Committee

MSMS offered testimony from two different avenues during the hearing, first coming from MSMS Preident-Elect Kenneth Elmassian, DO and Michael Chafty, MD, JD, who chairs the MSMS Board Legislative Policy Committee. Both of the physicians commented on how the having these reforms for Michigan's physicians puts Michigan in a category that it has never been accustomed to: a destination for physicians to practice. "Like many other states, prior to the adoption of meaningful tort reform in 1993 Michigan was a state in crisis," said Dr. Elmassian. Elmassian went on to say, "Those of us who live through this crisis are obligated to be vigilant to maintain the intent of the reforms passed in 1993. Senate Bills 1115-1118 seek to do just that."


Kenneth Elmassian, DO

Opponents against the legislation said that it would hinder the patent's or the patent's family's ability to gain recourse for a mistake of a physician. They also say it would take away the ability to provide for the services that a person needs to counter the pain and suffering sustained by the injury. Another argument against the bills was that the tort reforms would not help an impending physician shortage in Michigan because we simply don't have one. Referring to a study from the AMA from 1995, as was pointed out by Dr. Chafty in his testimony, the amount of physicians Michigan has is the right number to serve the population that needs health care. Dr. Chafty noted that with the increasing amount of physicians getting closer to retirement and the growth in the amount of people that are going to need care, the need for physicians will grow to an amount of 4,500 by 2020.

The committee continued taking testimony until 4:30pm that day. It will reconvene again in a week to continue taking the testimony from all of those wishing to testify. MSMS will continue to offer coverage of the proceedings.

The Senate Health Policy committee did not meet this week but there are rumblings that the committee will be posting for the coming week taking up expanding scope of practice for nurses.

House:

The House Health Policy committee did meet this week and had a presentation on drug adherence from CVS pharmacies. MSMS was not able to attend the meeting but understands it was very informative.

The House Insurance committee met this week working on their continued effort to reform Michigan's auto no fault insurance system. This week they considered a series of bills that would exempt certain persons from being protected by the Personal Injury Protection (PIP) sections of the policy. MSMS was concerned with three bills in the package House Bill 5587, 5588, and 5589. These bills would exempt those committing a crime or in the process of committing a crime and their accomplice from PIP coverage and also those who are operating under the influence of alcohol or a controlled substance to be covered under PIP as well. The MSMS Legislation and Regulations committee will be considering these bills at their next meeting. We will continue to monitor their progress.

The House Judiciary committee will be scheduling a hearing for the House versions of the MSMS supported tort reform package this coming Thursday, May 31st at 10:30 am in the Anderson House Office Building. The House versions of the bills are 5669, 5670, 5671, and 5672. Once the committee meets, MSMS will have coverage of the events as they unfold on Twitter, Facebook and our blog.

Budget:

The House, Senate, and Governor have come to an agreement on the target numbers for the coming year's budget. This is positive news for the Department of Community Health budget where more money was allotted for the department which leave the possibility that GME could receive even more funding. MSMS is working with the legislative leaders to ensure just that. The House Republicans are looking to build into their budget an income tax relief package for Michigan that would reduce the income tax rate. Its uncertain the amount of savings that tax payers would see. MSMS will continue to stay with the budget until its signed into law.

For more information on Michigan politics and legislative activities stay connected with MSMS at http://www.msms.org/advocacy. With the upcoming elections, you need to know who support you and your profession, go to http://www.mdpac.org to find out that information and more!

Legislative Update: Week of May 21st (Midweek Update)

Kenneth Elmassian, DO

Today the Senate Insurance committee took testimony on Senate Bill 1115, 1116, 1117, 1118, affectionately known as the "The Patients First Reform" package. This effort, spearheaded by MSMS and the physician community, is the first significant tort reform package since the early 1990's.

Elmassian and Chafty testify for
the Senate Insurance Committee

MSMS offered testimony from two different avenues during the hearing, first coming from MSMS Preident-Elect Kenneth Elmassian, DO and Michael Chafty, MD, JD, who chairs the MSMS Board Legislative Policy Committee. Both of the physicians commented on how the having these reforms for Michigan's physicians puts Michigan in a category that it has never been accustomed to: a destination for physicians to practice. "Like many other states, prior to the adoption of meaningful tort reform in 1993 Michigan was a state in crisis," said Dr. Elmassian. Elmassian went on to say, "Those of us who live through this crisis are obligated to be vigilant to maintain the intent of the reforms passed in 1993. Senate Bills 1115-1118 seek to do just that."


Michael Chafty, MD, JD

Opponents against the legislation said that it would hinder the patent's or the patent's family's ability to gain recourse for a mistake of a physician. They also say it would take away the ability to provide for the services that a person needs to counter the pain and suffering sustained by the injury. Another argument against the bills was that the tort reforms would not help an impending physician shortage in Michigan because we simply don't have one. Referring to a study from the AMA from 1995, as was pointed out by Dr. Chafty in his testimony, the amount of physicians Michigan has is the right number to serve the population that needs health care. Dr. Chafty noted that with the increasing amount of physicians getting closer to retirement and the growth in the amount of people that are going to need care, the need for physicians will grow to an amount of 4,500 by 2020.

The committee continued taking testimony until 4:30pm today, and it will reconvene again in a week to continue taking the testimony from all of those wishing to testify. MSMS will continue to offer coverage of the proceedings.