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Thursday Mar 14, 2019

Your State Legislature Is a Train Wreck? Don't Look Away

I love health policy. I like following legislation and reading health policy journals, and I read as much about payment models and health disparities as I do about what most would consider normal evidence-based medicine.

Here I am being recognized on the floor of the West Virginia Senate for participating in my state's Doc For a Day program. Being in the state capitol reignited my interest in health policy and advocacy.

But this year has been different. Early in West Virginia's legislative session, which started in January and lasted for 60 days, lawmakers introduced a bill to eliminate mandatory vaccination requirements for public schools -- just as measles cases were emerging across the country.(www.cdc.gov) I got so mad that I decided not to follow the session as closely. It was just too frustrating.

In past years, I have felt I gained energy by following -- and being involved in -- legislative efforts. Being actively engaged in the legislative process, particularly on issues that affect my patients or my profession, has helped me overcome burnout. It's well known that when you feel you don't have the power or ability to change a negative situation, it has negative psychological effects. And there were points during this year's legislative session that I felt depressed by my state.

Fortunately, the vaccine exemption bill never gained traction. But as it died, we began to see active discrimination against the LGBTQ community from delegates. Hateful words were spoken in the House(www.usatoday.com) in support of legislation that would have allowed people to be fired or evicted based on sexual orientation or race. The proposed amendment to a bill was a literal rollback of antidiscrimination language.

At the same time, legislators started working on a bill that would have allowed college students to carry guns on campus.(www.wvpublic.org) Fortunately, discrimination against the LGBTQ community did not stand -- although it was by only a slim 12-10 committee vote -- and the campus carry bill was also defeated.

Then there was a proposed update on 60 water quality standards, with a focus on known carcinogens, that was driven by the West Virginia Department of Environmental Protection based on recommendation by the U.S. Environmental Protection Agency. This led to the most offensive move of the entire session -- one that sacrificed the entire state's health for the sake of industry profit. The House rejected the suggested updates, siding with the West Virginia Manufacturers Association's claim that the state doesn't need to listen to the EPA(www.register-herald.com) because people here are fatter than in other states and, thus, our bodies can handle more pollutants. And because West Virginians drink less water than people elsewhere, we are less exposed to the pollutants.

We did have a few bills intended to improve health that actually passed. Early in the session, a bill allowing people convicted of drug-related felonies to access Supplemental Nutrition Assistance Program (SNAP) benefits(www.wvgazettemail.com) passed the Senate unanimously and then was approved by the House. This leaves only two states -- Mississippi and South Carolina -- that still limit SNAP benefits based on drug convictions.

Then in the last week of the session, West Virginia became one of only 10 states to allow pharmacists to dispense birth control pills via a standing order.(www.wvlegislature.gov) It is essentially a "behind-the-counter" birth control source that will undoubtedly improve access in situations where women who don't have time to make a doctor's appointment and who are likely already on oral contraceptives simply need a refill.

Finally, the West Virginia AFP organizes a Doc for a Day program, and this year, I chose my day to serve by looking through my office schedule for the day with the fewest patients scheduled. It just happened to be March 7, during that last week of the session. I'm glad I went at the end of the chaos because being there forced me to rekindle my interest in health policy. Once I was in the building, I regretted the distance I'd had from the issues I care about. Although I didn't testify during any committee meetings because of my duties as Doc for a Day, I did send a few (I think helpful) texts to one of our state senators during a health committee discussion.

Lesson learned: Complacency isn't good for me or my patients. I had to go back to being an advocate. And I'll never forget where I got my start -- at the AAFP's Family Medicine Advocacy Summit. That annual event, which gives family physicians hands-on experience advocating on Capitol Hill, is scheduled for May 20-21 in Washington, D.C.

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va. You can follow her on Twitter @BecherKimberly(twitter.com).

Read other posts by this blogger. 

Posted at 11:15AM Mar 14, 2019 by Kimberly Becher, M.D.

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