Although day one of the AAFP's 2018 State Legislative Conference here would go on to be dominated by swift-moving slide decks and sobering talk about Medicaid, a morning roundtable for state progress reports kicked off the event with a welcome early jolt of optimism.
After recognizing recipients of the 2018 Leadership in State Government Advocacy Awards, on Oct. 26, the roundtable allowed chapters to tout triumphs, point to successful compromises and recount significant close calls in state legislatures.
Because the reports came in alphabetical order by state, one of the most impressive lists wasn't heard until nearly the end of the session. But the victories that the Virginia AFP (VAFP) notched moved the room and echoed concerns that had come up earlier and would arise again as the conference unfolded.
For one, Medicaid expansion goes into effect on Jan. 1 in Virginia, with eligibility limits growing to include those with household incomes at 138 percent of the federal poverty line.
"The Commonwealth's share will be paid for by a tax on for-profit hospitals, although those hospitals will be partially reimbursed by an increase in Medicaid inpatient reimbursement rates," the chapter noted in its report.
- Constituent chapter representatives who participated in a roundtable discussion during the AAFP's 2018 State Legislative Conference touted triumphs for family medicine and highlighted other important statehouse actions.
- Family physicians successfully lobbied against state bills that would have expanded scope of practice for nonphysician health care professionals.
- Other wins involved direct primary care, Medicaid expansion and physician shortages.
The Virginia chapter also was proud of its work beating back a bill that would have allowed "doctors of medical science" programs in the state to license "advanced-study physician assistants with a scope of practice tantamount to that of a primary care physician."
"While physician workforce shortages remain, the VAFP continues to promote investment into existing physicians and into medical residency programs in order to meet the needs of Virginia's patients," that chapter noted.
Members of the West Virginia AFP (WVAFP) seated nearby joked about reunifying their states before expounding on their 2018 legislative experience, which was more ill-starred. The state legislature passed a bill mandating acceptance of electronic prior authorization requests but it was vetoed by the governor, despite support from the chapter and several other medical professional groups.
It's worth noting that the WVAFP collaborated with the AAFP Center for State Policy on grassroots advocacy efforts dealing with the prior authorization issue both during and after the legislative session that were, the chapter said, "well-received by members and by legislators."
The Florida AFP (FAFP) reported another notable drive for hands-on advocacy. The Florida legislature invites physicians to serve as Doctor of the Day during its 60-day session, and physicians who participate "get unique access to the House or Senate floor, attend committee hearings and meet with legislators while not serving in the Capitol clinic," the chapter explained.
"In 2018, a record 15 FAFP members served, meaning some weeks had multiple members participating," the chapter reported.
The FAFP also reported an important win for direct primary care practices.
A bill signed into law in March amended the Florida Insurance Code "to provide that a direct primary care agreement is not insurance and is not subject to regulation under the code," but rather is simply "a primary care medical practice model that eliminates third-party payers from the primary care provider-patient relationship."
As cannabis-related initiatives continue to land on ballots nationwide and statehouses work out their own measures on this hot-button issue, the Indiana AFP (IAFP) successfully supported a state bill(www.indystar.com) that legalized cannabidiol oil with tetrahydrocannabinol content of 0.3 percent or less, reporting that "our position is that if patients feel that it helps them, there is no reason for it to be illegal." The chapter called passage of the bill "a great bipartisan effort."
A bill in Indiana regarding chiropractors' scope of practice also reflected the efforts of the IAFP, which was able to have language regarding chiropractors' "specific ability to order and interpret advanced diagnostic imaging on all areas of the human body" removed from the legislation.
The Michigan AFP described success in shaping proposed legislation to avoid harming physicians and in addressing physician shortages.
After it was revealed that former Olympic gymnastics physician Larry Nassar, M.D., had sexually abused patients, Michigan legislators proposed bills aimed at protecting patients that included "some potentially serious consequences for physicians," the chapter reported, "most notably the criminalization of errors in documenting certain procedures."
With input from a physician panel that included a family doctor, the legislation was amended to ensure that such errors wouldn't unduly threaten practices.
Meanwhile, Michigan's 2019 budget earmarks $5 million for student loan repayment for family physicians who practice for two years in underserved areas. A separate $5 million initiative called MiDocs(www.mafp.com) is "aimed at expanding residency slots in existing residency programs for primary care residents who have the opportunity to practice in underserved areas."
Scope of practice had a big year in South Carolina, where a bill signed into law this year made, the chapter reported, "significant updates to the Nurse Practice Act as it pertains to practice by advanced practice registered nurses (APRNs)."
The chapter's outreach about the law includes a substantial FAQs page(scafp.org) that explains how the updated protocols affect physicians.
APRNs factored into the Georgia AFP's year, as well. The chapter declared victory in successfully opposing independent scope of practice for APRNs who provide services in counties with a population of less than 50,000.
A prescription drug monitoring program and a requirement that drivers access their cell phones only with hands-free technology were among the other advocacy wins for the Georgia chapter in 2018.
Finally, the Colorado AFP mentioned a big if in its report that has since become a when.
"If Jared Polis is elected governor, we may have Medicaid buy-in/public option legislation," the chapter reported.
Polis, who won on Nov. 6, has talked a lot(www.westword.com) about health care in his state. The Colorado chapter's report reminded members that the new governor's ideas have included "proposing a sort of regional public option that would be a compact among Western state governments to offer a public option as one large risk pool."
A cliffhanger, then. But one family physicians seem ready to work with.
Related AAFP News Coverage
In the Trenches blog: State Legislative Conference Offers Insight Into 2019's Top Issues