Governor Kicks off Legislative Session with State of the State Address

• He announced a proposal to improve access to dental care for our families who cannot afford visits to the dentist. This would be a one-time expenditure will help to buy dentistry equipment for our primary care clinics. He called for all dentists to support the effort by volunteering one day a month at our primary care clinics.
• He referenced the need to embrace the advances in healthcare technology, including electronic health records and telehealth applications, saying that West Virginia will continue to be a national leader in using information technology to transform our health care system.   
• He called for an increase in efforts to detect and prosecute medical fraud, beyond insurance, "to all other forms of health care coverage."
• He has asked the insurance commissioner to work with insurance carriers to establish new, affordable benefit packages that will increase coverage options for those unable to afford the insurance products currently available. Specifically, the insurance commissioner would design new coverage plans that promote healthy lifestyles and reward personal responsibility, emphasizing preventive care and catastrophic coverage.
• The insurance commissioner would also develop a web site where individuals and businesses can obtain information on existing insurance options, "so they can become informed consumers".
• He has asked Medicaid to apply for a federal waiver to design a program of basic medical and preventive care coverage using the medical home concept.  First focusing the program on expanding healthcare coverage for working West Virginians, both individuals and parents, whose salaries are at or below 50 percent of the Federal Poverty Level, increasing this to 100 percent of the Federal Poverty Level at some point. 
• He referenced that to pay for the Medicaid expansion "if necessary in the future, I will propose an increase in our state’s cigarette tax to pay for its continuation". (It is unclear about how far into the future this may be and at what rate)

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WVSMA Proposes 2009 Legislative Policies

Each year the WVSMA shares with the Legislature and the Administration our legislative policies.  These policies are designed to be an educational tool for legislators and for our members to use when talking with lawmakers about policy concerns.  These policies are developed over months of discussion by the WVSMA Legislative Committee and then are approved by the Executive Committee and presented to the WVSMA House of Delegates.

The WVSMA Legislative Committee is an active committee of member physicians and alliance leaders.  The committee meets every other week during the legislative session.  Any WVSMA member interested in legislative policy development is welcome and encouraged to join the committee.  Please contact Amy N. Tolliver, MS Government Relations Specialist for more information at Amy@wvsma.com.

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Protecting Medical Liability Reform Legislation

POSITION:
The WVSMA strongly supports the need to preserve the integrity of the Medical Professional Liability Act and to protect against any threats to erode the current statute.

ISSUE:
In recent years West Virginia’s healthcare system has been in severe crisis.  The lack of affordable and/or available medical liability insurance forced many physicians to either restrict the services they offer, move their medical practice out of state or quit practicing altogether.  The Legislature has made great strides in passing new laws designed to stabilize the medical liability system and preserve patient access to care. 

Due to these significant reforms a stabilization of West Virginia’s medical liability market is occurring.  Premium rates have stabilized and West Virginia’s largest carriers recently filed for and received approval from the Insurance Commission for premium rate reductions.  Data also reflects a significant reduction in new claims being filed.  It is critical that the achievements that have been made in recent years are kept in place. West Virginia has a long way to go.  Reforms of this magnitude take years to be fully realized.  We must stay the course.

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Protecting the Healthcare Provider Tax Phase-Out

POSITION:
The WVSMA strongly supports the continued phase-out of the healthcare provider tax with no interruption or slowdown.

ISSUE:
The healthcare provider tax was imposed in 1993 as the Legislature’s solution to generate additional funding for Medicaid.  It was considered an unfair burden by physicians and other healthcare providers and repeal of the law has been fervently sought since its inception. 

Physicians (MD’s and DO’s) were taxed at a rate of 2%. All the following individual healthcare practitioners were taxed at the rate of 1.75% of their gross revenue: Chiropractors, Dentists, Nurses, Opticians, Optometrists, Podiatrists, Psychologists, and Therapists.

In 2001 the Legislature passed a bill initiating the eventual repeal of the tax through a ten-year phase out.  As a result, on July 1, 2009 the tax on physicians will be reduced to 0.2 percent.  Under the current plan set out in code, the tax is to be eliminated on July 1, 2010.  The WVSMA strongly supports the continued phase out of the provider tax.

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Eliminating the Medicaid Cost Shift

POSITION:    
The WVSMA strongly supports fully funding the West Virginia Medicaid program to ensure appropriate reimbursement to healthcare providers for the services they provide and to lessen the cost shifting that occurs to the private healthcare market.

ISSUE:
Medicaid is the largest public health insurance program in the State. The program has become the healthcare safety net for approximately 300,000 low-income people.  Roughly 1 out of every 6 West Virginians, our most vulnerable population – the poor, children, disabled adults and the elderly – are enrolled in Medicaid. 

Why is employer-based health insurance eroding? Government payers like Medicaid account for a large segment of the patient population in West Virginia.  When Medicaid does not pay its full share of costs, healthcare providers must shift the non-reimbursed cost of serving government covered patients to private sector payers.  Simply put, through this cost shift the private sector businesses subsidize public program beneficiaries.  Under-funding government programs creates a hidden tax that inflates prices and forces employers to pay more than their fair share for healthcare. 

To help reduce cost-shifting to the private sector and the growth in the number of uninsured and underinsured in the State, the WVSMA supports responsible initiatives that help secure funding to sustain the Medicaid budget.  Initiatives that are reflective of the state’s fiscal health but also provide the required level of healthcare services for the State’s most at-risk population.

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Supporting Health Care Reform Efforts

POSITION:    
The WVSMA supports efforts to bring about healthcare reform in West Virginia.

ISSUE:
West Virginia, like the rest of the nation is faced with the serious threat of rising costs in health insurance, lessening availability of insurance and concerns with chronically ill patients and a progressively unhealthy population.

West Virginia lawmakers, healthcare providers, business men and women came together over the past year to develop a working plan to move West Virginia forward and out of this healthcare crisis.  A plan was developed which is a good first step toward addressing some of the largest problems facing our state.  The plan aims to open doors to new opportunities and more efficient ways of providing care to our patients.

The WVSMA was a partner in developing this plan and supports the following recommendations outlined in the proposal:

•           Encouraging the establishment of Patient-Centered Medical Home through pilot projects.

•           Establishment of a Central Verification Organization (CVO) for more efficient credentialing of physicians.

•           Initiating wellness and prevention programs.

•           Supporting and funding the development of Health Information Technology infrastructure.

•           Expanding access to care through tax credits to small businesses.

In addition to the official proposals made in the Roadmap to Health recommendations, the WVSMA proposes and encourages the establishment of Health Savings Accounts (HSA) including adding them as an option to the traditional PEIA program.

Now is the time for West Virginia to step up and be a leader in healthcare reform.  The recommendations outlined above will lead our state toward a healthier population while controlling the rising expenditures in health care spending.

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Implementing Asbestos/Silicosis Reform Act

POSITION:    
The WVSMA joins with the West Virginians for Fairness Coalition in support of legislation that would establish (1) minimum medical criteria and procedures for asbestos and silica claims; and (2) require a physician with a physician-patient relationship with the exposed worker to diagnose and establish the presence of these criteria in the exposed worker.

ISSUE:
Mass litigation involving asbestos (and potentially silica) has had and likely will continue have a significant impact on our courts, employees and businesses. West Virginia needs to establish standards and medical criteria for an individual who wants to file a claim related to an injury or impairment from asbestos or silica exposure. Several other states have enacted legislation establishing medical criteria and standards as a way to help improve an injured persons’ ability to adjudicate a claim and to receive appropriate compensation. These standards and medical criteria will help combat claims for non-impaired individuals which only clog the court system to the detriment of truly injured individuals and families.

The WVSMA joins with the West Virginians for Fairness Coalition to support legislation that would establish (1) minimum medical criteria and procedures for asbestos and silica claims; and (2) require a physician with a physician-patient relationship with the exposed worker to diagnose and establish the presence of these criteria in the exposed worker. This legislation will not prohibit those individuals who are not presently impaired as a result of exposure to asbestos or silica from having their day in court.

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Strengthening Tobacco Control Efforts

Clean Indoor Air

POSITION:
The WVSMA supports policies that protect the public from secondhand smoke.

ISSUE:
More than 100 scientific studies demonstrate that secondhand cigarette smoke is a hazardous, cancer-causing air pollutant that causes disease and death in healthy nonsmokers and elevates risk for disease for people exposed to secondhand smoke.

Local boards of health, municipalities, various public agencies and private establishments in West Virginia have acted to protect the public health from secondhand smoke by restricting smoking in enclosed places. Countywide regulations have been adopted in 54 counties and have won widespread support from the majority of the public.

The WVSMA joins with the Coalition for a Tobacco-Free WV in support of policies that provide the maximum possible protection from secondhand smoke in all places open to the public and in places of employment.

Cigarette and Smokeless Tobacco Excise Taxes

POSITION:
The WVSMA supports a significant increase in West Virginia's tobacco excise tax.  Increasing tobacco excise taxes is the single most effective strategy in reducing tobacco use, particularly among children. It is a key component in a comprehensive tobacco-use prevention program.

ISSUE:
The WVSMA seeks to reduce or eliminate tobacco use by West Virginia citizens, especially children, and to eliminate the exposure to secondhand tobacco smoke, which is the third leading cause of preventable death among nonsmokers. The economic toll tobacco takes on human lives in WV is enormous. The state spends over $900 million a year on the direct health care costs of smoking, according to the West Virginia Bureau for Public Health.

It is well documented that increasing the price of tobacco products is the single most effective strategy in reducing tobacco use, especially among youth. One way to increase the price is through excise taxes. The current West Virginia excise tax on cigarettes is 55 cents per pack. This tax was increased in 2003, yet remains well below the national average of 96.1 cents per pack (as of Jan. 1, 2005). With the current tax on cigarettes West Virginia is ranked 36th among 50 states and the District of Columbia (as of September 1, 2006).

The WVSMA joins with the Coalition for a Tobacco-Free WV in supporting a significant increase in the excise tax on cigarettes and an equivalent increase in the excise tax on the wholesale price of all other tobacco products. This will provide not only one of the best mechanisms for reducing youth tobacco use, but also has the potential to bring in substantial revenue to the State.

Tobacco Prevention Funding

POSITION:
The WVSMA supports legislation to allocate adequate funding to tobacco use prevention, cessation, and education programs designed to reduce or eliminate tobacco use and exposure to secondhand tobacco smoke. In addition, we support state efforts to fully enforce all tobacco settlement provisions and maximize its benefit for healthcare and health related programs for West Virginia.

ISSUE:
During the 2000 Legislature, $5.85 million was allocated to begin ramping up to a comprehensive tobacco control program for West Virginia. While at the time this was a significant first step, these funds have not met the funding level needed to fully implement an effective and comprehensive statewide approach to tobacco control.

In each subsequent year, the Legislature appropriated the same amount of settlement funds for tobacco use prevention. While this has demonstrated a commitment to continue investing some funding for tobacco prevention, this is far below what is needed to implement a statewide, comprehensive tobacco prevention program in West Virginia.  In 2006, the first cut in the amount of tobacco prevention funding was made, with $250,000 being directed to drug enforcement efforts by the State Police.

An increase to at least the Centers for Disease Control and Prevention minimum recommended funding level of $14.1 million is needed for FY 2007-2008. The Coalition supports funding in subsequent years at the level of $28 million as recommended in Saving Lives and Saving Money: Blueprint for a Comprehensive Tobacco Prevention Program for West Virginia.

The WVSMA joins with the Coalition for a Tobacco-Free WV in strongly recommending increasing the tobacco prevention funding and implementing a statewide, comprehensive approach to tobacco use prevention.

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Reversing West Virginia's Poor Perinatal Health

POSITION:
The WVSMA supports initiatives to improve the health of pregnant women and children in West Virginia.

ISSUE:
The health of West Virginia’s babies has a tremendous impact on the state’s economy, workforce development and family well-being.  Twelve years ago, West Virginia birth statistics were much brighter than today. The State’s rates for pre-term birth, primary C-sections, vaginal births after cesarean section (VBAC), and low birth weight infants were all more positive for healthy outcomes.  While there are solutions to our child health problems, West Virginia has made little progress over the past decade in improving infant mortality. The Partnership is supporting the following initiatives in 2009:

•           Passage of legislation to create a uniform maternal risk screening tool.

•           Continuation of funding in state budget for lactation consultant trainings.

•           Assure adequate funding for smoking cessation education.

•           Passage of a study resolution on school health.

•           Seek changes in HIV statute to conform with CDC’s recommendations for routine testing of pregnant women.

Better health for our children will be the result of better health for pregnant women and infants.  About 21,000 new babies are born in West Virginia each year. This is a relatively small number - a workable number.  The WVSMA supports the recommendations of the Perinatal Partnership to address this need.

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Combating Poor Oral Health

POSITION:
The WVSMA supports efforts to make policy changes which foster improved oral health for West Virginia’s children and families.

ISSUE:
West Virginia is a leader nationwide in the percentage of our citizens with tooth loss and decay.  By the time of high school graduation, over 80 percent of West Virginia youth have had dental caries (infectious disease which damages the tooth leading to cavities); over 60 percent have had dental caries by age 8 and over 30 percent of West Virginia children suffer from untreated decay.  Over 45 percent of West Virginia adults, aged 65 and older, have lost all their natural teeth.

Dental disease is the single most prevalent chronic childhood disease and correlates directly to other health concerns. With today’s tools and technologies, oral disease is almost 100% preventable.  Prevention is cost effective, with the potential to save millions of dollars.

Ensuring good oral health is a blend of community responsibility and personal action.  Much more needs to be done for oral health education in West Virginia.  To promote the health of West Virginians, save health care dollars, improve learning and worker productivity, West Virginia should pursue policies that will address and improve oral health.  The WVSMA supports efforts to make policy changes that foster improved oral health for West Virginia’s children and families.

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Encouraging Routine Voluntary Screening for HIV

POSITION:
The WVSMA recommends the West Virginia HIV testing laws be updated and modified to require simple consent for routine voluntary HIV testing.

ISSUE:
Human immunodeficiency virus (HIV) testing is entering a new era in this country as lawmakers, health care and insurance executives, and public health officials are making changes in their respective fields to ensure that more people will know their HIV status.  Knowing their status is an important consideration for maintaining health and reducing the spread of the virus.

In 2006, the CDC revised their recommendations for HIV testing of adults, adolescents and pregnant women in healthcare settings.  The objectives of these recommendations are to increase HIV screening of patients, by urging routine voluntary screening of all persons in the healthcare setting; foster earlier detection of HIV infection; identify and counsel persons with unrecognized HIV infection and link them to clinical and prevention services; and further reduce transmission of HIV from pregnant women to their babies.

West Virginia’s law, enacted early in the epidemic, required informed or written consent before a test could be conducted; this was supported at the time by physicians and other healthcare providers because there were concerns for confidentiality and there were no available treatments for the disease. 

A change in West Virginia law will trigger a cultural shift among physicians and other providers and the general population that will ensure that HIV screening becomes truly routine. The essence of this important law change is to give priority to identifying West Virginians who are unaware of their HIV status and get them into care and treatment and prevention while sustaining the fundamental voluntary nature of HIV screening.

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Updating the Management of Intractable Pain Act

POSITION:
The WVSMA recommends updating the statutory definition of pain to conform with current state, national and international uses of the term.

ISSUE:
The West Virginia Legislature passed the Management of Intractable Pain Act in 1998.  At that time, West Virginia was ahead of most states in recognizing the importance of treating severe pain, especially for patients at the end of life.  The definition used in the Intractable Pain Act was the one that was prevalent at the time.  Nine years have passed, and this once favored definition is no longer preferred.  The definition of intractable pain in the West Virginia Management of Intractable Pain Act is ambiguous.  It has unclear intent leading to possible misinterpretation.  The current definition is not likely to relieve physicians’ concerns about regulatory scrutiny for prescribing opioids as a treatment of first choice for patients in severe pain.

The WVSMA recommends the definition be modified to conform with the new definition of pain developed by the International Association for the Study of Pain which is the most widely used definition of pain throughout the world. The definition reads as follows:  “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms as such damage.”

This proposed new definition has already been adopted by the West Virginia Board of Medicine and the West Virginia Board of Osteopathy in their “Policy for the Use of Controlled Substances for the Treatment of Pain” and is used by the Federation of State Medical Boards in their recommended policies on pain management.

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Protecting Against Non-physician Practitioner Scope of Practice Expansion

POSITION:
The WVSMA opposes the scope of practice expansion of non-physician practitioners without the appropriate education, training and supervision. Safety and protection of the patient is of utmost importance.

ISSUE:
Every year, in nearly every state, non-physician practitioners lobby for expansion of scope of practice to gain prescriptive and independent practice rights that were once the sole domain of physicians.  The WVSMA recognizes the inevitability of scope of practice overlap.  While some scope expansions are appropriate and beneficial to patients, many are unwarranted intrusions into the physician practice of medicine.  The health and safety of patients are threatened when non-physician practitioners are permitted to perform services that are not commensurate with their education, training and experience. 

Undoubtedly, there is a place for non-physician practitioners in the delivery of healthcare.  With appropriate education, training, and licensing, non-physician practitioners can and do provide extremely beneficial healthcare services.  However, problems arise when such non-physician practitioners seek practice expansions which are not commensurate to their education and training, and may adversely affect a patient’s health or safety.  Determining whether a specific healthcare profession is capable of providing the proposed care in a safe and effective manner is of paramount interest and should be done in a deliberate manner not under political pressure.

The West Virginia State Medical Association does support collaborative arrangements with nurse practitioners, physician assistants, and pharmacists.  Through such collaboration, patient access and quality care can be achieved without threatening quality care and patient safety.  However, protection of the patient is of the utmost importance.  Expanding the scope of practice without adequate medical training and appropriate supervision is unacceptable. 

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Strengthening the All-Terrain Vehicle Safety Law

POSITION: 
The WVSMA strongly supports strengthening West Virginia’s All-Terrain Vehicle safety law.

ISSUE:
Though the Legislature passed All-Terrain Vehicle (ATV) Child Safety law in 2004, much more needs to be done to protect the health and safety of our citizens. In 2004 the West Virginia Legislature passed legislation that requires ATV riders under the age of eighteen (18) to wear helmets. This is significant.  The law forbids underage riders from carrying guest passengers.  Additionally, the law mandated a training course be established for child ATV users and provided law enforcement with the ability to hold adults responsible, under certain circumstances, for their negligence in empowering underage children to unlawfully operate an ATV. 

The West Virginia Legislature has clearly taken a step toward ATV safety, but much more needs to be done to improve the state’s ATV safety laws.

The WVSMA strongly supports legislation with the following components: Removing these non road-worthy vehicles from our public roadways; expanding the mandatory helmet law to cover persons of all ages; strengthening the requirement for ATV safety instruction to require hands-on safety courses; and Prohibition of all passengers except on those machines which manufactures allow for passengers.

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Protecting the Motorcycle Helmet Law

POSITION: 
The WVSMA strongly supports maintaining West Virginia’s Motorcycle helmet law.

ISSUE:
In recent years, efforts have been made by various groups to repeal our critically important motorcycle helmet law.  Such an action by the Legislature would be highly irresponsible.  Helmets are the best-evaluated way to reduce motorcycle accident deaths and injuries. Helmets are 29-35 percent effective at preventing motorcycle deaths and substantially more effective against deaths from traumatic brain injury. A study conducted at the University of Southern California, which analyzed 3,600 motorcycle traffic crash reports, concluded that wearing helmets was the single most important factor in surviving motorcycle crashes.

The National Highway Safety Administration (NHTSA) estimates that helmets saved 1,316 motorcyclist’s lives nationally in 2004 and that 670 more could have been saved if all motorcyclists had worn helmets. (Motorcycle Safety Facts, 2004 data)

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