The Pa. election: Medicaid expansion vs. Healthy Pa.

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Well, that and many other issues. But those other issues are not the subject of this blog, and health care here could be pretty significantly affected by what happens on Nov. 4. So health care it is.

No worries — I’m not planning to start wading into politics now. I’m just going to take this excellent opportunity to show you two health care Q&As featuring Corbett and Wolf.

The first is from the Pennsylvania Homecare Association, and I would be remiss not to point out that, according to its website, this is the first voter guide in the organization’s history. Tells you something about what it thinks of the stakes, don’t you think?

Short answers from the gubernatorial candidates are here, and at the end there’s a link to a PDF that includes their full answers as well as summaries of the health care platforms of the many Senate candidates.

The second is — and I’ll quote here — “Reprinted with permission of the Pennsylvania Medical Society, Pennsylvania Physician magazine, Vol. 1., No. 1 ., Oct. 2014”:

Gubernatorial Health Care Q&A with Pennsylvania Physician magazine

Pennsylvania Physician magazine: We believe that the physicians who provide emergency care face unique challenges that merit higher standards in liability protections. Would you support legislation setting the standard of clear and convincing evidence of gross negligence to find liability in emergency care?

Corbett: I believe that Pennsylvania must continue to examine methods of reforming our medical liability system. The Fair Share Act — which I signed into law in 2011 — was a positive first step in eliminating an environment that fostered rising health care costs and out-of-control medical liability insurance.

In addition, working in partnership with the Pennsylvania Medical Society, I am proud to have enacted the “Apology Rule” in 2013. This legislation enables a health care professional to express empathy for an unexpected outcome without fear of admitting fault.

While we have made significant strides in enhancing Pennsylvania’s liability protections over the past three years, there is still work to be done.

Clear and convincing evidence of gross negligence appears to be an appropriate legal standard to protect our practitioners and attract talented physicians to our emergency rooms. I would welcome an opportunity to examine whether that standard could be implemented while preserving access to appropriate remedies when an incident occurs.

Wolf: I believe our policies need to fairly balance and protect patients’ safety while ensuring emergency medical care providers are able to effectively fulfill their responsibilities. I think reviewing how the Supreme Court’s changes to PA rules of Civil Procedure and the MCare Act have impacted medical malpractice insurance rates and patient safety will help us explore ways to address any imbalances. If, after thoroughly looking at the issues, there is a problem then I will work with key stakeholders to propose a legislative fix.

Pennsylvania Physician magazine: Given the significant disparity in training between physicians and other practitioners, PAMED is focused on promoting the physician-led team. Do you support the concept of the physician-led team as an alternative to scope of practice expansion and independent practice by allied health practitioners?

Corbett: I am not convinced that the expansion of scope of practice, such as for nurse practitioners or other practitioners, is the proper route to address our workforce shortage for primary care needs. Physician-led delivery offers promising cost consolidation in service delivery and enhancements in patient outcomes. I would have concerns about efforts to further compartmentalize service delivery unless the efforts could be justified with clear data to justify such an effort.

Wolf: I believe that we need to promote health care systems that are focused on the needs of patients. I know it requires a team of experts to work collaboratively to address complex needs of patients. That is why I have called for the expanded use of Patient-Centered Medical Homes as a tool to improve health outcomes for residents across the commonwealth.

Pennsylvania Physician magazine: Attracting physicians to work in Pennsylvania, particularly in underserved areas, has been difficult. Do you support expansion of the Primary Health Care Loan Repayment Program and increasing the level of loan repayment in that program?

Corbett: Yes. I believe it is incumbent upon state government to ensure all Pennsylvanians — regardless of geographic region — maintain access to quality and affordable health care. It is for this reason that my HealthyPA proposal continues supporting loan forgiveness programs designed to provide primary health care practitioners with incentive to work in underserved regions of the commonwealth.

Wolf: Yes. As governor, I will dedicate additional state funding to expand the number of primary care physicians who can participate in the state’s debt relief program for medical professionals and increase the number of residency slots for primary care doctors. This additional funding will allow Pennsylvania to keep primary care doctors in the state by offering a loan repayment program that is competitive with other states. And, it will allow us to increase the number of physicians working in Pennsylvania — especially in rural and underserved areas.

Pennsylvania Physician magazine: Would you sign legislation that bans non-compete clauses and restrictive covenants in physicians’ employment contracts?

Corbett: Such a law to ban non-compete clauses would face a long road in the General Assembly; I do not foresee such a measure which would involve the commonwealth interfering in the private affairs of service providers and their employers navigating the legislature in the current or upcoming legislative session. A more effective measure would be outreach and education to new physicians, such as information with which to approach “standard contract” stances of employers, limiting the duration and geographic scope of non-compete clauses and wherewithal to negotiate appropriate buy-out clauses.

Wolf: I know we need to make Pennsylvania an attractive place for all workers. And, I know that there are places in the commonwealth that are struggling to attract high quality health care providers. As governor, I will coordinate a multiparty discussion with my Insurance Secretary, Health Secretary, General Counsel, and Labor Secretary along with outside experts to fashion an understanding that works for all parties in this area and puts patients’ access to quality care first.

Pennsylvania Physician Magazine: Please comment on your No. 1 health care priority.

Corbett: The No. 1 priority of my administration — with respect to health care policy — centers on providing all Pennsylvanians with access to quality and affordable health care. My HealthyPA proposal is designed to achieve this goal by focusing on three key tenets:

1. Increasing Access — Increases our investment in primary health care practitioners and promotes recruiting and retaining health care professionals in underserved regions of the state.

2. Ensuring Quality — HealthyPA continues to protect older Pennsylvanians and individuals with physical disabilities by ensuring they receive the treatment they require and deserve.

3. Providing Affordability — HealthyPA will realize $125 million in savings from the implementation of the Medicaid Reforms and Private Coverage Option which is contained within our waiver application with the federal government.

Wolf: My No. 1 health care priority is to expand Medicaid and improve access to high quality medical care for residents across the commonwealth. Governor Corbett’s Healthy PA is just another move by his administration to direct taxpayers’ dollars to private companies at the expense of hardworking Pennsylvanians.

As governor, I will expand access to Medicaid, which will increase health care coverage to nearly half-a-million Pennsylvanians, save the commonwealth millions of dollars, and pump billions into the state’s economy.

And there you have it

The candidates, in their own words, on health care. Now you know.

• • •

I can’t let you go without a couple of unrelated tidbits.

The first is a study from the Robert Wood Johnson Foundation on how essential health benefits vary from state to state. Here’s RWJF’s brief explanation:

“All qualified health plans under the Affordable Care Act must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. As an interim policy for 2014 and 2015, the Department of Health and Human Services allowed each state to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits.”

The report looks at a list of benefits outside the 10 mandatory ones. It follows; as you’re reading it, try to figure out which one Pennsylvania includes.

• Infertility treatments

• Private-duty nursing

• Bariatric surgery

• Chiropractic care

• Hearing aids

• Routine foot care

• Acupuncture

• Weight loss programs

• Treatment for TMJ

• Nutrition xounseling

• Autism spectrum disorder services

The answer is chiropractic care. Also, in case you’re interested, the only other state that I found that requires just one item on that list is Utah, where qualifying plans must include nutrition counseling.

• • •

Finally, this week I discovered healthgrades.com.

I don’t know how accurate it is or how worthwhile the doctor rating stuff is — but what really impressed me is that you can put in an area, specialty and health care plan and it’ll give you a list of doctors who are covered (although you’d always need to confirm that, of course). I haven’t seen anything else that will do that.