Week six of the 2017 legislative session  is now behind us. This week I’ll take a quick look at President Trump’s nominee to head the Center for Medicaid and Medicare Services (CMS), then review Representative Fred Wood’s “Health Care Assistance Program” bill, and look at its implications for Idaho’s gap population. I have added new advocacy opportunities, and will discuss a few pieces of legislation in depth. This week I would like to extend special thanks to Rep. Melissa Wintrow for taking the time to provide me with comprehensive information on one of the bills I will highlight, H0146. As always, if you have questions, comments, or suggestions regarding issues or items that you would like to see followed here, please feel free to contact me at: tiffenystees.policyintern@gmail.com.

On the National Level

Last Thursday, Seema Verma underwent a confirmation hearing for appointment as administrator of the Center for Medicaid and Medicare Services (CMS), the trillion annual dollar agency responsible for managing health benefits for 100 million Americans, including the Children’s Health Insurance Program (CHIP). Verma is a private health care consultant and architect of the “Healthy Indiana Plan 2.0,” (HIP). The philosophical underpinnings of HIP, as co-stated by Verma, embody a “meld[ing] [of] two themes of American society that typically collide in our healthcare system, rugged individualism and the Judeo Christian ethic.” Verma noted that HIP was designed to give participants a sense of ownership, or “skin in the game,” related to their healthcare. Read Verma (and Roob’s) full article here. President Trump has referred to Verma as the person who “will transform our healthcare system for the benefit of all Americans.” In her confirmation hearing, Verma declined to answer questions directly related to her vision of Medicaid reform related to block grants or per capita caps. Verma did indicate that what she does support, "is the program working better, whether that is a block grant or per capita cap,” claiming further that, “there are many ways we can get there." Read source material for these statements here. Read the interim evaluation report of HIP 2.0 here. As of this writing, Verma’s official appointment is still pending.

On the State Level

On Monday, February 13^th, the House Health and Welfare Committee voted unanimously to introduce Rep. Fred Wood’s (R-Burley) bill H0160 (reported printed and referred to Health and Welfare on 02/15/2017). H0160, or “The Health Care Assistance Program,” proposes to use $10 million of the state’s Millennium Fund to provide primary care and limited prescription coverage to Idaho’s gap population. Wood testified to the committee that funds are limited and, therefore, coverage would only extend to “a limited sub-group of adults and is not comprehensive care.” Wood further stated, in comments made after the meeting, that eligibility would be determined, “basically on a first-come, first-served basis.” Similar to Verma’s HIP 2.0 plan, patients under H0160 would be required to pay participating provider fees up to $20, thereby demonstrating an autonomous commitment to their healthcare process. Read the full text of this bill at the link provided in the IPHA Bill Tracker below.

Sen. Steven Thayn (R) Emmett and Rep. Ryan Kerby (R) New Plymouth, have also proposed legislation to address Idaho’s gap. Bill S1082, (known as the “Community Primary Care Program”) was reported printed and referred to Health and Welfare on 02/13/2017. S1082 is intended to improve the health of low-income Idahoans, while also helping them to develop economic self-sufficiency. There would be a 3-year lifetime enrollment limit according to this program. Reflective of Verma’s “rugged work ethic” stance on the national level, qualifying participants under S1082 would be eligible for an additional $400/year if they engage in “life skills training” (budgeting, conflict resolution, cooking, job seeking strategies, goal setting, parenting or other relationship building, and wellness), or “personal improvement plans.” This program would be funded by state appropriations to the CAT Fund. The full text of this bill is linked in the Bill Tracker below.

 For easy to implement guidelines in contacting Idaho lawmakers regarding health care coverage issues facing our state, Close the Gap Idaho has an excellent template and instructions here. Use it, or pass it on.

Bills in Focus

H0146: Added Protections for Victims of Sexual Assault

H0146 (Rep. Melissa Wintrow, D-Boise), proposes to “codify standards for sexual assault victims’ access to medical examinations,” and, “sets standards for sexual assault evidence retention and preservation.” Further, this bill would ensure that victims are not denied medical exams based on their inability to pay for the same. Representative Wintrow will be presenting on this bill on Tuesday, Feb. 21 at 1:30pm in the House Judiciary and Rules Committee.

Representative Wintrow graciously offered me some clarification by email about H0146, a piece of legislation relevant not only to public health, but social justice in Idaho. She states:

Legislation that works to improve victims' rights is vital; right now, for every 1,000 sexual assaults, only 310 are reported to authorities, and only six perpetrators are convicted. This is a terrible miscarriage of justice and requires law makers to look at systems to better ensure justice.

Currently, there are massive inefficiencies within sexual assault reporting and investigation. There are currently many barriers for individuals when reporting a sexual assault. Victims are often ashamed and wonder if their story will be believed. Once a report to law enforcement occurred, there isn’t always a consistent way that evidence is treated or disposed of, thus the need for this legislation. These barriers contribute to the under-reporting of sexual assault cases in the United States and a lack of justice for victims.   In order to continue holding perpetrators accountable, the state needs to help provide assistance to the people who need it most -- victims. I believe it is our responsibility as government officials to create the most accessible and transparent systems for victims of crime, especially in this case since sexual assault is so grossly underreported.

After passing H528 in 2016 (Idaho Code 67-2929), setting minimum standards for processing sexual assault evidence kits with ISP, a number of questions arose about establishing time standards for biological evidence preservation and destruction in our state.  Law enforcement entities in Idaho have asked for direction from policy makers and legislators regarding the length of time they should preserve these kits.  

Thus, a working group of stakeholders was formed with the goal to create statewide standards for sexual assault evidence kit preservation/destruction to ensure consistent practice throughout our state.

The committee reviewed best practices from other states, work products of national crime victim organizations, the Violence Against Women Act, and perspectives of a variety of stakeholder groups. Efforts were made to ensure diverse representation on the committee in order to increase effectiveness.

H0191: Greater Freedom for Pharmacists

H0191 gives pharmacists the ability to directly give patients certain low-risk medications (such as birth control) for conditions that “do not require a diagnosis, conditions that are minor and self-limiting, and conditions that have a simple CLIA-waived laboratory test which guides clinical decision making.” H0191’s Statement of Purposes notes that other states have seen good outcomes through implementation of similar bills. Read more about pharmacists as drug prescribers here.

 

HCR003: Idaho Caregiver Alliance (ICA) Update

The ICA presented before the Senate Health and Welfare Committee on Thursday, February 16^th on behalf of their proposed, HCR003, a concurrent resolution designed to raise public awareness of the importance of Idaho caregivers, and recognize their enormous contributions to the State of Idaho. HCR003 was unanimously approved, with a “Do Pass” recommendation and will now be sent to the Senate floor. Read the ICA’s Idaho’s Family Lifespan Family Caregiver Action Plan in its entirety here. A link to HCR003 is provided in the Bill Tracker below.

Advocacy spotlight:

A chance to advocate on behalf of Tobacco 21, an initiative strongly supported by the IPHA, is at hand. A (tentative) full hearing in Senate State Affairs Committee (Room WW55, Garden Level), is scheduled for March 1^st at 8 a.m. Talking points for this tentative public hearing have been provided by the American Lung Association, Idaho and can be found here. Read more about what’s happening in the Legislature with this here.

Upcoming Advocacy Days & Involvement Opportunities

February 21^st: Rep. Melissa Wintrow will be presenting on H0126 at 1:30pm in the House Judiciary and Rules Committee. Please see my detailed description of this important piece of social justice/public health legislation above.

February 21^st: Consortium for Idahoans with Disabilities, 1st floor, Capitol from 8 a.m. to 2 p.m. (for more information visit CID on Facebook here

February 27^th: Alzheimer's Association Idaho, the Capitol. Be visible and wear purple to show your support on their advocacy day!

March 1^st: Tobacco 21 (tentative) full hearing at 8 a.m. More information is forthcoming.

IPHA Bill Tracker

Bill No.	Description	Last Action
S1003	Nurse emeritus licenses; licensure renewal & reinstatement	02/14/2017 H-Read first time; referred to Health & Welfare
S1004	Board of Nursing member raise in compensation	02/17/2017 H-Rep. out of comm. w/ a Do Pass Rec.; filed for 2nd reading
S1009	DEQ; crop residue burning	01/31/2017 Read 1st time; referred to Environment, Energy, & Tech.
S1013	Marijuana/drug paraphernalia repeal	02/16/2017 H-Read 1st time; referred to JRA
S1024	Child protective act/definition revised	02/17/2017 S-Read 2nd time; filed for 3rd reading
S1031	Veterans transport fund grant program	02/09/2017 Read 1st time; referred to State Affairs
S1037	Dentists licensing provisions revised	02/15/2017 H-Read 1st time; referred to Health & Welfare
S1038	Dentistry Board/emergency proceedings	02/09/2017 Rep. out of committee; to 14th Order for amendment
S1046	Health savings acct/high deductible plan	02/06/2017 Rep. printed; referred to Commerce & Human Resources
S1050	Immunizations/exemption forms	02/08/2017 S-Reported printed; referred to Health & Welfare
S1058	Telehealth access; cost coverage	02/09/2017 Reported printed; referred to Commerce & Human Resources
S1060	Health care/cytomegalovirus	02/09/2017 Reported printed; referred to Health & Welfare
S1081	Immunization assessment bd/sunset revised	02/17/2017 S-Read 2nd time; filed for 3rd reading
S1082	Community primary care program	02/13/2017 S- Reported printed; referred to Health & Welfare
H0002	Pharmacists reciprocal licensing	2/17/2017 H-Reported signed by Governor on this date
H0003	Pharma/tuberculin protein products	2/17/2017 H-Reported signed by Governor on this date
H0004	Pharmacists, tobacco cessation products	2/17/2017 H-Reported signed by Governor on this date
H0005	Controlled substances, opioids	2/17/2017 H-Reported signed by Governor on this date
H0006	Controlled substances	02/14/2017 H-Reported signed by Governor on this date
H0007	Massage therapists; change “establishment to school”	02/14/2017 S-Introduced; read 1st time; referred to Health & Welfare
H0008	Massage therapists; institute criminal background checks	02/17/2017 S-Rep. out of com. w/ a Do Pass rec.; Filed for 2nd reading
H0010	Chiropractic practice; licensure	02/17/2017 H-Rep. enrolled; signed by speaker; transmitted to Senate
H0011	Optometrists; licensure/provisions & revisions	02/09/2017 Sen. Introduced; read 1st time; referred to Health & Welfare
H0020	Vehicles; hybrid/plug-in fee reduction	02/17/2017 Sen. Passed: ayes 30, nays 2, excused 3;title approved to House
H0025	Tobacco permits, terminology	02/17/2017 Reported signed by Governor on this date
H0038	Mental health, cite ref added	02/17/2017 S-Introduced; read 1st time; referred to Health & Welfare
H0039	Medicaid; H&W agreements	01/24/2017 Reported printed and referred to Health & Welfare
H0040	Hosp, mentally ill, release notice	01/24/2017 Reported printed and referred to Health & Welfare
H0041	Individuals w/ disabilities/ABLE accts	02/13/2017 S-Introduced; read 1st time; referred to Health & Welfare
H0042	Behavioral health, council board	01/24/2017 Reported printed and referred to Health & Welfare
H0043	Med. assistance/eligibility/emotional disturbance	02/13/2017 S-Introduced; read 1st time; referred to Health & Welfare
H0044	Secure treatment facility act	01/24/2017 Reported printed and referred to Health & Welfare
H0045	Dieticians/licensing revised	02/06/2017 U.C. to be returned to Health & Welfare Committee
H0062	Youth mental health; conversion	01/27/2017 Reported printed and referred to Health & Welfare
H0080	Public Health Districts/Funding/bd of trustees	02/01/2017 Reported printed and referred to Health & Welfare
H0081	Health care, J-1 visa waiver program	02/17/2017 Rep. out of committee w/ a Do Pass rec. Filed for 2nd read.
H0091	Immunization register/pro license board	02/17/2017 H-Rep. out of committee w/ a Do Pass rec. Filed for 2nd read.
H0115	Physicians, license background checks	02/17/2017 H-Rep. out of committee w/ a Do Pass rec. Filed for 2nd read.
H0128	Medicaid; payment agreements	02/09/2017 H-Rep. out of committee w/ a Do Pass rec. Filed for 2nd read.
H0146	Sexual assault evidence; med exam	02/13/2017 House - Reported Printed and Referred to JRA
H0160	Health care assistance program	02/15/2017 Reported printed and referred to Health & Welfare
H0191	Pharmacy/prescriptions authorization	02/17/2017 H-Reported printed and referred to Health & Welfare
HCR003	Lifespan Family Caregiver Action Plan	02/17/2017 S-Rep. out of comm. w/ a Do Pass rec.; 10th order; held one legislative day