In this Q&A, Gov. Tom Wolf and Scott Wagner answer PAMED’s health care questions. Note: The opinions and ideas expressed by the candidates are not necessarily representative of the policies and opinions of the Pennsylvania Medical Society.
Q: What are your top three health care priorities?
WOLF: Ensuring access to quality, affordable health care: One of the first things I did when I took office was to expand Medicaid, which has provided health care to more than 720,000 Pennsylvanians. I’ve worked to reduce Pennsylvania’s uninsured rate to its lowest point in history at 5.6 percent, well below the national average of 8.8 percent. Since I have taken office, Pennsylvania has increased enrollment in the Children’s Health Insurance Program by more than 22 percent. The program now serves more than 180,000 Pennsylvania children. I have been a vocal opponent of Republican efforts to repeal the Affordable Care Act and destroy Medicaid, charge seniors more for their care, and strip protections for people with pre-existing conditions.
Combating the opioid epidemic: The heroin and opioid epidemic is a public health crisis, and it is one of my top priorities to help those suffering from substance use disorders find treatment, to save more lives, and to improve response coordination. I declared the heroin and opioid epidemic a statewide disaster emergency, which has improved coordination across state agencies and improved data collection efforts, implemented the new Prescription Drug Monitoring Program, increased access to Naloxone, and expanded treatment, serving thousands of additional individuals.
Protecting doctor-patient relationship: Health care decisions must be made between a doctor and patient without government interference. I have stood in the way of attempts to prevent women from making their own health care decisions by vetoing Senate Bill 3, the most anti-choice bill in the country. SB 3, a 20-week abortion ban, criminalizes a physician’s decision to perform an abortion and includes no exceptions for rape, incest, health, or tragic fetal anomalies. I will continue to stand up for the rights of women and medical professionals to make medical decisions and will stop any bill that makes it harder for women to access care and medical professionals to provide it.
WAGNER: One of the largest issues we currently face is the opioid and heroin epidemic. It is my priority to address this epidemic in a meaningful way that drives long-term results. We need to implement a coordinated care system at the state level to streamline access to care for our most vulnerable citizens and reduce costs. I will apply for a Section 1115 Waiver that will provide quality health care to our citizens in need, while decreasing costs and providing quality of life advances.
Q: Given the significant disparity in training between physicians and other practitioners, PAMED remains focused on continuing the health care delivery model of physician-led teams. Do you support the concept of the physician-led team as an alternate to scope-of-practice expansion and independent practice by allied health practitioners?
WOLF: Since taking office, I have worked hard to ensure Pennsylvanians have access to high-quality medical care. I expanded Medicaid and, as a result of this decision as well as efforts to ensure a stable marketplace in Pennsylvania, the state has the lowest uninsured rates in our commonwealth’s history. I have also committed to expanding broadband access and support telemedicine so that there are no barriers to quality care for our residents. I will continue to support policies to make sure residents from Philadelphia to Erie, Johnstown to Bradford, and everywhere in between are able to access high-quality medical care.
WAGNER: One of the main drivers for expansion of scope of practice is that many of our more rural citizens have limited or no access to primary care. As governor, I will support meaningful proposals that will ensure all Pennsylvanians have access to the primary care they need, but will work with the medical practitioners to ensure that additional access does not lead to inferior care.
Q: Physicians across Pennsylvania and the country have grown increasingly reliant on the use of technology in the treatment of their patients. Do you support the concept of a statutory framework for telemedicine? Furthermore, do you believe potential barriers to expanding telemedicine services and technologies, such as a health insurer’s unwillingness to compensate health care providers for telemedicine encounters, should be avoided?
WOLF: All Pennsylvanians deserve access to quality and affordable health care. Telemedicine can help thousands of Pennsylvanians living in rural communities gain access to health care, but it is important to recognize barriers that may come along with it and work to overcome them. Currently, more than 800,000 Pennsylvanians still lack access to robust, reliable, high-speed internet, especially in rural areas. That is why I recently launched a new initiative that will dedicate $35 million toward expanding broadband access to businesses and households in Pennsylvania. Additionally, I am committed to working with stakeholders, including insurance companies, to ensure telemedicine is a viable tool for residents and medical professionals.
WAGNER: Support of access to telemedicine should be a priority. As telemedicine has grown in use, it has been shown to improve access to care in rural areas and has led to an increase in the efficiency of health care providers while also decreasing costs. I would support a statutory framework as it will set forth a legal guideline and protect those patients that use those services, set forth specifics in regard to care and payment, and also remove some barriers to access. In order for telemedicine to effectively work in our more rural areas, however, we must expand broadband access across the commonwealth.
Q: Responding to the opioid abuse crisis has been a top priority for PAMED. Legislative overreach may result in a denial of legitimate patient access to these medications. What is your vision to address the epidemic in Pennsylvania?
WOLF: I am committed to using every resource at my disposal to help those suffering from substance use disorders find treatment, to save more lives, and to improve response coordination. From day one of my administration, I have taken action to curb this epidemic. I’ve issued a standing order so residents can access the overdose-reversing antidote naloxone and ensured that law enforcement, first responders, and schools are equipped with naloxone, which has reversed nearly 5,000 overdoses since 2014. I also oversaw the implementation of 45 Centers of Excellence, which in their first year of implementation have provided treatment to more than 11,000 individuals suffering from opioid use disorder, and added additional hub and spoke treatment options in 2017 as part of the CURES Act funding the state received. Most recently, I declared the heroin and opioid epidemic a statewide disaster emergency. This declaration, among many things, has enhanced coordination and data collection to bolster both state and local response through the establishment of an Opioid Command Center and expanded access to the Prescription Drug Monitoring Program.
Over the last four years, I have worked to engage medical professionals in meaningful discussions about the prescribing of opioids. Under my administration, in partnership with medical professionals, we have developed voluntary prescribing guidelines specific to practice areas and, with the reboot of the Prescription Drug Monitoring Program, we have finally begun to see a decline in the number of opioid prescriptions. Pain management is complex. And while I believe government should respect the ability of trained professionals to make educated decisions, I have heard too many stories of families who have been torn apart because of the overprescribing of opioids. In the face of an epidemic in which our family members and neighbors are dying, I believe the role of government is to step in and protect our residents, and that is why I have supported prescribing limits and mandatory prescribing guidelines. That said, I am always willing to sit and discuss the best path forward to protect residents.
WAGNER: From my personal experience as a co-founder of the York Regional Opiate Collaborative, I know that the most effective way to address this epidemic is through a multi-pronged approach focusing on prevention, treatment, and recovery. On the campaign trail, I have heard from chronic pain doctors as well as patients who depend on opioids to deal with pain. While I firmly support putting in place every mechanism possible to combat the misuse of drugs and battle the heroin epidemic, I am aware that we must look to all stakeholders in this battle to ensure that any policy shift or proposed law must balance access for those who are not abusers and truly are in need. Without taking steps to end this epidemic, however, we are continuing to do a disservice to families and all that live in Pennsylvania. The additional costs to the Commonwealth as we deal with this epidemic are not sustainable, and the toll it takes on our families is unacceptable. Everyone involved in this industry will need to reform the way they approach opioids.
Q: PAMED is committed to ensuring patients suffering from opioid use disorders have access to medication assisted treatment (MAT). Legislative overreach may result in physicians being unwilling to provide MAT services thus leaving patients without access to this much-needed service. What is your position on MAT, and how will you ensure access to those services?
WOLF: The type of treatment patients receive should be determined by a health care practitioner, and my goal as governor is to ensure that all levels of treatment are available. Medication assisted treatment has proven to be an effective method for treating opioid use disorder as part of a comprehensive treatment plan. I have expanded access to MATs for uninsured, underinsured, and privately insured patients who are suffering from addiction by establishing the Pennsylvania Coordinated Medication-Assisted Treatment (PacMAT) program and our Centers of Excellence. I also recently ended policies that delay access to MATs for opioid use disorder. I will oppose legislation that hinders the ability of medical professionals to provide MAT services to Pennsylvania residents, and I will continue to fight to ensure that patients have access to medically recommended treatment.
WAGNER: MAT programs that include counseling and behavioral therapies should be encouraged as a path forward for those in recovery. Again, when evaluating policy shifts and proposals, we must take into account potential roadblocks and balance those to ensure that necessary protections are not leading to long-term negative consequences for our citizens.
Q: Physicians have seen a dramatic rise in prior authorization requirements by health insurers over the past few years for treatments and medications that are widely accepted as clinical standards of care. Do you support reforming the prior authorization process by health insurers to improve timely and appropriate patient care?
WOLF: I am committed to working with medical professionals, insurance companies, and patient advocacy groups to ensure Pennsylvania residents have access to quality health care and health treatments. Earlier this year, I announced that my administration will be ending policies that delay access to treatment in our Medicaid program by waiving prior authorization requirements for evidence-based opioid use disorder treatments going forward. It is our goal to work with each of the commercial payers and the Medicaid managed care organizations to begin discussions around similar policies to create consistency in coverage across the health care sector in Pennsylvania. Where similar policies hinder access to critical and quality care, I will always advocate for consumers and work with stakeholders to address any unnecessary obstacles to care.
WAGNER: I support increasing the efficiencies in our health care delivery system to reduce costs and delays in care for our citizens. Legislative proposals, such as HB 1293, should be evaluated on their merits and any concerns from interested parties should be addressed. The language contained in that proposal ensures transparency, accessibility, and consistent application by insurers when it comes to prior authorization requests. Supporting legislative proposals that meet those goals should be supported for the benefit of all Pennsylvanians.
Q: Pennsylvania is a Medicaid-expansion state. Do you support continuing the expansion?
WOLF: One of the first things I did when I took office was to expand Medicaid, which has provided health care to more than 720,000 Pennsylvanians, including more than 125,000 people who are suffering from substance use disorder. It is imperative that we continue to work toward ensuring that all Pennsylvanians have access to affordable, quality health care.
WAGNER: In any evaluation of our Medicaid system, we must always take into account that the system involves a complex federal overlay. I believe that the full expansion of Medicaid is not effective at providing cost-effective care, as we have seen health care costs skyrocketing and Pennsylvanians struggling to access quality care. We must end the evaluation of a successful Medicaid program on the sheer number of people enrolled and evaluate our system on patient-centric advances. As governor, I will apply for a Section 1115 waiver that will allow us to provide quality health care services that are cost-effective and create avenues that drive better health outcomes and quality of life improvements. While I support continuing to care for those in need, we also must change our mindset in regards to this action. For my administration, success will be measured not by how many people we cover on Medicaid, but how many people we move from Medicaid to the labor force.
Q: With the rising cost of health care, and the complex physical and behavioral health care challenges of the most vulnerable citizens, what measures would you advocate to strike the proper balance between controlling costs and providing quality, evidence-based affordable health care in this arena?
WOLF: I have been working with a bipartisan group of governors to develop a plan to improve our nation’s health system performance to make it more affordable and accessible for all. The plan calls for focusing our health care system on value — we must align consumer and provider incentives, encourage more competition and innovation, reform insurance markets, expand proven state Medicaid innovations, and modernize the state and federal relationship.
WAGNER: The funding of health and human services in Pennsylvania accounts for roughly 40 percent of the budget. The services that they provide are necessary for our must vulnerable citizens and those who have fallen on hard times. One way to control costs while still providing quality care is to implement a Coordinated Care System at the state level. In many situations, an individual or multiple members of a family may use several of the services provided by the Commonwealth. By establishing a system that focuses on patient-centric care, requiring our different service providers to coordinate care, we cannot only provide better service to those individuals and families, but also decrease costs and improve access to the necessary care our citizens need.
Q: With the shortage of health care professionals across the commonwealth, what measures would your administration advocate for to recruit and retain physicians?
WOLF: Pennsylvania is home to some of the best medical schools, physicians, and practices in the world. We need to ensure that every resident has access to this incredible talent. I am committed to working with medical professionals and key stakeholders to develop a policy agenda to address barriers and ensure the commonwealth is recruiting and retaining physicians throughout the state.
WAGNER: It will be a priority of my administration to take the necessary steps to address and bridge our current skilled labor gap. I will publish a job security report that will be disseminated to parents, students, and schools, especially targeting those in grades four through eight, that will highlight workforce needs and potential wages based on a certain degree or certification. I will continue access to that vital information by requiring our colleges and universities to list on a publicly accessible database information about the potential job market and salary a specific degree will lead you. Highlighting our areas of workforce needs will serve as the best tool to advocate and recruit individuals to those areas of industry in the most need. We should also consider incentivizing the practice of medicine in our most vulnerable communities — including rural Pennsylvania. I would like to develop ideas around creating financial incentives for providing communities in need care for recent graduates.
Q: In June 2017, the Pennsylvania Supreme Court ruled that physicians cannot delegate the task of obtaining a patient’s informed consent to another health care practitioner, thus overturning long-standing policies and protocols that have been in place governing how hospitals and physicians provide information to their patients. Would your administration support a legislative fix relating to a physician’s authority to delegate the task of obtaining informed consent to another health care practitioner as previously interpreted under the MCare Act?
WOLF: It’s important for patients to fully understand the risks, benefits, and potential alternatives relative to any medical procedure. Before committing to a legislative fix, I would like to engage with physicians, medical professionals, patient care organizations, and health care administrators to understand how the outcome of the Supreme Court case is impacting patient care and analyze potential solutions that emerge from these conversations.
WAGNER: I would work with the medical industry and the legislature to remedy this situation legislatively. The MCare Act was intended to help reduce the number of medical errors, which in turn would help to reduce the annual cost of physicians’ medical malpractice. One of the concerns with this ruling was the overreach that the Court imposed on an occupation that is already fearful of legal liability. One of the unfortunate consequences of this decision is a delay in access to physicians and critical services needed by seriously ill patients.
A version of this article appeared in the fall 2018 issue of Pennsylvania Physician Magazine, PAMED’s print magazine, and was reprinted with permission.