A Note From KMS Executive Director Rachelle Colombo
Now that the 2023 Legislative Session has concluded, I want to take a moment to again thank you for allowing the Kansas Medical Society to actively advocate on your behalf. Though the healthcare landscape is divided over some of the current ideological issues of our day, there is still much that unites this sacred profession on behalf of the patients you serve. It is on these issues where we can most effectively use our collective voice and expertise as an organization.
Most of the legislative session was dominated by ideology around health-related matters, often pitting polarizing politics against more precise policy. Though this dynamic is not new when considering issues of personal belief, it has become decidedly more predominant in the health arena, making our commitment to advocating on issues of agreement within the house of medicine even more critical and difficult.
Under the dome, lingering feelings about the public health response to the COVID-19 pandemic were compounded by the Dobbs decision and Kansans rejection of a constitutional amendment to re-establish the legislature’s ability to restrict abortion. In short, some folks have let the COVID experience eclipse their understanding of the role of public health altogether. For instance, in an effort to ensure that COVID vaccines cannot be required for school children, “healthcare liberty” has now been extended to all mandatory childhood vaccines, unless the Governor vetoes the measure.
Similarly, the legislature took up issues around the biological definition of gender, gender reassignment treatment and procedures, and dozens of bills dealing with various aspects of abortion. Though each of these issues is medical in nature, has relevant scientific data and practical implications to consider, and inserts the lawmaking process into the practice of medicine – none of them are viewed solely through a medical lens by the Legislature, or by many Kansans. These issues are complicated, personal, ideological and often not agreed to by members of the same profession, political party or even family.
Many of you have asked where this leaves the House of Medicine. I suggest it leaves us squarely within our society’s mission, as established 164 years ago at the Eldridge Hotel in Lawrence, Kansas on February 10, 1859. On that day, a group of pioneer physicians met and chartered the Kansas Medical Society with the mission of providing high-quality, physician-led care to all Kansans. That remains our top priority and it takes shape by intentionally focusing our advocacy. It means focusing on those issues which unite the medical community and have prevailed through the Spanish Flu, foreign wars, the civil rights movement, the establishing of Roe v. Wade, and much more.
From its earliest days, the Kansas Medical Society focused on that mission by working towards the creation of our state’s medical board, ensuring quality. The Kansas Medical Society sought the founding of the University of Kansas Medical School in 1905 and continues to support our state’s medical school. The Kansas Medical Society fought for malpractice reforms in the 1970s and 1980s to ensure that physicians could afford to purchase medical professional liability insurance and continue providing access to Kansans statewide. And from the very beginning, the Kansas Medical Society has sought to protect Kansas patients by limiting the practice of medicine to physicians with the highest level of medical training, licensure and oversight. These issues are as ever-present today as they were in 1859. And even today, in a legislative environment dominated almost entirely by divisive issues, the Kansas Medical Society’s commitment to its 164-year-old mission to provide physician-led care to all Kansans remains relevant and effective.
The times are ever-changing, but in many ways the old axiom is true: there is nothing new under the sun. While our mission has not changed, the way its implementation requires new thinking, awareness of the challenges and opportunities facing the medical profession and most of all – a united commitment to the profession and the patients you all serve.
It is a privilege to continue to advocate on your behalf and to hear from you about your varied opinions and experiences related to both our foundational issues and those that have more recently arisen. While society at large has felt a bit fractured in recent years and there is no doubt that some of that has seeped into the health care arena, the core principles which brought you into practice continue to come through and serve as the backbone of patient care.
You are served by a legislative committee comprised of your peers from across the state representing a mix of specialties. Together, they consider and follow the scores of proposals which move through the legislative process and direct our engagement with elected leaders, both on and off the record. They are deliberative, intentional and committed to our mission, which means setting aside personal bias and beliefs in service of the medical community and we are indebted to their judicious leadership.
Thank you for belonging to the Kansas Medical Society, for engaging with your patients, peers, legislators and locals to advocate for high quality care for your neighbors. Thank you for teaching me about the work you do and how I can best advocate for you.
Sincerely,
2023 Legislative Update
The 2023 legislative session adjourned at the end of last week. This session was heavily influenced by a number of controversial social issues, including transgender rights, abortion and vaccine policy. Much of the legislature’s last week was spent in attempts to override vetoes by Governor Kelly, as well as completing work on the state’s budget for the fiscal year which begins on July 1.
Among the gender-related bills vetoed by the governor which the legislature failed to override was SB 26, which would have revoked a physician’s license for providing gender-affirming care, including hormone therapy, to minors. The legislature did override the governor’s vetoes of several other bills affecting transgender individuals, including legislation prohibiting student athletes who were assigned male at birth from playing on girls’ athletic teams, as well as legislation that mandates incarcerated people to be divided by their gender assigned at birth, and which allows the state to require the separation of the sexes in settings like domestic violence shelters, rape crisis centers, public restrooms and locker rooms.
Concerning abortion policy, the legislature overrode two vetoes, including HB 2313, the “born alive” bill, which provides that in the event an abortion or attempted abortion results in a child being born alive, the bill requires any health care provider present at the time the child is born alive to exercise the same degree of professional skill, care, and diligence, to preserve the life and health of the child as a reasonably diligent and conscientious health care provider would render to any other child born alive at the same gestational age, and to ensure that the child is immediately transported to a hospital. Also passed over the governor’s veto was HB 2264, which except in the case of a medical emergency, prohibits a physician from providing, inducing, or attempting to provide or induce a medication abortion that uses mifepristone without informing the woman that it may be possible to reverse the intended effects of a medication abortion that uses mifepristone. The legislature failed to override the veto of HB 2325, which would have prohibited facilities where elective abortions are performed from obtaining liability insurance from the Health Care Stabilization Fund.
Finally, in one of its last actions before adjournment, the legislature passed a heavily amended HB 2285, which combined the provisions of several other bills, including some which would significantly restrict the authority of the KDHE Secretary and local health officers regarding infectious and contagious diseases. The bill also would prohibit the Secretary from requiring the COVID-19 vaccine for any child enrolled in school or cared for in a child care facility. The bill passed both chambers with very slight majorities, and a veto by the governor is expected by many.
Other less controversial bills were passed in the last week with substantial majorities, and they are unlikely to invite a governor’s veto. One is Senate Substitute for HB 2060, which amends Kansas Medical Student Loan Program and the Medical Residency Bridging Program to allow students in the loan program to switch between approved postgraduate residency training programs without violating their loan agreement. The bill also would add obstetrics and gynecology to the list of approved specialties that are eligible for medical student loans and associated loan forgiveness through service commitments. The bill also authorizes medical service scholarships to Kansas residents who are enrolled in or admitted to the Kansas College of Osteopathic Medicine in Wichita.
Another bill passed and sent to the governor was Substitute for SB 131, which creates a licensure waiver for certain health care professionals accompanying sporting teams. The bill also includes provisions allowing pharmacy technicians to administer vaccinations.
The Legislature also passed SB 174, which among other things, increased the penalties for violence against healthcare providers, as well as legalizing fentanyl test strips.
Regarding the state’s budget, the legislature approved a much-needed 3% increase in the Medicaid physician fee schedule. Also included among the many provisions in the final budget bill was a provision preventing the Board of Pharmacy from taking action to prohibit “white bagging” of certain prescription drugs. White bagging is a practice where health insurers require that a patient’s infused or injected medications be shipped from a designated, third party specialty pharmacy to the site of care for administration, usually a hospital or outpatient clinic, instead of allowing the provider to buy and bill for the drug and its administration through its customary channels. The Pharmacy Board had recently adopted regulations to more closely regulate white bagging, and this provision in the budget bill stops the Board from taking any action to prohibit that practice. It also prevents the Board from prohibiting “brown bagging”, which is when the drugs are shipped directly to the patient, who then takes the drug to the provider for administration. This is basically a fight between hospitals and health insurers. Insurers apparently use the practice to restrain their drug costs, and providers are concerned that it exposes them to increased liability because it circumvents the clinical sites’ established drug safety procedures and medication supply chain integrity. Interestingly, this provision was quietly inserted into the final budget bill at the behest of some insurers without a bill being introduced or any public hearings or “normal” legislative process.
Other legislation of note which failed to advance this year included the CRNA independent practice bill, medical marijuana and Medicaid expansion.
For questions about the above or any other legislation, please contact Rachelle Colombo
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