COVID-19 & Healthcare

By Craig McDermott, cross-posted from Random Musings

What started out as a quiet week last week became colorful in a hurry when the Arizona Senate passed a package of budget bills, including provisions for Medicaid expansion.

Now the whole package is scheduled to go over to the House for consideration.

As
of this writing, there isn't anything in terms of committee agendas or
floor calendars posted for the coming week for either chamber, so all
that's left to do is speculate a little.

1.  The bills
face a murky path in the House, but speculation is that they are likely
to pass.  There just may be a little drama first. 

2.  On Friday's Horizon on KAET (PBS channel 8 in Phoenix), the journalists who were part of their weekly "Journalists Roundtable" speculated that the bills won't be heard (and voted on)
until after Memorial Day.  According to them, this coming week may see
House Speaker Andy Tobin try to push, or at least go through the motions
of pushing, his proposal to put the Medicaid restoration before the
voters.

However, while there do seem to be enough votes
in the House to pass Medicaid restoration, it doesn't seem likely that
there is any real support for putting the question before the
voters – mostly because they think it will be approved by the voters
anyway, and by a wide margin, making the legislature look worse for
passing the buck on an easy decision.

Note: As of now, KAET has not posted Friday's episode of Horizon on its website, but will likely do so on Monday. 

by David Safier

The NY Times has a good op ed by UCLA law prof Joanna C. Schwartz on the value of malpractice litigation in reducing medical errors. Contrary to the notion that malpractice suits result in people hiding problems, she says it encourages improved practices.

New evidence, however, contradicts the conventional wisdom that malpractice litigation compromises the patient safety movement’s call for transparency. In fact, the opposite appears to be occurring: the openness and transparency promoted by patient safety advocates appear to be influencing hospitals’ responses to litigation risk.

[snip]

[W]hile hospitals historically took an adversarial and secretive approach to lawsuits and error, that has begun to change. In recent years, hospitals have become increasingly open with patients: over 80 percent of hospitals in my study have a policy of apologizing to patients when errors occur. And hospitals are more willing to discuss and learn from errors with hospital staff.

What accounts for these changes? Several factors appear to have overcome historical resistance to transparency, including widespread laws requiring disclosure to patients and confidentiality protections for internal discussions of error. Hospitals have also found that disclosing errors to patients and offering early settlements reduces the costs and frequency of litigation.

My study also shows that malpractice suits are playing an unexpected role in patient safety efforts, as a source of valuable information about medical error. Over 95 percent of the hospitals in my study integrate information from lawsuits into patient safety efforts. And risk managers and patient-safety personnel overwhelmingly report that lawsuit data have proved useful in efforts to identify and address error.

My knowledge on this issue is minimal. When I have questions, my usual go-to guy is Barry Kirschner, a friend and local lawyer. He sent me an email expanding on the op ed.

One of many reasons people have an incentive to drive more carefully is the cost of insurance and the threat of accountability should they be responsible for an accident. There is less irresponsible drinking and driving and risky conduct because of this civil liability.

Posted by AzBlueMeanie:

In 2004, a handful of Republican senators joined with Democratic senators to wrest control of the Arizona Senate chamber from an obstructionist Senate President. It hasn't happened since — until today.

A bipartisan Senate coalition, led by the Republican majority leader John McComish no less,
gave tentative approval Thursday to Gov. Jan Brewer’s proposal to restore and expand
Medicaid (AHCCCS). Ariz. moves closer to Medicaid expansion:

[The coalition beat back more than a dozen hostile GOP amendments sponsored by Senate President Andy Biggs and Sen. Kelli Ward, in a failed attempt to weaken the measure.]

The measure awaits a formal vote of the full Senate, which is expected
to come later today. If it passes, as expected, it’s likely to run up
against a buzzsaw in the House, where the fate of Medicaid expansion,
and the budget it’s attached to, remain uncertain.

Senate President Andy Biggs, R-Gilbert, a steadfast opponent of the
governor’s proposal, fought unsuccessfully to kill it with a slew of
amendments, including requiring a two-thirds vote for approval,
eliminating a hospital tax that will help pay for expansion, converting
all state employee health insurance to Medicaid and repealing expansion
if even one Medicaid patient is found to be an undocumented citizen.

* * *

But again and again, two members of Biggs’ leadership team and three
other GOP senators stood with the chamber’s 13 Democrats to defeat
Biggs’ amendment. Majority Leader John McComish, Majority Whip Adam
Driggs and Sens. Rich Crandall, Steve Pierce and Bob Worsley joined
Democrats to approve the Medicaid amendment on an 18-12 vote.

By Craig McDermott, cross-posted from Random Musings

Correction added on 5/15 – during my initial perusal of SB1492, it
appeared as if some Medicaid expansion provisions were included in it
already.  While there are some changes to AHCCCS provisions contained in
it, they are minor and *not* part of a Medicaid restoration package.

Well, the Senate has introduced its budget package, placing the
Medicaid restoration plan in the budget itself but adding a kicker, SB1493.

It has the rather innocuous subject of "elections; omnibus".

It really should be called "extortion; all-in-one; every bad election-related scheme offered by the Republicans this year".

There's
summarily removing voters from the permanent early voting list (PEVL),
effectively barring most schools from serving as polling places, making
successful recall elections all but impossible, barring organizations
and campaigns from collecting and returning early ballots, elevating
administrative barriers to initiative petition drives, and more.

Any one scheme would render a bill "unpassable" (and has, many times during this session); placing them all in one bill means that the Senate leadership (read: Andy Biggs) expects factors other than the merits of the proposals to influence legislators' votes on the bill.

The other bills in the package are: