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June/July 2007
Note: Questions relating to state legislative activity or any of the items noted in ACS Cross Country may be directed to Mindy Baker, State Affairs Associate, at mbaker@facs.org.
UPPL Repeal Successful in Several States
As reported in the February 2007 issue of ACS Cross Country, the American College of Surgeons continues to support the repeal of UPPL (Uniform Accident and Sickness Policy Provision). These laws currently allow insurance companies to deny payment of medical claims for injuries sustained while the injured party was intoxicated or under the influence of a controlled substance. ( http://www.facs.org/ahp/feb07crosscountry.html#2)
Since that time, a total of seven states have introduced legislation to repeal their UPPL statutes. The District of Columbia also adopted UPPL repeal in January of this year. Three states-- Illinois, Indiana, and Oregon--have all passed repeals, and Tennessee passed a resolution asking its state comptroller to study alcohol and drugs laws including UPPL. The comptroller will report to the state legislature by December 1, 2008.
Both California and New York have passed UPPL several times in the past few years, only to have their respective governors veto the legislation. This year in California, AB 1461, a “Meth Deterrence Pilot Program,” includes a section repealing the UPPL. AB 1461 has passed the state assembly and is on track to pass the senate. Early indications are that Governor Schwarzenegger (R) will sign the legislation.
In New York, AB 3846 is currently in the assembly’s Insurance Committee. Fellows in New York are encouraged to write to members of the Insurance Committee urging them to support this legislation by visiting: http://capwiz.com/sslac/issues/alert/?alertid=9881196. First-term Gov. Eliot Spitzer (D) has indicated his willingness to sign this legislation should it make it to his desk.
South Carolina’s HB 2348 was introduced in early May and was assigned to a committee, but was not heard before the legislature adjourned in mid-June. Indications are that the bill will be reintroduced in 2008.
Finally, Texas HB 634 was left pending in committee upon adjournment in May, effectively “killing” the bill. The Texas legislature only meets in odd years and will not start a new session until January 2009.
Background
In 1947, the National Association of Insurance Commissioners (NAIC) adopted the UPPL (Uniform Accident and Sickness Policy Provision) as a model law. The law states that health insurers would not have to reimburse patients for costs incurred when an accident is a result of "the insured's being intoxicated or under the influence of any narcotic." Most states adopted this language, and it is still on the books in many states. In 2001, NAIC formally changed its position to support the repeal of this legislation.
In September 2006, the American College of Surgeons formally adopted a statement supporting the repeal of UPPL laws. (http://www.facs.org/fellows_info/statements/st-55.html)
State’s that have successfully repealed UPPL:
Colorado (2006), Connecticut (2006), District of Columbia (2007), Illinois (2007), Indiana (2007), Iowa, Maryland, Nevada, North Carolina, Oregon (2007), Rhode Island, South Dakota, and Washington State.
“...courts have ruled that, in the absence of explicit laws, insurance companies can sell policies that use exclusions to limit liability. Court rulings vary by state, with some being more lenient (requiring proof only of alcohol use prior to injury) and others being more strict (requiring proof of a causal relationship between the use of alcohol and the injury).” Source: Ensuring Solutions to Alcohol Problems at George Washington University Medical Center.
(Please post any comments you may have about this issue on the ACS Advocacy Bulletin Board located on the Web portal.)
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2007 A Successful Year for Tennessee’s Trauma Community
The Tennessee trauma community is celebrating several legislative victories in 2007. Thanks to the efforts of a diverse coalition, legislation was passed increasing the cigarette excise tax from 20 cents to 62 cents. The additional funds generated will be used primarily for education, but approximately $10 million will go to the trauma system.
Also, legislation was passed requiring children to wear helmets while riding an “off-road” vehicle. SB 1994 is headed to the Gov. Phil Bredesen’s desk. Although the Governor has not indicated if he will sign the bill, if he does nothing, the bill automatically will become law.
Advocates were successful in stopping a repeal of the state’s motorcycle helmet law. Originally introduced by Rep. Joey Hensley, a family physician from Hohenwald, TN (who later withdrew his sponsorship), the bill passed out of the transportation committee, but was unable to make it out of the House Finance, Ways & Means Committee in time for adjournment.
(Please post any comments you may have about this issue on the ACS Advocacy Bulletin Board located on the Web portal.)
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Fellows Attend 2007 ACS Leadership Conference
The College hosted its annual Leadership Conference in Washington, DC, from Monday, June 4, to Wednesday. June 6. Seventy Chapters were represented, and 60 young surgeons participated in the conference.
Monday’s sessions included remarks from ACS leadership, presentations on pay for performance, spokesperson training, initiatives for engaging young members, and leadership skills training.
On Tuesday, seven US Congressmen visited with Fellows in between issue briefings from ACS Washington, DC, staff. A short state affairs update and a session on “How Capitol Hill Really Works” rounded out the afternoon. Later that evening, a reception was held on Capitol Hill, and those who signed up had personal visits in their elected officials’ offices on Wednesday morning.
Fellows who are interested in setting up a similar “Advocacy Day” at their own state capitol are urged to contact the state affairs staff -- Jon Sutton, Manager, State Affairs, jsutton@facs.org or Mindy Baker, State Affairs Associate, mbaker@facs.org.
(Did you attend the Conference? Share your experiences on the ACS Advocacy Bulletin Board located on the Web portal.)
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Update: Connecticut’s HB 6652
In the April 2007 issue of ACS Cross Country it was reported that, like many states, Connecticut was struggling with how to fund a proposal that would provide universal health care to its citizens. Included in the original proposal was a 3 percent tax on revenue derived from furnishing health care services in the state and applied to all providers of medical services including physicians, hospitals, nursing homes, and other facilities. Thanks to the hard work of the medical community, including the CT Chapter of ACS, this tax was ultimately removed, but several other negative provisions remained in the bill.
Fortunately, the two remaining “negative provisions”—a sales tax on “cosmetic” services and a cap on physicians preventing them from charging more than 200 percent of the Medicare fee for any service—were removed from the proposal.
According to the Connecticut State Medical Society, “HB 6652 still contains praiseworthy provisions to increase access for the uninsured and underinsured population. Its inclusion of electronic medical records, wellness care, and prevention are consistent with the principles developed by CSMS earlier this year.”
HB 6652 has not been passed, and the Connecticut legislature is currently in special session to discuss access to health care and the state’s budget.
(Please post any comments you may have about this issue on the ACS Advocacy Bulletin Board located on the Web portal.)
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ACS Advocates for Surgeons at the AMA House of Delegates Meeting
One place where the American College of Surgeons and other surgical societies can advocate for their members is during the AMA House of Delegates (HOD) meetings. The HOD wrapped up its Annual Meeting this week with action on a number of surgery-focused issues:
- Definition of Surgery: Excerpted from the College’s “Statement on surgery using lasers, pulsed light, radiofrequency devices or other techniques” , this definition was unanimously adopted by the HOD. College delegates and others emphasized the need for the HOD to adopt the definition as developed by the College, since it would be important for both organizations to have the same definition when advocating on federal and state legislative and regulatory proposals dealing with non-physician scope of practice and other licensing issues.
Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is a part of the practice of medicine. Surgery is also the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reduction for major dislocations and fractures, or otherwise altered by any mechanical, thermal, light-based, electromagnetic, or chemical means. Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system is also considered to be surgery (this does not include administration by nursing personnel of some injections, such as subcutaneous, intramuscular and intravenous when ordered by a physician). All of these surgical procedures are invasive, including those that are performed with lasers, and the risks of any surgical intervention are not eliminated by using a light knife or laser in place of a metal knife, or scalpel.
Patient safety and quality of care are paramount, and therefore patients should be assured that individuals who perform these types of surgery are licensed physicians (defined as doctors of medicine or osteopathy) who meet appropriate professional standards.
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- Surgeons’ Attendance during Surgical Procedures: The AMA will study the issues surrounding policy that requires operating surgeons to post their surgical cases so that they are actually physically present in the operating room performing or supervising their surgical cases, during the majority of the case and during all crucial or essential phases of the surgical procedure. Delegates preferred a study due to the overall complexity of the issue and to provide an opportunity for surgical organizations to participate in a study.
- Stereotactic Breast Biopsy: A resolution calling on the AMA to support efforts to stop FDA regulation of stereotactic breast biopsy was referred to the AMA Board of Trustees to permit the board to decide how to respond to the issue. Surgeons supported this move, and the College looks forward to working with the AMA on this important issue.
For further information contact jsutton@facs.org.
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Past Issues of ACS Cross Country:
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ACS State Affairs
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Division of Advocacy and Health Policy
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Jon H. Sutton
Manager, State Affairs
Chicago Headquarters
312-202-5358
jsutton@facs.org |
Mindy Baker
State Affairs Associate
Chicago Headquarters
312-202-5363
mbaker@facs.org |
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Revised June 28, 2007
Advocacy and Health Policy
This page and all contents are Copyright © 2003-2007
by the American College of Surgeons, Chicago, IL 60611-3211
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