HARRISBURG, Pa. (AP) - For many Pennsylvanians, the path to medical care may soon be less likely to lead to a doctor.
In one of the most far-reaching attempts at the state level to make health care more accessible and affordable to everyone, Gov. Ed Rendell is seeking to lower barriers in Pennsylvania laws and regulations that prevent a wide range of nonphysician health professionals from providing basic types of care.
From nurse practitioners and nurse midwives to dental hygienists and pharmacists, the Rendell administration wants to reshape health care practices in Pennsylvania to help provide lower-cost preventive care.
The Democratic governor's initiative is an example of states stepping into a void created by a lack of federal action on health care reform.
'The national agenda's been overwhelmed by Iraq, and Washington has been paralyzed by ideological and policy gridlock on health care,' said Drew Altman, the CEO of Kaiser Family Foundation, which studies health policy. 'The states, on the other hand, are closer to the problem and can't hide from it.'
Across the nation, governors have been taking bold steps to improve access to health care and lower costs -- primarily by proposing universal or near-universal health insurance, which is also an element of Rendell's plan.
Massachusetts, Vermont and Maine have already enacted universal-coverage plans. California Gov. Arnold Schwarzenegger has proposed a $12 billion plan that would require individuals, employers and health care providers to contribute to the cost. Illinois Gov. Rod Blagojevich has proposed funding his proposal with a payroll tax and a tax on most business transactions.
Pennsylvania's plan is noteworthy because it deals broadly with licensing of nonphysicians across all categories along with insurance coverage, according to the National Governor's Association. Other states have addressed licensing issues in piecemeal fashion.
'This has the potential to be two steps forward instead of just one,' said Kathleen Nolan, division director of health for the NGA Center for Best Practices. 'I don't know of another state pursuing such a comprehensive, holistic approach.'
Rendell's 'Prescription for Pennsylvania' would explicitly allow nonphysicians to perform some of the same basic duties as doctors, such as taking medical histories and giving physical examinations. It would also allow dental hygienists to practice without a dentist's supervision in certain settings -- including schools and clinics -- and would end the state's distinction as the only one in the nation barring nurse midwives from prescribing drugs.
Equally important, the legislation would address obstacles created by insurance regulations. For instance, it would allow nonphysicians to be designated as primary-care providers for insurance purposes and would require insurers to include them in all health care provider networks.
Although many insurance companies recognize nurse practitioners as primary-care providers, some managed-care companies do not.
'There's a good argument to make that, over the long term, insurance costs will decrease because we're going to have people seeing providers more frequently and more routinely, and illnesses will be treated more timely and with fewer complications,' said Barbara Holland, a lawyer for the Governor's Office of Health Care Reform.
Physicians say they support Rendell's goal of improving health care access and affordability by giving other professionals a bigger role, but they are watching closely to make sure that the result does not mean increased competition for patients.
'When you look at how hard our job is, and how much difficulty we have doing it, with all the training and experience that we have on top of that, what's going to happen if you let people try to do what we do with a fraction of that training?' said Dr. Mark A. Piasio, president of the Pennsylvania Medical Society.
Holland said the administration is being careful to maintain requirements that nurse practitioners and others work closely with doctors even as it seeks to loosen regulatory and statutory restrictions.
'One of the things we took into account was not wanting to push too far, and acknowledge that were are legitimate concerns with respect to patient safety and quality (of care),' she said.
The basic backbone bill for Rendell's proposal was introduced two weeks ago and has been assigned to a House committee. No strong opinions have been voiced yet in the Legislature, although some Republicans question a proposal to partially fund health insurance with a payroll tax on businesses that do not provide coverage.
If Rendell gets lawmakers to embrace his ideas, the Kaiser Family Foundation's Altman said, Pennsylvania could become one of a select few states to spur the federal government into action.
'We can't reform state by state, but a handful of pacesetting states can help show the way for national reform, if in fact a new president and Congress can get their act together in 2009,' Altman said.
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