LEG REG REVIEW GPAHU Edition 2018, 8th Issue *** March 5, 2018


The annual House and Senate Appropriations Committee hearings on the State Budget conclude this week.   Tops on the list for many will be the Department of Education (March 5 for House; March 6 for Senate), Department of Human Services which runs the state’s Medicaid program (March 6 for House and March 7 for the Senate), and Department of Aging on March 6 in the Senate.  Topping off the hearings is the Governor’s Office and Office of the Budget on March 8 for both House and Senate Appropriations Committees where scrutiny may center on from where the revenue will come to fund the State Budget.  PA Cable Network (https://pcntv.com/schedule/ ) airs most of the hearings.



On February 23, 2018, a group of Governors – two Republican (Ohio and Nevada), two Democrats (Pennsylvania and Colorado) and one independent (Alaska), released a document outlining the approach that should be taken to “transform health care systems to produce better health outcomes at a lower cost to governments, employers, and individuals.”  One of its’ major goals is to stabilize the individual market, to provide “access to a healthy, stable, and competitive market of insurers from which to choose.”


The document says that America is looking at the wrong set of choices such as either having high quality health care or reducing costs; either being fiscally responsible or being generous and humane; either fostering individual accountability or supporting people in need.  To the Governors, these are false choices. Examples of better approaches would be:


  • Building upon existing financial incentives to encourage consumers to secure coverage and prepare for out of pocket expenditures
  • Directly combating anti-competitive behavior particularly among local hospital systems, pharmacy benefits managers, and pharmaceutical companies
  • Moving away from fee for service care to value outcome care as a basis for Medicaid reimbursements


The document does not list specific legislation or regulatory changes per se but it does suggest looking at bureaucratic impediments to drug importation.  Following is a link to the Bipartisan Blueprint for Improving Our Nation’s Health System Performance: https://www.governor.pa.gov/wp-content/uploads/2018/02/23.02.2018-Bipartisan-Health-Care-Blueprint.pdf



On March 3, 2018, the PA Insurance Department listed five regulations that it hopes to pursue in 2018 and early 2019.  These include Medicare Supplement Insurance (Medigap), Health Insurance Company Reserves, Transportation Ride Sharing Network (Uber, Lyft) endorsements, Privacy & Opt-Out Annual Notices, plus a major re-write of Producer Licensing.  The licensing regulation is expected in spring 2019 and will set forth requirements and standards for a single licensing system.



  • Minority House Transportation Committee Chair Rep. Bill Keller (D-Phila.) is not seeking re-election.  This means that both Majority and Minority Chairs of this committee will be new in 2019.
  • House Majority Leader Rep. Dave Reed (R-Indiana) has dropped his congressional plans because of the PA Supreme Court imposed redistricting and is running for re-election.
  • Rep. Madeleine Dean (D-Montgomery) has withdrawn her bid for the Democratic nomination for Lt. Governor and is choosing to run for Congress in the redrawn open 4th congressional seat.



  • March 13 is the date of the special congressional election in southwest PA’s 18th district, pitting PA House Representative Rick Saccone (Republican) against Democrat Conor Lamb.  Saccone was elected to the PA House in 2010.  Lamb was an attorney with the Marines and former Assistant District Attorney in Pittsburgh during the Obama Administration.  This is seen as a referendum on Trump and GOP control of Congress.  Notables such as former Vice President Biden and President Trump are actively campaigning in the district.  The district includes parts of Westmoreland, Washington, Allegheny and Greene Counties.


There is a strong contrast between the two on insurance with Saccone’s campaign saying Under Obamacare, health insurance has become unaffordable. Rick Saccone will utilize free-market principles to fix our healthcare crisis.”  Lamb’s platform says that “The Affordable Care Act has flaws, but it has provided affordable coverage to more than a million Pennsylvanians who were previously uninsured.  Republicans in Congress spent the past year trying to take health insurance away from people with no plan to replace it. Now, costs are likely to go up for many of us, especially those with preexisting conditions. That is unacceptable, and it’s a failure of leadership.”



  • Cancer Drug Repository Program administered by the State Board of Pharmacy issued income thresholds for eligibility.  Also known as the Cancer Drug Bank, this program was established to gather unused expensive cancer drugs and provide them to those who cannot afford the prohibitive price. An individual’s eligibility is based on family income: One-person family, less than $42,490 in 2017 to be eligible for 2018; 2-person family income is $57,610; 4-person family threshold is $87,850, etc.  Details: Janet Getsy Hart 717-783-7156; st-pharmacy@pa.gov
  • Health Care Cost Containment Council (PHC4) meets March 8 in Harrisburg.  PHC4 has the responsibility of collecting health treatment data (for example, the numbers of re-admissions due to hospital-acquired infections).  There has been interest in expanding its purview to chart health provider treatment pricing and drug pricing as consumer comparison tools.


UPCOMING:  The PA Insurance Fraud Conference will be held April 12 and 13, 2018.  Sponsored by the Insurance Fraud Prevention Authority (IFPA) and the Delaware Valley and Greater Pittsburgh chapters of the International Association of Special Investigation Units (IASIU), details are available from Tom Donahue 717-691-1828; tdonahue@helpstopfraud.org.


IN PASSING…Former U.S. Congressman Jon Fox from Montgomery County has passed away.  Personal note:  When I first visited him in his congressional office in the Cannon House Office Building in Washington, I saw on his wall a framed invitation to President Nixon’s 1969 inauguration.  When I commented, he told me that his new office in D.C. was the same office that Nixon had when he was first elected to Congress decades before.  He wanted to recognize that bit of history.  I thought that was pretty classy.  Vince


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