September 30, 2022
Interview conducted by Holly Pisarik, Senior VP of Advocacy & Policy Counsel, SCMA, and Ben Homeyer, President, 1101 Public Affairs on Sept. 21, 2022.
About Senator Davis:
As you know, Republicans in NC were close at the end of their legislative session to passing Medicaid expansion. Do you foresee any similar efforts in SC this upcoming session? Do you have a position on this issue?
Historically I’ve been opposed to Medicaid expansion, but I’m open to the idea if it can be coupled with the waivers that some Republicans in other states have been able to obtain.
As a practical matter, anytime you can increase the supply of something and empower demand, usually you will get a better product at a lower cost. In this context, you are talking about empowering demand. Medicaid can be a very cumbersome vehicle, so I’m for Medicaid expansion if we can couple that with waivers that empower patients to decide and direct their own healthcare.
Longer term, I’m skeptical about the federal government’s ability to continue funding Medicaid at these historic levels, but ultimately, I am open to discussing Medicaid expansion if it can be accompanied by these waivers that some other states have been successful in obtaining.
Repeal of CON is one of the SCMA’s top legislative priorities again this upcoming session. You, among other senators, were instrumental in S.290 passing the Senate with overwhelming support. Do you foresee it receiving the same level of support in the Senate this upcoming session?
Yes, it will. I think that both the Republican and Democratic vote last year was pretty strong. Based on the empirical evidence from states that have repealed CON, there is a direct correlation between access to care and decrease in costs.
I’m not interested in regulations that are going to tweak CON. I’m interested in repealing CON in its entirety. If you are for markets, if you are for competition, if you are for patient choice, then you ought to be for CON repeal.
Beyond the outcome of H.5339, the SCMA was very disappointed in how some Representatives and Senators portrayed physicians in the debate about abortion in SC. The SCMA would like to thank you for trusting the integrity of physicians and defending them in the debate. Is there anything you want to say about the abortion debate or H.5339?
When legislators step into the medical arena they should do so with a lot of modesty. We didn’t go to medical school or go through medical residency. We don’t have that training. One of the disturbing aspects of the debate regarding access to abortion was this belief by some legislators that physicians would act unscrupulously – that they would cut corners or circumvent state law – which to me is ludicrous because doctors are obligated to follow a very strict code of ethics.
I have talked to a lot of physicians, and they have a hard enough time in an emergent situation with a woman whose life may be in jeopardy. At that point in time, there should be nothing on that physician’s mind other than what she or he thinks is in the best interest of the patient.
As with CON repeal, we can look at other states and see what the effect of very restrictive or proscriptive abortion laws have had on the practice of medicine. You hear about physicians checking with their hospital administrators or with their attorneys to get an opinion about what a particular statute means before they render care. That’s ridiculous. As policymakers, the last thing in the world we should want is for doctors to make decisions based on what 170 politicians in Columbia decide. Physicians ought to be making those decisions based on their ethical duty to provide the very best care to their patient.
To me, that ethical duty is sufficient guidance, which is why I offered amendments during the abortion debate to create a safe harbor for physicians from criminal or civil liability. We should expect no more from a physician other than that he or she practice in accordance with the standard of care applicable to their specialty.
Your Pharmacy Access bill passed this past legislative session. In light of the abortion debate, do you think the timing of this bill was fortuitous?
I anticipated that, at some point in time, the Supreme Court was likely to either reverse or substantially modify Roe v. Wade, which would likely lead to more restrictive abortion regulations and, consequently, more unwanted pregnancies. And I wondered: what’s the appropriate policy response to that?
What I struck upon was making access to hormonal contraceptives easier, particularly for those in rural areas. The current state of the law was that you needed a prescription from a physician, but in rural areas, many women do not have access to primary care physicians. So removing that barrier – allowing women to obtain hormonal contraceptives from their pharmacist without the necessity of a prescription seemed a reasonable step.
Based on your record in the Senate, clearly healthcare in SC has always been important to you. The SCMA thanks you for your interest and support over the years. Why are medical issues so important to you?
So much of the state budget goes to supporting healthcare and figuring out a way to get a better yield or return on the money we spend has been a focus of mine. It’s good taxpayer stewardship.
I believe trying to apply market principles is a worthwhile endeavor in healthcare. It’s not a perfect market, but I think it’s worthwhile taking some of these conservative principles about increasing supply and empowering demand, and applying them in some of these larger settings like education and healthcare. It’s an interesting policy exercise and I think it’s our obligation as lawmakers to try to get the best return possible on taxpayer dollars.
We anticipate there will be bills related to telemedicine this upcoming legislative session. Based on telemedicine utilization numbers over the last two years, I think it’s safe to say that we’ve all learned that there is a role for telemedicine. One concern for physicians is that parity in pay for telemedicine visits will survive the pandemic. Do you have an opinion on this issue?
COVID presented a paradigm shift, and you are going to see an increased use of telemedicine. My sense is that the qualitative experience through telemedicine is getting better and better as technology gets better. Obviously there will be instances where the patient needs to be in the physical presence of their physician for the physician to provide an appropriate level of care, but in a vast number of instances, a telemedicine visit is going to be qualitatively just as efficacious as an in-person one. If that’s the case, there ought not be any decrease in the compensation paid to the physician. The physician is still rendering a certain amount of time and undertaking a certain degree of responsibility for care given in accordance with the standard of practice, and this equates the in-person with the telemedicine visit.
Will S.2 (Elimination of DHEC) come up again this year?
I think it will come back up again, if for no other reason than Senator Peeler wants it to come back up. He has a lot of prestige and influence in the Senate and has put a lot of time into looking at the structure of state government in this area.
DHEC is a sprawling, very large agency, and you can intellectually or academically make the argument for breaking it apart. But the devil is in the details, of course, so we need to speak with practitioners and with stakeholders like the SCMA who are directly influenced by the state agency’s actions and listen to them. The last thing we want to do is come up with something in a vacuum and then impose it upon the healthcare community, only to discover what sounded good in theory doesn’t work in practice.
There are two issues that I know you feel very strongly about where our opinions differ – cannabis and scope of practice. Let’s talk a bit about those two issues. Do you anticipate that there will be changes to the bill that you introduced last year on medical marijuana?
Yes, I think there will be. It’s good to have groups like SCMA and SLED engaged in the process and interposing their objections and concerns. It’s only when that happens that you end up with a piece of legislation that works.
We’re not enemies at all. The legislative process sometimes results in different stakeholders being on opposing sides of the fence, at least initially, but if everyone works in good faith, we can ultimately get to a work product that benefits everyone.
The more individuals or stakeholder groups that are involved, the more they share their opinions, the better this piece of legislation becomes. I want to come up with a solid medical-marijuana bill that empowers doctors to help patients who, in the doctors’ opinion, could benefit. I am open to safeguards to avoid unintended consequences. For example, we made a huge step forward earlier this year when the bill was amended to involve pharmacists at the dispensing level. I’m not resting on my laurels. I’m going to take what we passed last year in the Senate, and I’m going to further refine it and better address the concerns that some of my colleagues in the Senate expressed.
It’s the same thing with Scope of Practice. It’s by necessity confrontational because anytime you start talking about someone’s practice area, it becomes more intensely felt. There are things that only a medical doctor can do. A medical doctor has training above and beyond what a nurse practitioner does or what a PA has. That’s just an empirical fact. There will always be things that require a physician.
My point has always been that if there are things that non-MD professionals are trained to do, and they can do them safely, and if our code of laws does not allow them to do those things, then the legislative code should be synced up to allow non-physician medical professionals to do what they are competent to do. I have never wanted to go beyond that.
Sometimes we are very passionate about our views, but it is never acrimonious. There will be other times like in CON repeal, where we’ll end up on the same side of the fence in trying to persuade others. That’s the nature of legislation.
Beyond what we’ve talked about, what are your top legislative priorities this year?
Is there anything specific that you would like to say to SC physicians?
I respect your skill and expertise and the incredible amount of time you had to spend to obtain it, and I fully appreciate the critical role you play in society. We rely upon folks like Ben and Holly representing the physician’s voice, and they do a great job, but you should consider running for office and serving the legislature, particularly if you are a physician looking to cut back on the number of hours you practice. Offer yourself to public service. That would help the Senate immeasurably. We don’t have a physician in the Senate, and increasingly, we’re going to be asked to make decisions that impact the healthcare industry. Again, you have great lobbyists looking out for your interests in Columbia, but it would be even better to have a physician with that authority and experience speaking to the issues as a legislator. There are certain things that only a physician can bring to the legislative debate.
Is there anything with which the SCMA can assist you?
Do what you’ve always done, which is to continue being a good, faithful voice for how physicians feel about the issues that come before us. You can’t have good legislation without information from trusted sources. SCMA has always been a trusted source. I appreciate the fact that you engage in a productive way, not only on educating us but looking at what was proposed and offering to make it better or encouraging us to consider alternatives. You’re a very visible presence, and legislation coming out of the Medical Affairs Committee and the General Assembly would not be any good without your involvement. So keep up what you’re doing.