RICHMOND, Va. - The Virginia General Assembly is missing an opportunity to bring care to medically under-served parts of the state, nurse practitioners say.
Going into the session, several bills would have loosened regulations and let mid-level medical providers operate in the mostly rural areas without enough doctors.
But Mark Coles, a nurse practitioner and chairman of government relations for the Virginia Council of Nurse Practitioners, says all those bills have essentially been gutted.
Coles says now, they would do nothing to stop the common pattern in small towns, where a longtime practice with a doctor and two nurses could close its doors.
"The doc retires or becomes ill. They're having great difficulty in finding someone to buy that practice, and typically the practice would have to close," says Coles. "The community loses all three providers."
Senate Bill 369 would have permitted nurse practitioners in an under-served or high-unemployment area to see patients without the current requirement of a collaborative agreement with a doctor.
But the bill was changed to create a pilot project for doctors instead, to use telemedicine to see patients remotely. Coles calls that an empty promise, and says lawmakers are just helping doctors protect their professional turf.
"What's happened at the halfway point is these bills have been watered down or, in fact, the bills that are being voted upon now aren't the original language at all," he says. "That it's language that's been proposed by organized medicine."
He cites a Federal Trade Commission staff report that says within limits, nurse practitioners are "as safe and effective as independent health-care providers."
Coles thinks people in rural Virginia have gone long enough without easy access to primary medical care.
"It may be months before you can get your initial visit, and you might have to drive a long way," he says. "We're simply saying, 'Let's have the opportunity for a couple of NPs to start their own practices in these areas.'"
The Medical Society of Virginia argues that doctors are better suited to handle that care; Coles says studies have shown nurse practitioners do just as well. He adds one big problem is that doctors often don't want to practice in rural areas.
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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.
Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.
"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained
Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.
Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.
"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.
Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.
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New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.
The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.
"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.
Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.
Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."
"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.
Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.
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The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.
Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.
"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.
Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.
Hennessy said the experience was traumatic.
"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.
An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.
Disclosure: American Heart Association Western States Region contributes to our fund for reporting on Health Issues. If you would like to help support news in the public interest,
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