Industry officials and lobbyists from restaurants, telemedicine and medical marijuana agree that this year was one of the busiest and most successful legislative sessions they have ever seen. The American Telehealth Association tracks around 600 bills, six times their usual workload, with many of these permanently prolonged actions helping what was once a niche industry become a major player.
Industries are pushing for their case before state lawmakers do rely on surveys to find broad support for these new amenities. But there are also concerns that the legislature is moving too quickly and not taking into account the long-term effects.
“I would advise lawmakers to be careful,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans. “Once things are set in law, it is difficult to get things done.”
The governors of Alabama, Massachusetts and New Jersey announced that they will end their emergency ordinances in the coming weeks after Alaska, North Dakota and Oklahoma have already done so. Courts in Michigan and Wisconsin said their governors did not have the power to extend their orders.
And while other governors have not set a set date for their orders to end, the general recognition is that given the dramatic decline in Covid-19 case numbers in every state, the many vaccines available, and falling unemployment, there is little need for a state of emergency.
“The industry recognized that the ability to serve take-away cocktails came under exceptional circumstances,” said Whatley. “If it goes away, it could take years to return to these states.”
Before the pandemic, no state allowed take-out cocktails, but after the local food was closed, nearly three-quarters of states waived these rules for establishments with permits to sell local wine and liquor. Hard liquor has the highest margin of all items in most restaurants, and the move has increased sales off-premises by more than 5 percent, Whatley said.
Restaurant owners say they will still need this lifeline even if their dining rooms are now open. Surveys from various states show that patrons, especially millennials, overwhelmingly agree and put pressure on lawmakers to act. However there is There has been pressure to tailor legislation to protect liquor stores from competition and some have criticized these measures as a public safety risk.
Nebraska Republican Gov. Pete Ricketts on Wednesday signed legislation allows alcohol to go, making his state the 14th to do so. Legislation is before the governor of Missouri, and almost every other state has a similar effort. Virginia Democratic Governor Ralph Northam and Connecticut Democrat Ned Lamont, with the help of their state restaurant associations, have signed laws to make outdoor dining easier.
Massachusetts Republican Governor Charlie Baker proposed a bill Tuesday that would extend special permits for al fresco dining through November.
Baker plans to end his state of emergency on June 15, and this looming deadline has sparked a spate of activity. The Massachusetts Medical Society, a commercial group that represents doctors, is pushing for a Covid-era rule to be extended to require doctors to be paid equally for telemedicine and in-person visits from Medicaid and private insurers. These parity rules have been extended permanently for mental health and until the end of 2022 for general practitioners and patients with certain chronic conditions. But for most other doctors, equal pay ends in mid-September, 90 days after the emergency ordinance expires on June 15. Insurers could then negotiate lower tariffs for telehealth services, which they believe are justified because doctors have less overhead during this time. t having an office.
“Ninety days is not enough to fill your office, especially in a state where hiring medical assistants is extremely difficult,” said Barbara Spivak, family doctor and vice president of the Massachusetts Medical Society. She said she had never treated patients through telemedicine before the pandemic, but she soon realized that the availability of virtual care means much fewer missed appointments and greater patient comfort.
Psychiatrists across the country have seen the same thing. A 2020 survey found that 32 percent of psychiatrists reported that all of their patients kept their appointments, opposite 9 percent before the pandemic broke out.
Telemedicine advocates have changed their minds about lawmakers since the beginning of Covid-19, focusing the arguments more on health equity and expanded access. People who are disabled, home chained, caring for an elderly relative, or unable to find childcare would lose access if payments were cut, said Joseph Kvedar, president of the American Telemedicine Association.
“It will encourage inequalities and inequalities if we abruptly end telemedicine,” he said.
More than a dozen states have already codified some of the pandemic’s telehealth rules, and Kyle Zebley, director of public order at the American Telemedicine Association, said this was the most successful year his organization had in its three decades of history. This week, the group scored another victory when Texas lawmakers passed bill that would permanently allow Medicaid to cover telemedicine. This legislation would also allow audio-only services to address broadband access concerns in low-income and rural parts of the state.
Telemedicine boosters are far more successful in states than in the federal level, where there is little consensus on how to go further, due to concerns that virtual appointments can encourage overuse of health services and lead to fraud. The Trump administration has waived some Medicare rules that restrict the use of telemedicine, but more far-reaching changes require laws.
Many states have made it easier for patients to get medical marijuana even during the pandemic, allowing not only access to telemedicine but also roadside delivery or collection. Pennsylvania attorneys are now pushing for permanent Covid-era rules that allowed roadside pickups. Patients can also receive a three month supply of medical marijuana instead of a 30 day supply. The bill, passed by a U.S. state committee on Monday, also allows caregivers to administer marijuana to an unlimited number of patients, effectively legalizing its dispensing.
“All of these things worked well during the pandemic, and there’s no reason it shouldn’t continue,” said Luke Shultz, a patient advocate who sits on the governor’s advisory board for medical marijuana.
There is also a push in at least 10 states to permanently allow virtual notaries, as was the case in West Virginia in March and Florida in April.
Some of the lobbying efforts are aimed at restoring restrictions that were in place before the pandemic. In New Jersey, health organizations are campaigning for the reintroduction of a smoking ban in casinos after Governor Phil Murphy temporarily rejected a long-standing exemption from the state’s anti-smoking law. The gambling industry is fighting back, claiming a permanent ban would further weaken Atlantic City’s operations.
A bipartisan group of lawmakers has tabled a bill codifying the smoking ban, but it is not slated for a hearing, and similar bills put in place over the past decade have not been removed from the committee.
Revenue at Atlantic City casinos was supported by sports betting and online gambling in early 2021, even when compared to pre-pandemic totals, according to a current report from the American Gaming Association. That strengthens the case for maintaining the ban, said Michael Davoli of the American Cancer Society. Similar efforts are underway in Michigan and Pennsylvania.
New Jersey lawmakers are also investigating whether the pandemic should permanently change the scope of what advanced office nurses and medical assistants can do without consulting doctors. One of Murphy’s Covid-19 enforcement orders exempted these clinicians from obtaining medical approval to prescribe drugs to treat substance use disorders.
Laws that would have done the same were foiled just two months before the pandemic began amid the pushback of the American Medical Association.
Lawrence Downs, CEO of the medical group Medical Society of New Jersey, said codifying these regulations after overcoming a state health crisis would diminish the role of doctors in “team-based” care. Although he hasn’t seen a study that says in one way or another how patient outcomes were affected by the temporary waiver, “we are against continually doing what was put in place in the emergency.”
If anything, the emergency was evidence that the existing regulations were unnecessary, said MP Nancy Munoz, a Republican nurse who sponsored the law.
“I can’t think of a better time to do it than now,” she said. When Murphy signed his executive order, “I said, ‘The sky will not fall.’ The sky has not fallen. “