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Lawmakers Hate Special-Interest Turf Wars

In committee just ahead of my Medicaid bill was another unrelated bill. It proposed to expand the scope of practice of non-physician health care providers, mainly advanced practice registered nurses (APRNs), to prescribe opioid medications, especially the anti-addiction medication buprenorphine.

The problem the bill would fix was that certified pain-medicine specialists were in cities but not in this largely rural state’s poor hollers. It would allow APRNs to fill that health care gap.

Rows of physicians dressed in white lab coats faced the committee. Their lobbyist warned that only medical doctors could prescribe opioids and APRNs would get people killed. A few lawmakers countered that their constituents weren’t going to get pain relief without APRN help.

As the hearing devolved into a “turf war” – physician vs. nurse, urban wealth vs. rural poverty – a committee member turned on his microphone and addressing the doctors said, “My constituents aren’t the kind of people who come to the capitol in their Escalades to tell me how to do my job.” The doctors’ lobbyist seemed to ignore him.

The average viewer might not have caught more than a lawmaker’s peevish word. But so much more was being said. The lawmaker acknowledged that the doctors had won the turf war. The lawmaker was ignored, I guess, because before the meeting was gaveled to order, the deal had already been cut. and rural lawmakers and nurses were not part of the negotiations.

Of course, most committee meetings are just theatre ratifying what had earlier been agreed to. (Fundamental number 15 on Effective Lobbying Is Getting Votes! 27 Fundamentals for Successful Lobbying)

My Medicaid bill was enacted allowing the elderly poor to stay in their homes with state assistance. We had done behind-the-scenes negotiation with special interests, the state Medicaid agency, advocates for the poor, etc. We too cut the deals out of the public eye. That’s just good lobbying. Lawmakers want to hear consensus, not facts. The legislature similarly also ratified our earlier deal.

However, this fallout of the doctor-nurse turf was especially unfortunate as APRNs even in the remote mountain counties hardest hit by opioid abuse couldn’t prescribe to get addicts off oxy. And with some irony as to the doctors saying that nurses will get people killed, the state has the 3rd highest rate of opioid death rate in the country. Normally, lawmakers hate and turn off to turf wars. But sometimes the relative power between parties is so disproportionate, and one side’s lobbying is done so well, that somebody just gets rolled. Lobbying is a fun job most, but not all, of the time.





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