From Kansas City Medicine, Third Quarter 2020
Read PDF of full Kansas City Medicine candidate Q&A
(Jerome Howard Bauer did not respond to our questionnaire.)
What lessons have we learned from COVID-19, and how can we be better prepared for future pandemics?
Parson: There have been a lot of lessons, but one of the most important is the effectiveness of our “box-in” strategy to protect the most vulnerable. “Box-in” mobilizes facility-wide testing in senior centers and veterans homes to test all residents and staff the moment we know anyone in the facility is positive. This is why Missouri has been able to avoid the terrible outcomes for seniors that we saw in early breakout states like New Jersey and New York. The other important lesson is that the state must communicate frequently and clearly. That is why I continue to have frequent press briefings on COVID-19.
Galloway: The most important thing the governor can do in a public health emergency is to convene public health experts and follow their consensus advice. I do not believe the current governor has been willing to do that. For instance, Gov. Parson’s continued resistance to a statewide mask rule, which public health experts in Missouri and the White House have advised Missouri to adopt. Coordinating response, resource distribution and scaling capabilities are all important elements of responding to a pandemic. But, every decision must be guided by science and data, not politics.
Combs: Biggest lesson learned is to ensure accountability in lockdowns by having the decision-making process in the hands of elected officials rather than appointed officials. Too much power in the DHSS and local health departments. That said, we must ensure the proper PPE is stocked and stored for future use. Lockdowns are ineffective (e.g., Sweden versus the rest of Europe) and must not occur. Hygiene is important and personal space a must.
Now that Medicaid expansion has passed in Missouri, what steps need to be taken to implement expansion per the Affordable Care Act?
Parson: A few years ago, Missouri would have been unprepared for Medicaid expansion. But I appointed Todd Richardson as the Director of Missouri HealthNet (Medicaid) to meet exactly this kind of challenge. Right now, Todd is convening experts to make sure expansion in Missouri is as smooth and cost effective as possible.
Galloway: Voters have spoken, and eligibility for Medicaid will be expanded. The question is whether opponents interfere with its implementation through the appropriations process or other attempts to hinder Missourians from receiving health care. I supported expansion and campaigned in favor of it. Governor Parson publicly opposed it and campaigned against it. Missouri should follow the lead of so many other states that have realized public health and fiscal benefits from expansion. Those benefits of expansion will be a key part of our coronavirus recovery. We can do it without raising taxes or cutting other programs as many other states have done.
Combs: The biggest issue looming for Medicaid expansion is the amount of money Missourians must pay out in the coming years. The budget will have to be adjusted to fund this new requirement, and where does that funding come from? What state funding needs reduction and/ or elimination? Medicaid is a large part of the state’s budget, and growing exponentially; so where will Medicaid be in 5 or 10 years? Another looming question is that of continued federal funding share … with the national debt nearing $30 trillion, how long can Missourians expect the federal government to continue their levels of funding?
Though physicians (MD and DO) undergo many more years of education and training, other specialties such as nurse practitioners are lobbying for legislation to grant them similar scope of practice authority without physician supervision. What is your position on granting greater scope of practice authority to nurse practitioners and other health care professionals?
Parson: I believe it is important to acknowledge the value and distinctions of specialized medical training. Missouri needs to maintain and expand our trained workforce of highly skilled health care professionals to meet the needs of our citizens today and in the future. Any discussions of statutory changes regarding expanded scope of practices should be focused on areas of our state where acute shortages of highly trained health care professionals exist, with the goal of providing all regions of Missouri with the highest quality health care possible.
Galloway: When government considers regulatory changes in the field of health care, safety must be given the strongest possible consideration against economic benefits of a proposed rule change. Many of our rural areas lack physicians, and access to even primary care is a significant issue. If patient safety can be preserved or enhanced, and regulatory changes generate clear economic benefits to patients, providers, or insurers, it should be open for consideration.
Combs: I fully concur with health professionals being granted more scope of responsibility and greater freedom to practice unsupervised. Moreover, I would favor the state no longer license health practitioners, but have the individual disciplines regulate themselves.