Rep. Raymond Ward (R-Bountiful) is the House Chair of the Social Services Appropriations Subcommittee 2022. Ward is a practicing family physician and is affiliated with the Utah Medical Association and Utah Academy of Family Physicians.
Ward recently spoke on his caucus’ health policy priorities at our 2022 Utah State of Reform Health Policy Conference on April 7th in Salt Lake City.
In this Q&A, Ward reflects on the 2022 legislative session and on future legislative items he hopes to implement in the next session.
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State of Reform: How would you summarize this session’s health policy legislation? What would you say is the most important legislation that came out?
Rep. Raymond Ward: “I think the biggest issue is not one that gets a lot of headlines, but it was making sure that we increased payment in a number of different small areas enough to keep staff working to provide those different services. The biggest one that got attention was services for people with disabilities, because the frontline workforce there was completely leaving the field. It was really bad, and services were just shutting down. Hopefully, what we did will be enough to keep our workforce there.”
SOR: Can you tell me a bit more about what the committee did to address workforce shortages?
RW: “The amount of money that you need to pay to get someone to respond to a wanted ad for an entry level job is not the same as it was two years ago. That’s not a governmental decree, and it’s not a government set minimum wage. It’s just where the private market went. We see that here in my medical office where it took us four or five months longer than I wanted to say, ‘Look, I know that that’s less profit at the end of the day, but we can’t hire staff and we have to adjust how much we’re offering in the wanted ad.’
As a private business, we’re able to make that change and it’s still tough, but now we have people answering to our wanted ads. But the government is slow. They can only adjust one year at a time and administrators are still somewhat distant from the contractors with whom we contract for the services. So, the session is our one chance to try and be accurate about [what agencies need what funds for their workforce needs].”
SOR: Can you tell me about the fiscal year 2023 budget from the Social Services Appropriations Subcommittee? What’s in it and how has it changed from previous years?
RW: “Some of the big rocks in the social services budget include some increases in pay where we tried to identify the most at-risk job categories across social services—including the Division of Services for People with Disabilities (DSPD), which was the biggest one. The other big change in the budget is hardly discussed because of our process in Utah. We have what’s called consensus for Medicaid. To keep Medicaid running, our fiscal analysts from the legislature work together with the department and the governor’s office to come to what they call a consensus number where an increase will need to be made just for Medicaid. That is probably bigger than any other appropriation that the committee makes, but is taken for granted at the beginning of a session.
We are in a very odd time since two years ago under the Trump administration we said it’s a public health emergency (PHE) for COVID. So one may not be taken off the Medicaid at all period, unless they themselves asked to be taken off. Well, every state has rules about when you can come on and when you no longer qualify. So, all those rules have just been put on hold and the longer that time goes on, the more people get put on Medicaid and then no one gets taken off. That just distorts things, and so we have a very large increase in the number of people on Medicaid since that normal review isn’t happening.
The administration has continued to extend the PHE. There were several discussions this year about what other portions of people who receive Medicaid ought to receive longer services. Should you cover a woman a year postpartum? Should you cover contraception up to a higher percentage of poverty? Should you do something different for somebody who’s just been released from prison? All those are valid discussions, but I don’t even know how to discuss them right now because right now, no one gets taken off ever.”
SOR: What were the most important bills relating to health policy to pass or fail in this session?
RW: “Utah has been one of the stingiest states about saying doctors can prescribe medicines, but they can never also dispense them, but most other states do allow that. So this year, one of the bills that I worked on was able to get an agreement between prescribers and dispensers. So, now a medical office that wishes to also dispense medicines can get just a license called a ‘dispensing practice license’. If it’s an acute medication—so less than 30 days and it comes prepackaged and it’s not a controlled substance—then they could stock their most common medicines and also dispense them to folks if they wanted to do that.
You can drop in for your visit and we take care of everything for [the patient] there. You don’t have to go anywhere else. But on the other end of the scale, you think of? clinics serving a homeless population. Someone might have a big cellulitis on their leg, and you can write them a prescription but you know what the pharmacy is two thirds of a mile away and it’s night and it’s down the frozen road. They might not make it clear down there to wait for an hour and then get your prescription. So let’s just put that into their hands there so they don’t fall through the cracks that way.”
SOR: What do you and your caucus plan to tackle in the next legislative session?
RW: “The Social Services Appropriations Committee would like to have some different process for DSPD services, in particular our waiting list, which just gets more and more people on it every year. People have been there for 10 years, they’ve been there for 15 years, they’ve been there 20 years, and more. On the one hand, I know the waiting list is a bottomless pit. Right now, it’s kind of hit and miss every year whether money gets appropriated directly to the waiting list. Some people come off the waiting list every year because people die or move out of the state and that frees up some money, so then some other new ones come on. But, I know there’s interest on the committee to try and find some other process so there are at least some high acuity people that we don’t leave in the lurch on the waiting list forever.”
This interview was edited for clarity and length.