Tuesday, May 17, 2016

Anatomy of a House Bill (HB3016)

One thing that I dreaded as a new president of the Oklahoma Chapter of the American Academy of Pediatrics (OKAAP) 3 years ago was the legislative advocacy that would be expected of an OKAAP leader.  I often felt like I didn't know or understand enough about an issue to truly advocate for it effectively at the legislative level.  I was intimidated by the thought of having to sway a law maker for or against an issue.  Just because I know medicine and pediatrics doesn't mean that I felt confident to speak to complex legislative issues and the thought of emailing a legislator let alone speaking to them in person was the last thing I wanted to do.  Or, so I thought.

With time and the help of my AAP colleagues at various meetings including the OKAAP Board meetings, the Annual Leadership Forum (ALF), the District VII meetings, and the AAP's National Conference and Exhibition (NCE), I learned a great deal about how to be an effective advocate for children.  Over time, the knowledge of how things work legislatively flowed over to combine with my passion for pediatrics and now that I've come to the end of my OKAAP presidency, I am far more comfortable being "politically active" than I was 3 years ago.

The first annual OKAAP Legislative Conference convened in the Fall of 2015 in partnership with the Oklahoma State Medical Association (OSMA).  We spent an afternoon meeting with the OSMA lobbyist to discuss a legislative agenda for the OKAAP during the upcoming legislative session.  This was when we were informed about SB 830 by Senator Ervin Yen - an anesthesiologist who was committed to removing non-medical vaccine exemptions in Oklahoma.  We heard that he was having trouble getting his bill heard in committee.  When asked what the chapter could do to help with SB 830 we were encouraged to help with a vaccine poll that Senator Yen was conducting through Sooner Poll.  The OKAAP started a GoFundMe account and successfully raised money to partially fund the vaccine poll regarding strengthening Oklahoma vaccination laws.  The results of the poll were favorable.

Unfortunately, SB 830 was never heard in committee but Senator Yen is determined to keep trying and we are committed to helping him succeed.  As this legislative session proceeded, the OKAAP was asked to weigh in on various bills and, thus, I was thrust into my new political advocacy efforts.

A laundry list of anti-LGBTQ bills that would be harmful to children.  We responded to these bills with an op-ed written with the help of Ian Van Dinther, Senior State Government Affairs Analyst at the Division of State Government Affairs of the AAP.  I would be remiss if I didn't mention the LOADS of support that AAP National has to help chapters with local legislative efforts.

SB1273 aka Shepard's Law which would require child care providers to follow safe sleep standards and establish an advisory committee and peer review board.  When the bill passed in the Senate and was going to the Governor for signature, the Office of Management and Enterprise Services (OMES) contacted the chapter for comment.  We sent an email to OMES supporting the bill which was signed into law by Governor Fallin.

HB 2962 - Oklahomans for Autism Insurance Reform.  We signed a letter of support for the bill which would require state funded insurance plans to eliminate the excluded diagnosis of autism and to cover evidence-based treatments.  This was signed into law by Governor Fallin on May 4, 2016.

Medicaid proposed provider cuts of 25% and the Medicaid Rebalancing Act of 2020.  The OKAAP met with the Oklahoma Health Care Authority (OHCA) CEO, Nico Gomez, to discuss how the chapter could help with avoiding these devastating provider cuts.  The Rebalancing Act relies heavily on a cigarette tax and Mr Gomez asked for our support for the cigarette tax.  We responded with a position statement and talking points for our members and continue to advocate with legislators to support the cigarette tax.

HB 3016 - the "Parental Rights Immunization Act".  This little bill proved to be the most bothersome bill to the OKAAP this legislative session.  We were late in the game on this one getting notification only after the bill had already passed through committee and the House.  At the senate hearing, Senator Yen offered 2 amendments:  (1) adding in language to remove non-medical vaccine exemptions and (2) replacing the requirement for providing Appendix B of the Pink Book with a web link to the information instead.  Unfortunately, his amendments did not pass but HB3016 did pass.

Just prior to going to Governor Fallin for signature, the OSMA responded with a letter and we were asked by OMES to comment as well.  We sent an email to OMES and sent a call to action to our members to contact Governor Fallin encouraging her to veto the bill.  I spent the better part of a day calling up members and asking them to call the Governor's comment line about HB3016.

Governor Fallin elected to veto HB3016 on April 29th.  I was really happy to hear this and it was at this point that I remember thinking that this advocacy stuff wasn't so scary after all and that what we did really does make a difference.  We spoke and the Governor heard even using some of the same verbiage from our email in her veto message.  We were supported by not only the OSMA but also by the Oklahoma Osteopathic Association and the Oklahoma State Department of Health.

From here on out, the "pro-information" activists (who claim not to be anti-vaccine but by all accounts are clearly not pro-vaccine) went kinda nuts.  I was introduced for the first time to the "Oklahomans for Vaccine and Health Choice Political Action Committee" (OVHC PAC) who seemed to be celebrating their victory with HB3016 in the House and Senate and were utterly shocked that the Governor would veto the bill.  Not only were they shocked, they were blatantly offended.  They swarmed the OKAAP Facebook page and posted all sorts of offensive memes and comments to which I spent a good deal of time over the weekend moderating.  Many offensive comments were removed and posters were banned.  A few posters were more respectful and I posted responses to their comments.

They took to Twitter to display their unhappiness with the Governor's decision using the typical anti-vax rhetoric which usually involves accusations related to money/being bought or suggesting someone is "anti-informed consent" simply because they opposed a poorly worded bill that wasn't well thought out.  They created memes to push their agenda which, imo, was even more entertaining than their "Big Pharma" accusations.  It was the most incredible display of Butthurt I've ever seen.

In fact, the OVHC PAC even went so far as to put together a press release that specifically targeted the OKAAP and me personally in a vain attempt to discredit us.  A few select quotes taken out of context is exactly what I'm used to seeing from anti-vaxers.   The full article I wrote is posted on our OKAAP website explaining how that instead of singling out flu vaccine and treating it differently than the other vaccines we recommend, we now approach the flu vaccine THE SAME as all the other vaccines we give.  We also obtain informed consent as we are required to by federal law - via the Vaccine Information Statements.   I'm not sure their press release was even picked up by any media outlet.  I can only imagine what was said about the OKAAP (and about me specifically) behind the scenes.

"Operation Override" quickly ensued.  They insisted that the bill only mandated 4 pages (the vaccine excipient and media summary) rather than 34 pages (the Pink Book, Appendix B) but the bill clearly says:  "....making available for review the Centers for Disease Control and Prevention's "Epidemiology and Prevention of Vaccine-Preventable Diseases:  Vaccine Excipient and Media Summary" (also known as the 'Pink Book", Appendix B)".  The bill incorrectly asserts that the summary (4 pages) is the same as the appendix (34 pages).  This error draws into question whether Representative Grau actually read the Pink Book as he doesn't seem to know the difference between the summary and the appendix.

But let's not actually confuse the OVHC PAC with the facts.  They'll just keep insisting that the bill only calls for 4 pages even though it's simple to demonstrate that this is not so.  I finally had to post a clarification to our Facebook page after OVHC PAC threw out terms like "liar", "uninformed", "willfully ignorant", etc.

Things calmed down for a short while and then we received notification from Senator Yen late last week (Friday, May 13, 2016) that HB3016 would be brought back to the House by Representative Grau for an override vote.  So on Monday, I wrote up a list of talking points for members and the chapter sent another call to action for members to contact their House Representatives to encourage them to vote to sustain Governor Fallin's veto.  I also sent a personally addressed email to every House member explaining the reasons for the Governor's veto and asking them to consider upholding it.  I actually received a reply back from Representatives Lockhart, Cox, and Hardin.

Although we were expecting a vote on Tuesday, May 17th, the vote actually occurred on late Monday afternoon and we received an email notification from OSMA (Wes Glinnsman) immediately after the vote took place.  The override vote did not pass with 55 voting yes to overriding the veto and 38 voting no.  A 2/3 majority vote (68) was required for the override to pass.

I felt like we had dodged another bullet and was pretty happy that for my first significant political advocacy effort, the result went our way.  The backlash from the "pro-information"/"anti-vax" contingent was much more somber this time around.  A couple of tweets and only a couple of comments on our Facebook page in response to the failure of "Operation Override".  This was the only one that I had to delete:

As OSMA's lobbyist put it, though, they can try again at any time.  Yay.  So for now, we just need to keep our ears to the ground.  Our attention, though, will be turning to the cigarette tax and getting the legislature to head off a catastrophic cut in Medicaid payments.