Significant Health Professional Shortages Persist in Rural PA

Gerrymandering plus unfair legislative rules yield an unresponsive legislature where good solutions to important issues rarely get a vote.

A significant swath of rural Central PA has inadequate primary care. Two bills to address the issue were passed this year—one in each chamber of the PA General Assembly. Neither passed both houses.

PA Gov Department of Health
PA Gov Department of Health

The Problem

For years Pennsylvania’s Department of Health and legislators have known that PA does not have enough primary care doctors to treat residents in a large swath of mostly-rural PA running from SW to NE. A three-part story reported last year in Lehigh Valley’s Morning Call details medical needs going unfulfilled in coal country.

Given the opioid crisis and COVID-19 impacting the state in 2020 in particular, Pennsylvanians might have expected some urgency from legislators to ensure enough qualified medical personnel to keep us safe. Nurse practitioners have the education and skill to take some duties of a primary care physician, if given the scope of work to do so. Twenty-one other states and the District of Columbia currently allow nurse practitioners full practice authority.

Two bills giving independent practice and prescribing privileges to nurse practitioners were passed during the past session, one in each chamber. Neither was enacted into law.

The Solution

Revise the rules to enable popular bills from both houses to have an easier opportunity to be enacted into law.

How did both chambers end up passing bills but not enacting laws?

The Senate passed Senate Bill 25, considered, debated and passed in a couple of previous sessions since first being introduced by Senator Patty Vance in 2013. Each legislative session is two years, so this critical health care issue has been debated now for seven years.

In the PA House, House Bill 100 also addressed the scope of authority of nurse practitioners. The bill had a majority-party sponsor and at least fifty cosponsors, with strong support from both parties.

The House did not act on the Senate bill and the Senate did not act on the House bill. Each bill was stalled in committee in the other chamber as the session ended. The chambers did not reconcile their bills before the session ended, so no law was enacted. This happened despite clear support from legislators and the urgent need for more licensed health care professionals.

How is this possible?

Pennsylvanians get short-changed on bills they support. Legislators do, too.

Bills voted out of one chamber are not required to be voted on in the other chamber. Bills passed in one chamber are placed in committee in the second chamber. The committee chair has complete control over what bills get heard in committee. Committee chairs are not required to place bills on the agenda or to explain why they do not. So much for transparency, accountability, or effective legislative action.

House and Senate procedural rules matter.

Many other legislatures employ rules to keep good legislation moving. Pennsylvania’s legislature has no such rules in place, which is one reason it has an agenda fairness score of zero!

Contact Your Legislator

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Rules Reform