Health-care changes to require extensive action by Legislature

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HARRISBURG -- The General Assembly will play a crucial role in determining the ultimate success of the major health-care policy changes proposed by Gov. Ed Rendell.

In his wide-ranging "Prescription for Pennsylvania," the governor asked legislators to debate some thorny political issues, such as enacting a statewide ban on smoking in workplaces, including bars and restaurants; increasing the $1.35-a-pack-tax on cigarettes, which was last increased by 35 cents in 2003; and imposing, for the first time, the state's 6 percent sales tax on the sale of cigars, pipe tobacco and smokeless tobacco.

"We want to promote a healthy lifestyle" as one way of lowering health care costs, he said. "I will ask the Legislature to make all workplaces smoke-free, including bars and restaurants."

Mr. Rendell said he's never been able to understand why the sale of cigarettes is taxed but chewing tobacco and cigars aren't.

"Of all the states that have a cigarette tax, I think we are the only one, or one of the few, that do not have a tax on smokeless tobacco and cigars, even though they've been proven to be almost as harmful as direct cigarette smoke itself," he said.

Mr. Rendell also is asking the Legislature, before it adjourns June 30 for the summer, to consider other major changes, such as giving back to the state insurance commissioner the power to review and approve all health insurance rates. The commissioner used to have such authority but some of his power was revoked by the Legislature several years ago, he said.

He also wants a new law expanding the medical functions that nurse practitioners are permitted to do, so that hospitals can set up emergency room adjuncts, staffed by nurse practitioners.

They would be able to do such things as treat dog bites or give shots as a way to ease the burden on emergency room doctors and cut down the waiting time for patients who rush to the hospital for emergency treatment.

Mr. Rendell is also proposing a "medical loan forgiveness" plan for doctors who agree to work a certain length of time in underserved areas, especially rural areas and inner cities.

House Speaker Dennis O'Brien, R-Philadelphia, reacted cautiously to such controversial changes. He said a bill on smoke-free workplaces came up for discussion in the 2005-06 term but was never voted on.

He said he will have House committees debate various parts of the package.

The smoke-free workplace idea likely will go to the State Government Committee, headed by Rep. Babette Josephs, D-Philadelphia; changes to the insurance commissioner's power would go to the Insurance Committee, headed by Rep. Tony DeLuca, D-Penn Hills.

"I will not dictate to those chairmen" what to do with the bills, said Mr. O'Brien, describing his role more as an arbiter to reach consensus on issues. "I want the committee processes to work and bring any proposals to the (House) floor" for debate and possible action.

Mike Manzo, a top aide to House Majority Leader Bill DeWeese, D-Waynesburg, said the governor's plans will almost certainly require the House committees to hold numerous public hearings, both here and in towns around the state.

"Absolutely, we will take these issues across the state and try to build a consensus," he said. "We would be fools to rush into this. We have miles to go" before enacting anything.

State Sen. Jim Ferlo, D-Highland Park, said he doesn't agree with everything in the Rendell plan but he's glad the governor kicked off a major debate on health care reform.

Mr. Ferlo does like the proposed ban on workplace smoking, saying he had supported such a bill, introduced by Sen. Stewart Greenleaf, R-Montgomery, last year.

"The jury is 'in' on the issue of second-hand smoke," Mr. Ferlo said. "Smokers shouldn't contaminate the air for fellow workers or the public."

Rep. Don Walko, D-North Side, also supported the ban, saying it will "improve the health of customers and employees and reduce health-care costs."

Bill George, president of the state AFL-CIO, said the smoke-free workplace proposal poses a dilemma for some of his member unions.

He said many unions represent blue-collar workers who are smokers and many of them don't want government telling them where they can or can't smoke.

On the other hand, he said, "All the new studies show the harm of tobacco. We think the time has come" to consider banning smoking in workplaces, bars and restaurants.

Bureau Chief Tom Barnes can be reached at or 717-787-4254.


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