Merit-based health care bill raises concerns about patient outcomes

BOISE — The Senate Health and Welfare Committee voted Tuesday to send House Bill 928 for amendment to align an effort to remove diversity, equity and inclusion initiatives from health care with federal civil rights statute.

Under the Merit-Based Health Care Act, which passed out of the House last week, all health care facilities in the state that receive Medicaid funding will be required to eliminate any diversity, equity and inclusion (DEI) practices including hiring based on race or sex, mandatory bias training or pledges in support of DEI tenets.

The legislation permits the attorney general to investigate alleged violations and provides that any entity in violation of the bill will be provided with a written notice and an opportunity to correct violating behavior. In the event this behavior is not corrected, a health care facility can receive penalties ranging from $5,000 to $100,0000 depending on the number of employees under a health care provider and whether the action was a first, second or third violation.

In committee discussion of the bill, Sen. Mark Harris, R-Soda Springs, questioned whether the legislation would preclude a clinic from hiring a female OB-GYN. Sen. Ben Toews, R-Coeur d’Alene, who co-sponsored the legislation, said it would only come into conflict with the legislation if a female applicant had lesser qualifications than a male applicant. 

Sen. Melissa Wintrow, D-Boise, questioned what problems the legislation was seeking to address in the first place. Rather than pointing to any present practices taking place in Idaho health systems, Toews said the aim was to prevent hiring quota efforts that prioritize characteristics other than merit and, in turn, “puts lives in danger.”

Toews, along with fellow bill sponsor Sen. Josh Kohl, R-Twin Falls, urged the committee to send the legislation for amendment to remove the inclusion of “sexual orientation” and “gender identity” within the definition of discriminatory hiring to align with federal statute. 

The majority of public testimony on the legislation came from members of the health care field who opposed the legislation on the grounds that it would lead to confusion within Idaho’s health industry and lessen the quality of care that can be provided for patients throughout the state.

Dr. Michael Fields, a family medicine physician based in Moscow, said he was in opposition to the legislation on the grounds it would lead to negative impacts for patient outcomes in the state. With modern medicine recognizing these outcomes are influenced by a number of factors outside of biology, such as financial resources, geographic environment and distance to care, taking this into consideration is a matter of “responsible matter practice” rather than ideology, Fields said. 

“While this bill is framed as promoting merit-based health care, its practical effect would be to restrict evidence-based training and practices that help health care professionals provide safe and effective care for diverse patient populations.” Fields said. 

If these practices were to go away, the state would be setting up health care professionals to provide “cookie cutter medicine” that fails to take into account the differing needs of Idaho patients, Fields said.

Dr. Cathy Canty, a family practice doctor based in Twin Falls, said implicit bias training in particular can lead to both more accurate diagnoses and better health outcomes. 

Canty recalled being able to attend a training on the practices and rituals of regional Indigenous tribes, among which were fasting for a certain period of time. Canty said if she were to come across a patient belonging to these tribes who had pneumonia and was diabetic, they could be at risk of hypoglycemia and prolonged hospitalization if they were to partake in fasting.

In the event these circumstances were to arrive, Canty said she now knows she would need to have a conversation about whether or not they are fasting and discuss the use of their insulin.  

“Based on this example, equity training can actually save money in health care by making us more conversant and undressing of different, not frequently considered contributors to a patent’s health care," Canty said.

Contradicting Canty and other health professionals who testified, Sen. Brian Lenney, R-Nampa, said implicit bias training “teaches racism as a clinical fact” and “has no place in medicine.” 

While legislators pointed to a provision in the bill allowing for the collection of demographic data for “legitimate clinical care,” health care providers said the legislation left too much uncertain as to whether this data could be applied in medical practice and what could qualify as “legitimate,” which lacks a definition in the bill. 

Liz Woodruff, testifying as the executive director of the Idaho Academy of Family Physicians, said there wasn’t concern about the bill’s assertion that hiring practices align with federal statute, but believed there to be a “contradiction” within the legislation of being able to collect data and implement that data to adjust patient care accordingly.

Dr. Richard Bosshardt, a plastic surgeon based in Tavares, Fla., testified in favor of the bill and claimed medical education has been “diluted" with DEI training. By having the legislation in place, Bosshardt said, neither patients nor physicians themselves will be left questioning whether they received their position on the basis of ability or diversity.

In her concluding remarks on the legislation, Wintrow disagreed with the bill’s assertions about the health care system on its face, describing the resistance to trainings perceived to be under the DEI umbrella as a result of confusion and misinformation. Across all levels of the medical field, Wintrow asserted positions were already decided by merit.

“They have to get into med school, they have to pass tests, they have to go to residencies, they have supervision,” Wintrow said. “There’s no one getting a job that cannot practice medicine.” 

In a voice vote, the committee opted to send the legislation for amendment with Harris and Wintrow both voting no.