BISMARCK
There are two components to House Bill 1353, the controversial bill that takes money away from the state's anti-tobacco program and gives it to UND's School of Medicine and Health Sciences to fund an expansion.
Training
The first component would have the medical school focus more on training doctors and other health care workers for the state, particularly in smaller communities, which have had a hard time getting and retaining the doctors they need.
- State law now says the school's primary focus is simply to "educate" health care workers without mentioning where those workers might go. The bill would change that to "increase the health care workforce."
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- The bill would change the composition of the medical school's advisory committee to give those with boots on the ground more say and give smaller communities more weight than the cities.
Instead of one member each from seven different organizations such as the state Department of Health or the North Dakota Medical Association, it'd have eight members, four from communities with populations less than 5,000, two from communities of less than 30,000 and two from communities with more than 30,000.
Among the eight, at least five must be "involved regularly in patient care" rather than administrators.
It cuts the number of members representing the medical school's campuses in the state's four major cities from four to two.
- The bill also plays a bit of politics. State law now says a member of each of the two main parties from the House and Senate, four altogether, will be on the committee. The bill says there will be two from each chamber, with no partisan requirement, to be picked by the chairman of legislative management, who, naturally, is a member of the majority party.
- One of the duties of the committee is to report to lawmakers on how the school is meeting health care needs in the state. The bill would require the report's focus specifically on how to increase the health care work force, increase the number of residencies -- essentially apprenticeships for new med school grads -- and how to fill 80 percent of those residency slots with UND graudates.
Residencies are key because, statistically, doctors tend to stay in the area where they did their residencies.
Funding
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The second component is funding. It not only takes money from the state's anti-tobacco program; it would end the program.
- State law now provides specifically for a "tobacco prevention and control trust fund," which draws money from a portion of the 1998 tobacco settlement meant to pay for the attorney fees incurred by the state attorneys general that sued the tobacco industry.
The bill replaces that fund with a "health care programs trust fund" that would pay for the cost of any UND med school program that increases the state's health care work force.
The payout from big tobacco runs out 2017.
- State law now also requires 10 percent of another portion of the 1998 settlement be set aside for public health programs, of which 80 percent must go to anti-tobacco programs. The bill replaces that requirement, so any public health program will do.
This money does not have an end date and could fund the medical school as well.
- Finally, the bill eliminates Section 23-42, which contains the entire anti-tobacco program. The section says there will be such a program, that it must follow guidelines by the Centers for Disease Control and Prevention and that an executive committee will control that program.
The committee has broad powers to complete its mission, including employing staff, lend money or borrow it, give grants, lease property and do what any private company can do.
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The bill would end all this.
- UND's medical school would get $28.9 million for a new building and $5.8 million or as much as needed to increase the number of students it can accept and the number of residency slots.
