(The Center Square) – “We all just need a little break. It’s been a tough hearing,” said Department of Health Secretary Dr. Debra Bogen toward the end of her testimony before the Senate Appropriations Committee on Wednesday.
Legislators grappled with tough issues – and each other – as they pushed for clarity on the proposed 9.7% budget increase for the state’s primary health agency. There were differences of opinion on the most important objectives in a field with need in every direction, frequently leading back to the perceived competition between rural and urban regions for state resources.
Marijuana, rural healthcare and maternity care were key areas of concern. The hearing opened with questions about reopening the doors of shuttered facilities even as the question of how to fill the massive vacancies in those currently operating remained unanswered.
The recent announcement that UPMC Cole in Coudersport, Potter County will be ending its labor and delivery services that leaves a gaping hole for birth centers across a five-county region brought rural health care to the forefront.
Though the issue is a frequent topic of discussion in the legislature, rural Pennsylvanians say not enough has been done to stem the flow of providers out of their towns.
Bogen noted that when students spend 12 weeks in a rural post, they are more likely to seek out careers in rural health. One of the biggest obstacles to doing so is the distance between school campuses and potential rural opportunities, creating additional housing and transportation demands for students.
Despite the logistical challenges to rural recruiting, Sen. Cris Dush, R-Brookville, suggested that those needs were being denied attention while the state strives to reduce disparities in maternal and infant health outcomes for Black women.
“There’s been a lot of ink spilled over Black maternal health,” said Dush. “But the most rural part of this state has been excluded from getting any help in this area, and I want to know why.”
His comments inflamed several committee members and directly contradicted the efforts made by the Shapiro administration, the general assembly, and the Department of Health, including proposed legislation to incentivize rural health care workers, the most recent of which was first introduced last year.
Minority Chair Sen. Vincent Hughes, D-Philadelphia, asked Bogen to restate some of the driving statistics behind the state’s maternal health initiatives. Black women are twice as likely to die during pregnancy and the first year of their children’s lives relative to their white counterparts.
“Would that not seem to warrant special extra attention because the issue is so acute?” asked Hughes, who was assured that the agency uses data like this to inform their decisions.
Republican legislators pressed Bogen on the state’s medical marijuana program as the governor pushes for adult-use cannabis sales. It is not expected that recreational marijuana sales would be under the purview of department.
Faced with mounting concerns around the impact of marijuana use on cognitive development in adolescents, several senators sought to better understand the risks of widespread use and current strategies to mitigate them. Bogen noted that products are evaluated and approved by the state to ensure packaging and marketing don’t appeal to children.
Unlike other states, Pennsylvania’s medical program does not allow for the sale of candy-like edible marijuana products, nor does it allow for smoking dry leaf, though committee Chair Sen. Scott Martin, R-noted that the sale of dry leaf products for vaporization was approved by Bogen’s predecessor outside the state’s legislative process.
Though the agency has been looped into discussion around the impact of legalization, concerns about smoking in public and screening driver’s for intoxication would be better addressed with law enforcement, Bogen said.
Another recurring theme throughout the hearing was the uncertainty created by funding cuts at the federal level. According to Bogen, the department is not currently facing any cuts, but they are monitoring the situation closely. She says 60% of the department’s funding sits under the blade of the federal government and Elon Musk and DOGE, including 500 employees.
Bogen says many of the major programs overseen by her department are federally funded including WIC, and the state’s emergency preparedness efforts, and its vaccination program. Medicaid, medical research funding, and dollars for public health education and awareness all have massive impacts on the agency’s work.
Even without cuts from DOGE, the state faces the end of federal grants given to address needs that arose from COVID-19. New appropriations from the state’s own coffers will be required to maintain those programs.
