Common Denominator in Failed State Health Reform: Budget Woes

But the states may be a different story.  A round up of failed– or at least disappointing– health reform state initiatives over the past two weeks shows a consistent factor in the process: budget woes.  Many states have shown themselves to be not willing to overlook state budget crises in favor of immediate health reform.

Case in point: Washington State.  The state’s House approved a bill last week that would remove thousands of beneficiaries from basic state health care.  State officials would have authority to remove residents receiving separate benefits from the state’s Department of Social and Health Services, as well as discretionary removal of residents based on income, perceived access to private insurance, and how long a particular resident has received basic state health care.  The bill, according to the AP/Seatle Post-Intelligender, is likely to save the state $250 million (of the $9 billion annual budget gap that the state hopes to close).  The proposal is currently awaiting a vote in the state Senate.

Washington also recently imposed a new rule that would cut Medicaid reimbursements for brand-name prescription drugs– an intended savings of $1 million dollars a month.  However, two weeks ago the AP/Seattle Post-Intelligencer reported that a federal judge imposed a ban on enforcement of the new measure over concerns that it would restrict access to prescription drugs.  A hearing on May 18^th will determine whether the ban will be lifted or stayed.  Read more

Mergers In State Health Reform: Increased Efficacy or More Bureaucracy?

State Delegate Don Perdue told the The Herald-Dispatch, “Health reform has been tried a number of times.  It fails because one agency is not talking to another, because the vision somewhere gets lost in the process.”  One might imagine Delegate Perdue to be referring to health reform in just about any state– and even the federal government.  Are West Virginia legislators so far ahead of our representatives in Washington?  Hopefully not.  As our blog reported last week (Obama Officially Establishes White House Office of Health Reform), President Obama recently signed an executive order with an arguably similar purpose: work with several federal executive branch agencies, states and local officials, and Congress to enact health reform and develop and implement strategic initiatives to strengthen the performance of the health care system.

In Massachusetts, Governor Deval Patrick isn’t having as much luck.  The Boston Globe reports of a letter the Governor wrote to the chair of the state’s Health and education Facilities Authority (HEFA) instructing the agency to merge with the state’s Development Finance Agency by July 1, 2009.  The Governor’s office maintains that the merge will enhance HEFA’s ability to provide tax-exempt financing for hospitals and health facilities (as well as state educational institutions).  Critics see the attempt as a “power grab” and an attack on the safeguards that keep HEFA, and other quasi-public authorities like it, safe from political pressure and “gubernatorial interference.” Read more

Iowa Turns to Health Care in Finding Same-Sex Plaintiffs “Similarly Situated”

The Iowa Supreme Court unanimously ruled today that marriage should not be limited to a man and a woman after reviewing Iowa’s marriage statute under strict scrutiny.  The case is Varnum v. Brien.  Interestingly, when it came to the important constitutional touchstone of whether same-sex couples are in fact “similarly situated” with straight couples, the Court cited two examples to rule affirmatively– one of which is family health care decisions.

“Society benefits…from providing same-sex couples a stable framework within which to raise their children and the power to make health care and end-of-life decisions for loved ones, just as it does when that framework is provided for opposite-sex couples.”

That notion as expressed is a first.  While a handful of American states’ high courts have ruled that marriage should be afforded to same-sex couples, the Iowa Supreme Court is the first to expressly mention family health care decisions in the evaluation of whether same-sex couples are similarly situated with heterosexual couples.  Two courts’ opinions ruled in favor of same-sex marriage without a “similarly situated” finding: Hawaii in Baer v. Lewin (74 Haw. 530 (1993)) and Massachusetts in Goodridge v. Department of Health (440 Mass. 309 (2003)).  And although California (In re Marriage Cases, 43 Cal. 4th 757 (2008)) and Connecticut (Kerrigan v. Commissioner of Public Health,  289 Conn. 135 (2008)) ruled similarly under an Equal Protection argument, these opinions found plaintiffs “similarly situated” based on their intent to enter into formal, legal, recognized family relationship– without highlighting the importance of family health care decisions.

The ruling has already caused a stir in the State Capital.  Reactions vary across the political spectrum.  Proponents of same-sex marriage are ecstatic.  Opponents have already raised the possibility of a constitutional amendment.  Other legislators, such as State Rep. Dave Heaton, aren’t exactly warmed up to the idea of same-sex marriage, but recognize the need for rights– such as the Court’s concern for health care decisions– for same-sex couples.  To read those reactions and more, click here.

States’ Attorneys General Get Busy With Health Reform

Across our nation, states’ attorneys general are stepping up in the fight for health reform.  Not too long ago, Modern Healthcare (subscription required) ran a piece called “When Attorneys General Attack,” featuring health reform-oriented attorneys general.  Among them was Michigan’s Mike Cox (who is aggressively working to preserve state oversight of Blue Cross and Blue Shield of Michigan), Minnesota’s Lori Swanson (who filed a suit against a major hospital and clinic network alleging illegal interest rates), and Texas’ Greg Abbott (who alleged, and forced a settlement, that Memorial Herman orchestrated an agreement among health insurance providers not to do business with facilities owned by Memorial’s competitors).

Cuomo’s interest in health reform doesn’t stop there.  As reported in my last post (States Respond to College and University Health Care Practices), Cuomo heads one of the nation’s leading state efforts investigating college and university health care practices.  The head of Cuomo’s Health Bureau, Timothy Clune, recently spoke to a seniors home in Middletown, New York and highlighted Cuomo’s commitment to helping New Yorkers with their medical and health insurance problems.  The Times Herald-Record reports Clune as stating that the Attorney General’s office “handle[s] health-care issues from the $60 denial to ensuring that people get the life-saving care they’re entitled to.”

Read more

States Respond to College and University Health Care Practices

A little while back, NPR Morning Edition reported that states are taking a closer look at how health insurance and care is provided at colleges and universities. You can listen to the broadcast or read its transcript here.   While many colleges and universities simply require proof of insurance for admission (and offer a school-sponsored plan to uninsured admitted students), some schools charge an additional health fee or even require participation in the school’s particular plan.  Students with their own insurance who opt-out of the school plan, if there even is such an option, often find that on-campus health facilities will not accept their private insurance and that they must pay for treatment with cash.  Even worse, a recent survey showed that less than one quarter of such out-of-pocket expenses are in turn reimbursed by students’ private insurance companies.  This dilemma has caused many parents to purchase the school sponsored insurance, despite the fact that their child is already insured– effectively causing them to pay double. Nonetheless, Chad Henderson, director of health services for the University of Rhode Island and president of the American College Health Association, told NPR that school-acceptance of private health insurance can be “an administrative nightmare” because of “multiple carriers with multiple different policies, multiple different beneficiary bundles.”

Student medical debt, despite student medical insurance coverage, has increasingly become a concern.  The Boston Globe recently highlighted efforts of Massachusetts state regulators that would require colleges and universities to tally and report the amount of student medical care liability which surpasses school provided insurance coverage.  The proposal is in part a product of the diligent efforts of student organizers at Massachusetts’ Tufts University, who formed the Student Health Organizing Coalition.  Tufts Daily, the student newspaper of Tufts University, reported on the state effort in Massachusetts, as well as the efforts of Attorney General Andrew Cuomo in New York State.  Cuomo recently launched an investigation of New York colleges and universities that will most likely lead to disclosure requirements similar to those proposed in Massachusetts.

Other states are seemingly less skeptical of schools’ involvement with health insurance.  Read more

Washington State Provokes National Dialogue on Assisted Suicide

This Thursday, Washington will join Oregon as one of only two states to allow assisted suicide, reports the Seattle Times.  Initiative 1000, the Washington law’s genesis, was approved by voters this past November with a surprising level of support, which included that of popular former-Governor Booth Gardner.

The law will allow patients with less than six months to live to ask their doctors for a life-ending prescription.  There are a number of requirements to be satisfied by patients, but HealthNews.com contends that the law lacks appropriate ethical safeguards.  As a result, several Washington hospitals have already opted out and will disallow doctors to write such prescriptions on hospital property.  HealthNews.com also reports that opponents take issue with the uncertainty of six-month diagnoses of fatality– that is to say a terminally-ill patient who could have lived two years may turn to the new law prematurely after an overly cautious and dire diagnosis by her physician.  Nonetheless, there are others like Dr. Robert Thompson of Seattle’s Swedish Medical Center, who tells HealthNews.com that he believes in the law for “the sake of compassion, and for a person’s own individual rights.”

The dialogue in Washington is spreading across the nation and into other state legislatures.  Last week, New Hampshire legislator  Charles Weed introduced a bill that would make his state the first to legalize assisted suicide by an act of the legislature rather than voter initiative.  According to the Associated Press, Weed and his colleagues in New Hampshire are not atypical.  The legislatures of Massachusetts, Montana, New Mexico, and Vermont will be calling votes on similar bills before their current sessions close.  Hawaii’s legislature failed to pass a similar bill last month.

State law enforcement has also entered the fray.  Last week’s Chicago Tribune Sunday edition tells the story of a Georgia sting operation resulting in the arrest of four members of the Final Exit Network, one of the nation’s leading pro-assisted suicide groups.  Before the arrest, undercover agents sought and were about to receive assisted suicide from the members.

What’s more, media outlets are responding to the growing focus on assisted suicide.  This week, Time Magazine featured a brief history of assisted suicide.  Visit it here.  Additionally, for a state-by-state break down of assisted suicide laws, visit last Thursday’s Atlanta Journal-Constitution.

Las Vegas Health Care Practices Prompt State and Federal Concerns

This week MSNBC covered special hearings held by the health committees of both the Nevada Senate and Assembly.  The hearings aimed to reform certain state laws as a response to last year’s hepatitis C outbreak in Las Vegas, NV.  The outbreak required over 60,000 Las Vegas surgical center patients to be notified of possible infection– the largest patient-related notification effort in U.S. history– after improper injection of anesthesia resulted in several cases of hepatitis C.

According to MSNBC, proposed reforms in state law would offer stronger whistle blower protection for nurses, more frequent inspections of health facilities, and a streamlining of the reporting and investigation of future major patient problems.

In addition, Las Vegas is among a handful of regions at the center of federal concern over Medicare spending.   Yesterday, the Las Vegas Sun reported that a new study by the Dartmouth Atlas Project finds Las Vegas hospitals to be among the top ten percent most expensive in the country for Medicare spending costs.  Dr. David Goodman, co-principal investigator of the report, tells the Las Vegas Sun that these costs do not necessarily reflect a high level of care, but may actually be a product of “greedy” Las Vegas doctors billing for services beyond what they provide.  In the same interview, Goodman expressed fear that such practices may lead to the bankruptcy of Medicare– a program that some argue will be deficient by over 660 billion by 2023.

Such practices have not gone unnoticed in Washington.  House Representative Henry Waxman (D-Ca), Chair of the Energy and Commerce Committee, sees the recent Stimulus as an opportunity to establish needed oversight, according to CQPolitics.  In addition to monitoring state spending of Stimulus funds designated for health care, Waxman’s committee has crafted an oversight plan that looks out for “Medicare waste and fraud” in general.

Stimulus Sparks Changes in States’ Approach to Health Care

Today, President Obama will release $15 billion in Medicaid funds to the states according to USA Today.  As further reported by the NY Times, this is only one small portion of the $127 billion states will see over the next two and a half years for health care alone.

Attached to these funds will be the addition of a new category of individuals who qualify for Medicaid.  Stimulus legislation allows “those who are receiving unemployment benefits, their spouses and child under 19,” to now be eligible for Medicaid, reports the Times.  Further, states must abandon the use of any means test when unemployed individuals apply for Medicaid.

The affect this will have on states’ approaches to health care has not gone unnoticed. Republican Governor Mark Sanford (SC) has been a vocal skeptic of such changes to the extent that State Policy Network has described Sanford as fearing that the federal government is taking “yet another step in the march towards a government takeover of health care.”

But it’s not just Republicans that are at odds concerning the plan. Democratic Governor David Paterson (NY) is meeting with state legislators this week to attempt to reach an accord on how New York’s stimulus money will be spent on health care, reports Newsday. State legislators would like to see a share of the stimulus fill recent cuts to hospitals and other health care facilities and programs, but Governor Paterson would rather further reduce those state initiatives in the state budget.