New Jersey Medical Marijuana Legislation Update: Poised to Pass?

Supporters are hopeful that before Governor-Elect Chris Christie takes office next month, the New Jersey legislature will pass — and current Governor Jon Corzine will sign — medical marijuana legislation.  In February 2009, the “New Jersey Compassionate Use Medical Marijuana Act,” which would allow patients suffering from “debilitating medical conditions” to treat their symptoms with marijuana without fear of state criminal reprisals, passed the state Senate.

In June 2009, Seton Hall Law’s Center for Health & Pharmaceutical Law & Policy issued a position paper calling on the full legislature to pass the Act, arguing that it would “allow New Jersey residents with debilitating medical conditions access to marijuana to ease their suffering without creating an undue risk of abuse or diversion.”  Soon thereafter, the Act cleared the Assembly Health, Human Services and Senior Citizens Committee, albeit with a number of amendments, including several bolstering the Act’s already strict safeguards against abuse and diversion.  (For a detailed summary of the differences between the Senate and Assembly versions of the Act, see below.)

According to an article in the New Jersey Law Journal, a legislative aide “says they are trying to get the [Act] posted for a floor vote on Dec. 7, Jan. 7 or Jan. 11, the remaining voting sessions in the current term.  The Assembly is expected to pass it.”  Due to the amendments added by the Assembly Committee, the Senate would need to pass the Act again before it would reach the Governor’s desk.  Even if the Act is not passed during the current lame-duck session, however, there is hope for its passage in sessions to come. Governor-Elect Christie has indicated that, with sufficient restrictions in place, “he would be supportive of such legislation.”

Summary of Differences between Assembly and Senate Versions

Change to definition of “bona fide physician-patient relationship.”

The Senate’s version of the Act (S119) requires that patients who wish to use medical marijuana obtain a “written certification” from a physician with whom they have a “bona fide physician-patient relationship.”  Such a relationship is said to exist whenever a physician has completed a full assessment, including a physical examination, of a patient.  The Assembly’s version (A804) includes a significantly narrower definition, providing that only the physician with “ongoing primary responsibility” for treating a patient’s “debilitating medical condition” can approve that patient to use marijuana.  Such a physician must be “board-certified, if available” in the specialty appropriate for caring for the condition which qualifies the patient to use marijuana.

Changes to list of eligible “debilitating medical conditions.”

• Whereas S119 would have granted eligibility for marijuana to patients suffering from “severe and persistent muscle spasms, including, but not limited to, those characteristic of multiple sclerosis or Crohn’s disease,” A804 limits eligibility to those with “intractable skeletal muscular spasticity,” which would, it would seem, include some patients with multiple sclerosis, but exclude those with Crohn’s disease.
• Whereas S119 made all patients with cachexia or wasting syndrome, severe nausea, or severe or chronic pain eligible, under A804 patients with those conditions are only eligible if their symptoms are the result of AIDS or cancer. Concomitantly, neither AIDS nor non-terminal cancer render a patient eligible unless they cause cachexia or wasting syndrome, severe nausea, or severe or chronic pain.
• A804 adds to the list of those eligible for marijuana, patients suffering from amyotrophic lateral sclerosis and multiple sclerosis. Patients with cancer that is “terminal” and glaucoma that is “resistant to conventional therapy” are also eligible; under S119 all cancer and glaucoma patients were eligible.
• Notably, both versions include a provision allowing for additional medical conditions to be added by regulation.

Changes to rules governing “medical marijuana alternative treatment centers.”

Under A804, eligible patients will no longer be permitted to grow marijuana.  The statute’s protection will only apply to patients who obtain marijuana from New Jersey Department of Health and Senior Services-approved “medical marijuana alternative treatment centers.”  A804 adds as a requirement of approval that such centers be operated on a nonprofit basis.  They do not have to be recognized as such by the IRS but they do need to comply with all state nonprofit laws.  Perhaps in an effort to mitigate hardship that might arise as a result of these, more restrictive, provisions, A804 exhorts DHSS to “seek to ensure the availability of alternative treatment centers throughout the State, including, to the maximum extent practicable, at least two each in the northern, central, and southern regions of the State.”

Other potentially-significant changes.

• Unlike S119, A804 does not protect patients and others from arrest or prosecution; its protection is limited to waiver of applicable “civil or administrative penalties.”
• A804 also eliminates protection for caregivers who assist patients with medical marijuana use. Instead, it provides that “[t]he commissioner shall adopt regulations to: (1) provide for the use by a registered qualifying patient of a designated individual in an emergency situation to transport marijuana to the patient who is otherwise unable to obtain marijuana from an alternative treatment center[.]“

NY State Senator Eric Schneiderman, Ian’s Law & the Insurance Company Two-Step

Interesting conversation over at WNYC on The Brian Lehrer Show: New York State Senator Eric Schneiderman (D-Manhattan/Bronx) was interviewed about legislation he and State Senator Neil Breslin (D-Delmar; Insurance Committee Chair) recently introduced called “Ian’s Law.”

Ian’s Law is meant to combat an insurer practice whereby insurers attempt to rid themselves of costly policies through a two-step process which circumvents state laws which forbid insurers from dropping policy holders because of conditions which require costly care.

The Insurance Company Two-Step, How it Works

Because insurers are forbidden by NY State law to drop individuals because of costly care, the insurer merely drops an entire class or group of people and then re-offers policies to that group– but omits coverage in the newly “re-offered” policies for the specific kinds of care which the costly care individual needs, and the insurer had formerly paid for. So… if someone has a chronic condition, which requires say… regular or  continuous skilled nursing care, the insurer just drops the entire group, and then offers everyone in that group a policy that does not include regular or continuous skilled nursing care. Voila! Pretty much everyone except the person who needs the skilled nursing care accepts and “re-applies” and the problem is solved. Two steps, no violation of the law and no more having to pay for all that costly care.

The following comes from Sen. Schneiderman’s website and describes Ian’s law and the litigation which brought the practice to light.

The bill is named for Ian Pearl, a 37-year-old man with muscular dystrophy who lost his insurance when Guardian, acting under current New York law, terminated the entire class of policies in the State  that covered Ian and others. Mr. Pearl became ventilator-dependent in 1991 and relies on a skilled nursing benefit under his insurance policy to receive care that has kept him alive since he suffered respiratory arrest.

The Pearl family charged in court that Guardian terminated the entire class of policies in New York in order to get around the fact that New York law prohibits an insurance company from dropping the policy of an individual simply because he or she needs care. An internal document from the insurer, released as a result of a legal challenge, showed that company officials justified dropping the entire line of policies statewide in order to get rid of “the few dogs”, like Ian Pearl, who were filing claims. Guardian, which denies any wrongdoing, has since settled with the Pearl family and restored Ian’s coverage.

In the interview with Brian Lehrer Senator Schneiderman said that the practice is “actually not limited to one company or one individual” and that “the litigation that Mr. Pearl brought revealed internal documents showing that they [the Insurance Co.] actually were scanning through their list of expensive patients preparing what they called “hit lists” of people who they were really trying to find a way to get rid of.” As noted in the quote above, these expensive insureds were referred to as “dogs.”

And that, in a nutshell is for profit health insurance. But I think there may be a larger lesson here as well. In many ways, this practice is not very different than the design of  “wellness incentives” substituting for pre-existing condition discrimination and penalties, a topic we covered just a little while back:

It may also be useful to consider how, in practice, “incentives” have been utilized by employers in the marketplace. By engaging in a two-step process, an employer may rather easily render a “wellness incentive” into a preexisting condition premium.

The Washington Post reports that

Valeo, an auto parts supplier, four years ago raised the deductible on an employee health plan to $2,200 from $200 for individual coverage and to $4,400 from $400 for family coverage. Then it gave employees the opportunity to reduce the deductible to its starting point by not smoking and by meeting goals for blood pressure, cholesterol and body mass index, said Robert Wade, Valeo’s director of human resources for North America.

“If they don’t comply, they end up being penalized, if you will, but we refer to it as a Healthy Rewards program,” Wade said.

And the point is this–Insurers hire the best and brightest they can find, and almost any legislation or regulation meant to protect the public from unconscionable unfairness is just one smart executive and two steps away– maybe three– from being danced around.

Autism, Autistic-Like, and Health Insurance Reform

In his post Implementing Reform: Children with Special Health Care Needs, Professor John Jacobi notes that providing “health insurance” to children with special health care needs (”CSHCN”) does not ensure that their needs will be met.  Many private health insurance plans do not cover services such as occupational, physical, or speech therapy for CSHCN.  Private plans frequently limit coverage for such therapies to otherwise healthy children who need therapy to facilitate their recovery from an illness or injury.

Through their power to regulate insurance, states can require private plans to extend coverage for needed therapies to CSHCN.  For example, in legislation passed earlier this year, New Jersey became one of an estimated 15 states to specifically require insurers to provide treatment for individuals with autism.  Children with autism have benefited from a wave of recent legislation — 8 states enacted laws related to autism and insurance coverage in 2009 alone.  Children with other special needs have been largely left behind.  Many go without services; others may be shoehorned into an inappropriate autism diagnosis.  A recent documentary, Autistic-Like, tells the story of parents pressured to accept an autism diagnosis in order to access state-funded services for their son.  While New Jersey’s autism mandate is admirably broad, requiring private insurers to cover occupational, physical, and speech therapy for individuals with “autism or another developmental disability,” other states’ mandates are strictly limited to children on the autism spectrum.

Insurance mandates are attractive to legislators because they are off budget.  They are not, however, without cost.  The Council for Affordable Health Insurance, an insurance industry association, estimates that “an autism mandate increases the cost of health insurance by about 1 percent.”  Mandates like New Jersey’s, which extends beyond autism, could lead to even greater cost increases.  Piecemeal reform that privileges some special needs over others has costs of its own, however, not the least of which are borne by children living with labels that do not fit.

Position Paper In Support of the “New Jersey Compassionate Use Medical Marijuana Act”

[Ed. note: mpp.org: "On February 23, the New Jersey Senate voted 22-16 to pass S119, also known as the New Jersey Compassionate Use Medical Marijuana Act. The Assembly health committee voted 8-1 to pass an amended version of the bill on June 4. It must now pass the full Assembly [If the amended bill clears the Assembly, it would return to the Senate for a second vote because of the changes] before it goes to Gov. Jon Corzine (D), who has said that he will sign the bill if it makes it to his desk.”]

Seton Hall University School of Law

Center for Health & Pharmaceutical Law & Policy

Statement In Support of the “New Jersey Compassionate Use Medical Marijuana Act”

The Center for Health & Pharmaceutical Law & Policy supports the passage of the New Jersey Compassionate Use Medical Marijuana Act (the “Act”) because the legislation has been carefully drafted to allow New Jersey residents with debilitating medical conditions access to marijuana to ease their suffering without creating an undue risk of abuse or diversion.

• Medical Evidence. Available medical evidence supports the use of marijuana to treat each of the debilitating medical conditions set forth in the Act: AIDS/HIV; cachexia (wasting syndrome); cancer; glaucoma; severe and persistent muscle spasms; severe nausea; severe or chronic pain; and seizures.
• Need for Access to Marijuana Despite Availability of Cesamet and Marinol Pills. While smoking carries with it certain health risks, smoked marijuana has meaningful advantages over the Cesamet and Marinol pills, which contain synthetic compounds that mimic marijuana’s primary active ingredient. Smoked marijuana is faster-acting, allows for more reliable dosing, and has fewer psychoactive side effects than the pills. In addition, smoked marijuana can be the only option for patients who can not swallow pills due to severe nausea and vomiting as a result, for example, of treatment for cancer.
• Abuse and Diversion. No state that has passed a medical marijuana law has subsequently experienced an increase in recreational marijuana use among its children and youth. The Act’s multiple safeguards against abuse and diversion of medical marijuana provide further reassurance. If passed, the Act would be among the most restrictive of all the states’ medical marijuana laws.

Below please find a brief position paper setting forth the medical evidence and policy arguments in support of the Act.

Seton Hall University School of Law

Center for Health & Pharmaceutical Law & Policy

Position Paper In Support of the “New Jersey Compassionate Use Medical Marijuana Act”

Medical Evidence

Medical evidence supports the use of marijuana to relieve symptoms or ameliorate the side effects of primary treatments of each of the debilitating medical conditions set forth in the Act: AIDS/HIV; cachexia (wasting syndrome); cancer; glaucoma; severe and persistent muscle spasms; severe nausea; severe or chronic pain; and seizures.  While conventional treatments are available for some of these conditions for some patients, smoked marijuana has the potential to help those individuals who do not benefit from, or can not tolerate, currently available therapies.[1]

AIDS/HIV and Cachexia (Wasting Syndrome)

Marijuana is an effective treatment for cachexia, also known as wasting syndrome, an involuntary loss of appetite and weight linked to disease progression and death in patients with AIDS/HIV.  The American College of Physicians has concluded that abundant support exists for the use of the cannabinoid delta-9-tetrahydrocannabinol (”THC”), one of the primary active ingredients in marijuana, as an appetite stimulant.[2] The FDA concurs, as evidenced by its approval of Marinol, a pill containing a synthetic version of THC, to treat “anorexia associated with weight loss in patients with AIDS.”[3]

Marijuana is also an effective treatment for AIDS/HIV-associated sensory neuropathy, a condition characterized by excruciating pain in the nerve endings that afflicts over a third of patients with AIDS/HIV.[4] In the past two years, three placebo-controlled, randomized, double-blind clinical trials published in the medical literature have demonstrated Read more

Health Insurance, Competition & the McCarran-Ferguson Act

A post by Jordan Cohen on June 17 raised a very important point:  “what [do] we currently know about the role of competition in the health insurance market [?]” As Mr. Cohen makes the connection between cost and competition and another relating to slowing the rate of growth of health care expenses generally, his caveat raises an important concern that the information supporting conclusions in this regard may be less than optimum. One factor to consider is that competition, or the lack thereof, in the insurance industry is subject to the distortions of a wide, if not dizzying, array of often conflicting state regulation.

The McCarran-Ferguson Act (”the Act”) exempts the “business of insurance” from federal antitrust law. Which is to say that federal antitrust law applies only to the extent that “the business of insurance” is not regulated by state law.  The Act goes so far as to permit price fixing — joint ratemaking — if permissible under state law.  Hovenkamp Antitrust Hornbook, at 732.  In one case, Mackey v. Nationwide Insurance Co., 724 F.2d 419 (4^th Cir. 1984) (Superseded by Regulation as Stated in Home Quest Mort. LLC V. American Family Mut. Ins. Co., 340 F. Supp.2d 1177 (D.Kan. Oct. 12 2004), the Act even protected the practice of redlining on the reasoning that it “related to the particular types of risks [the] company [was] willing to insure against.”  State of Maryland v. Blue Cross and Blue Shield Assn., 620 F. Supp. 907, 916 (D.C. Cir. 1985) (referring to Mackey).

While the lack of competition in the health insurance industry may well have other causes, which may or may not be cured through a public plan, the Act, with its exemption from federal antitrust law has not helped.  Private competition may have more to offer than currently realized in the McCarran-Ferguson environment.  Repealing the Act coupled with increased antitrust enforcement would seem a relatively affordable first step if competition, with the ultimate goal of benefiting the consumers/patients, is the goal.

I believe the repeal of McCarran-Ferguson will happen and that  Professor Greaney is correct that increased antitrust enforcement and better antitrust laws in the health care industry generally should be forthcoming– but I am somewhat more optimistic than he that this will happen sooner rather than later. While in the Senate, then Senator Obama “introduced legislation to repeal the McCarran-Ferguson Act for medical malpractice insurance.”  Furthermore, his picks of Christine Varney as assistant attorney general for the Antitrust Division and Jonathan Leibowitz as chairman of the FTC are said to have members of the insurance industry concerned about greater antitrust enforcement as well as the elimination of the McCarran-Ferguson exemption. I would suggest that AIG’s self-destruction at taxpayer expense does not bode well for the Act either.

Kaiser Health News, New Jersey Gets a New Hospital?, & Kicking Medicaid Grandma to the Curb

In the wake of declining newspaper presence, the Kaiser Family Foundation, a nonprofit private operating foundation known for its health care concerns, has started Kaiser Health News. In the present issue, there are two articles of special note for New Jerseyans. The one regards the plans of Hackensack University Medical Center, a 775-bed teaching and research hospital that is one of New Jersey’s most prestigious, [which] requested state permission to open a new hospital in Pascack Valley’s empty [hospital] buildings. Although Hackensack is a nonprofit, it announced that Westwood would be getting a for-profit facility financed by a private equity firm from Texas.

Not everyone approves.

The other regards measures that New Jersey legislators are considering in response to a recent investigation of assisted living facilities. KFN reports

Associated Press/Philadelphia Inquirer reports that “lawmakers this week will consider measures to enhance protections for assisted living residents in New Jersey to ensure they aren’t discharged simply because they pay with Medicaid.” The legislation comes in response to an investigation that found a Wisconsin-based assisted living firm called Assisted Living Concepts, which has eight facilities in New Jersey and more than 200 nationwide, “wrongly showed New Jersey residents the door once they exhausted their savings and were about to go on Medicaid, despite promises to allow them to stay.”

Both stories are worth reading.

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

Florida Senators Move to Pass Bill to Prevent Medicaid Fraud

Kaiser Family Foundation reports that Florida Senators will likely pass legislation aimed to prevent Medicaid fraud.

KFF states:

Florida Senate Health Regulation Committee Chair Don Gaetz (R) and state Senate Health and Human Services Appropriations Committee Chair Durell Peaden (R) at a news conference on Wednesday “expressed confidence” that lawmakers will pass legislation (SB 1986) aiming to prevent and detect Medicaid fraud, the Tallahassee Democrat reports. Medicaid fraud has become a considerable issue in Southeast Florida, where home health care clinics open quickly and operate with little to no regulation or accountability, according to Gaetz and Peaden. Miami alone has twice as many home health providers than all of California, they noted.

Florida is susceptible to heightened Medicaid abuse given its relatively large Medicaid enrollment and the concomitant funds devoted to Medicaid.  In 2005, Medicaid enrollment in Florida was almost 3 million people.  In Florida, Medicaid home health participants have increased by approximately 50% between 1999 and 2005 (from 14,793 in 1999 to 21,192 in 2005). In 2006, Florida spent approximately $12.7 Billion on Medicaid.  Approximately $1.5 billion of the $12.7 billion was spent on home health and personal care.  In 2007, Florida Medicaid expenditures increased to over $14 Billion.

In addition to other fraud prevention and detection measures, the bill would also create greater incentives for whistleblowers.  KFF states:

The bill also would increase to 25% the share of recovered money that whistleblowers would be eligible to receive. Peaden said money recovered from fraud would be redirected by his panel “into health care for the truly needy.”

Further, KFF reports:

The bill also would target companies’ recruiting of patients and the practices of filing claims for non-existent patients and ordering unneeded devices and treatments. Gaetz said Florida would work with federal and local agencies to create a database that would prevent operators of fraudulent companies from re-incorporating new clinics or home services and allow regulators to prevent fraudulent companies from renewing their operating licenses. Peaden said a companion bill is being worked out in the state House (Cotterell, Tallahassee Democrat, 3/26).

As we noted recently, a Florida case (Federal Court) which would fall rather squarely within the intended aim of the proposed legislation took 10 years to discover and prosecute.  The Florida legislation is similar in purpose to the Federal Civil False Claims Act, which members of  the U.S Senate have proposed to amend to strengthen a whistleblower’s action as well.

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.

ABC Special Highlights the Need for Education After SCHIP Expansion

ABC aired A Hidden America: Children of the Mountains last Friday with host Diane Sawyer. Children of the Mountains follows the lives of several children growing up in Central Appalachia.

The special raised several crucial issues, but I was struck by the lack of healthcare available to Appalachian children. Sawyer reported that a diet consisting of high-fat, salty foods and massive amounts of soda pop, particularly Mountain Dew, are responsible for a range of adverse childhood and adolescent health conditions.

One of the most serious health conditions addressed by Children of the Mountains is toothlessness. Sawyer explored how the consumption of large quantities of sugary sodas like Mountain Dew causes extensive cavities and tooth decay. Additionally, Appalachian children experience a lack of resources and health insurance coverage that surpasses that of many other low-income Americans.

The expansion of the State Children’s Health Insurance Program signed into law by President Obama last month requires all states to provide dental care to enrollees. While this is encouraging in light of the serious deficiencies in the availability of dental care to Appalachian children, The Kaiser Family Foundation reports that in 2004, 5.4 million uninsured children were eligible for SCHIP or Medicaid but not enrolled.

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