05/2003 State Update

ACLU Challenges Medicaid Cuts

The American Civil Liberties Union of Colorado filed a lawsuit attempting to prevent the state from balancing its budget by ending Medicaid benefits for thousands of immigrants. The class-action suit, filed on behalf of eight documented immigrants, seeks to block implementation of a law (SB 176) that reduces state funding for Medicaid by $1.3 million this year and approximately $8 million in 2004.

The law, which took effect April 1, ends Medicaid benefits for an estimated 3,500 documented immigrants. The suit contends the cuts are unconstitutional because they discriminate against documented immigrants who qualify for Medicaid benefits under federal law.

“The new law singles out sick and elderly legal immigrants who desperately depend on this assistance for vital medical care,” Mark Silverstein, legal director of ACLU of Colorado, said. Karen Reinertson, director of the state division administering Medicaid, did not respond to Health Care News requests for an interview.
Rocky Mountain News
March 28, 2003

Adults Will Lose SCHIP Coverage

The Department of Social Services sent letters to 23,000 adult residents, informing them they will no longer receive health coverage under the State Children’s Health Insurance Plan, called the HUSKY program. Some adults in the program, parents of the 206,500 children in the program, lost their health benefits April 1 because of cuts made to reduce the state budget deficit.

All children in the health care welfare program and about 66,000 parents will continue to receive benefits. The state expects to save $12 million this fiscal year and $50.7 million next fiscal year because of the cuts, David Dearborn, a spokesperson for the department, said. “Expenditures and enrollments were increasing. The program was curtailed because of the state’s budget and revenue crisis,” Dearborn explained.

Governor John Rowland (R) has allocated $60 million in each of the next two fiscal years for hospital emergency room aid to compensate for additional costs that may result from adults seeking care in emergency rooms and community health centers.
Connecticut Post
March 17, 2003

Bill Would Establish High-Risk Pool

In a recent news release, Dr. Merrill Matthews, director of the Council for Affordable Health Insurance (CAHI), applauded the state of Georgia “for considering legislation that would increase its citizens’ access to affordable health insurance. The U.S. Congress made the high-risk pool funding available; now Georgia legislators must take action to help those who need health insurance coverage.”

Last year Congress allocated $100 million to help states fund and establish high-risk pools. Thirty states already have these pools, which provide a safety net for uninsured people with a pre-existing condition who have been denied coverage, or whose medical condition has made the cost of coverage prohibitively high. CAHI encourages all states that haven’t implemented high-risk pools to start them … soon.

“As the nation continues to debate the best way to ensure access to affordable coverage, high-risk pools must be a part of the solution,” Matthews says.
CAHI News Release
March 28, 2003

Lawmakers Raid Seniors Trust

In an effort to balance the state budget, Iowa lawmakers have reversed the Robin Hood syndrome by robbing a trust fund meant to keep the poor and elderly out of nursing homes.

The $392 million fund, known as the Senior Living Trust, pays for meal deliveries, visiting nurses, transportation, and other services that make it possible for many elderly people to live independently.

With tax revenues down, lawmakers have raided the trust for other uses. They took $48.5 million for 2002 Medicaid expenses and $36 million for such expenses in 2003. Governor Tom Vilsack (D) wants to take $65.6 million more by the end of the 2004 fiscal year.

The trust was started with $95.6 million from the federal Health Care Financing Administration in 2001. Tom Lenz, a regional official with the agency, now called the Centers for Medicare and Medicaid Services, said the money came with no strings constraining how the state could use it.

Mark Haverland, director of the Iowa Department of Elder Affairs, said the trust was intended to reduce the state’s reliance on nursing homes and Medicaid by providing community services. Haverland, a former legislator, said the trust was an easy source of money. “The danger is when you spend this one-time revenue it goes away,” he said, “and then next year you’ve got to fill an even bigger hole.”

If the trust had been left intact, it could have drawn $10 million to $15 million each year in interest.
New York Times
March 29, 2003
Associated Press
March 28, 2003

New Regs Single Out Drug Industry

Pharmaceutical industry representatives said several bills being considered by the state legislature “unfairly single out” the drug industry and would “serve little purpose” for consumers and physicians.

The bills would require drug companies to disclose the cost of their marketing and advertising practices. State legislators say action is needed to address increasing prescription drug prices by informing consumers the newer, heavily marketed drugs are not necessarily better than older or generic counterparts.

State Rep. Thomas Kane (D), co-chair of the House Health and Human Services Committee, said “The best, most effective strategy (to lower drug costs) is consumer knowledge, consumer empowerment, consumer choice.”

Ann Robinson, counsel for the Pharmaceutical Research and Manufacturers of America (PhRMA), said a bill that would force drug makers to disclose how much they spend on consumer advertising would force companies to give up proprietary information and would not affect a physician’s decision on whether to prescribe a certain drug.
The Portland Press Herald
March 25, 2003

Ready to Repeat Tennessee Mistakes

The single-payer advocacy group Consumers for Affordable Health Care (CAHC) issued a set of five principles for lawmakers to consider in the health care debate. As a result, almost 100 health care reform bills are clogging up the state’s legislative calendar. The guidelines describe a program strikingly similar to the failed Tennessee single-payer plan called TennCare.

Proposed legislation includes a measure supported by Governor John Baldacci (D), who pledged “Maine will be the first state in the nation” to implement a universal health care system for residents. Democrats control both the House and Senate.

Other bills include one introduced by State Rep. Stephen Bowen (R), which would foster broader support for and use of medical savings accounts (MSAs). State Rep. Chris O’Neil (D) said measures more “substantive” than Bowen’s, such as the governor’s single-payer bill, will be debated later in the session and should take precedence.
Bangor Daily News
March 17, 2003

Thousands May Lose Medicaid Coverage

Health providers and business and religious leaders rallied March 27 for a 90-day moratorium on the budget cuts that would end coverage in MassHealth Basic for 43,000 beneficiaries. Providers have said the enrollment reduction, mandated by the legislature earlier this year to save the Medicaid program $32 million, will “ripple” through the health care system and affect many with private insurance through increased premiums and longer waits for emergency care.

As many as 6,500 beneficiaries may secure coverage through other Medicaid programs, and approximately 19,500 could receive care through community health centers and hospitals providing charity care. Nevertheless, advocates fear many people with chronic illnesses or substance abuse problems will die or “get so sick they require hospitalization.” According to the Boston Globe, those without access to a safety net are expected to crowd emergency rooms or simply go without care.

The Civic Leaders Committee to Save MassHealth, among others, has proposed using the state’s tobacco settlement funds to continue coverage through MassHealth Basic. Providers also are concerned the state’s uncompensated care fund is expected to have a $165 million deficit this year.

State Health and Human Services Secretary Ronald Preston said he hopes to restore coverage as of July 1 by overhauling the program and its funding structure. However, Governor Mitt Romney (R) and lawmakers said the cuts are “unavoidable,” and any move to prevent the cuts would have to originate in the legislature.
Boston Globe
March 28, 2003
Lexis/Nexis Research
March 31, 2003

Prior Authorization Measure Considered

The House Ways and Means Committee is considering a bill requiring physicians to obtain prior authorization from state health officials before prescribing any brand-name drug to Medicaid beneficiaries.

The proposal, designed to reduce spending in the state’s $6 billion per year Medicaid program, would tighten restrictions already in place. North Carolina currently requires physicians to receive prior approval from a pharmacy administrator before prescribing certain high-cost treatments, such as Botox, Celebrex, Vioxx, Zyban, and OxyContin.

In addition, the state Department of Health and Human Services limits its Medicaid reimbursements for some drugs. Barbara Brooks, administrator for the state Division of Medical Assistance, told the Winston-Salem Journal the current restrictions have saved the state more than $24 million, with Medicaid spending growing 11 percent in 2002 compared to 22 percent the previous year.
Winston-Salem Journal
March 26, 2003
Associated Press
March 27, 2003

Medical Marijuana Bill Advances

A bill that would allow people with serious illnesses to legally possess and use marijuana passed the Senate with broad bipartisan support and is in the House for consideration. The 22-7 vote came after senators amended the bill requiring minors under age 18 to have a parent or guardian sign the application to participate in the medical marijuana program. Supporters of the bill claim it does not change marijuana’s status as an illegal drug.

Sen. John Bloomer (R-Rutland) insisted, “I must be clear. We are not legalizing marijuana. We’re creating an exception for an individual to receive treatment.”

The bill requires a doctor’s certification the patient suffers from one of several specified conditions, or from diseases like AIDS and cancer. Medical marijuana users would be allowed to use the drug only at home; they or their caregiver also could grow medical marijuana in a locked indoor facility and transport it in a locked container.

Some observers wondered whether the bill was needed, pointing out there have been no reported cases of police and prosecutors going after sick Vermonters using marijuana. “It seems to me we have a problem in the closet, and we seem determined to bring it out of the closet,” said Senator Hull Maynard (R-Rutland).

House leaders say there is uncertainty whether the bill can clear that body, though a similar measure passed in the last session when Republicans held a wider margin. Governor James H. Douglas (R) has indicated he opposes the measure, but he stopped short of using the word “veto.”

Eight states–Alaska, California, Colorado, Hawaii, Maine, Nevada, Oregon, and Washington–have similar laws.
Vermont Press Bureau
March 17, 2003
Lexis/Nexis Research
March 31, 2003