The year 2001 saw a wide range of health care proposals at the state level, including efforts to address long-term care, Medicaid access and budgets, mental health, prescription drug coverage, women’s health, and SCHIP.
Unfortunately, many states passed new unfunded mandates, virtually guaranteeing further increases in insurance premiums—and increasing numbers of uninsured Americans. Efforts to tie low-income residents, senior citizens, and children to government-run medical care seem to be on the rise; Medicaid and SCHIP are becoming the default single-payer health care plan in many states.
Here are some highlights—and in some cases, low lights—from this year’s state legislative sessions.
Governor Don Siegelman (D) significantly increased funding for the expansion of community-based services for individuals served by the state’s department of mental health and mental retardation. In addition, he signed legislation that expands Medicaid coverage to uninsured or under-insured women diagnosed with cervical or breast cancer.
Governor Tony Knowles (D) allocated revenue to the division of alcoholism and drug abuse to establish a juvenile alcohol awareness program and to increase community-based outpatient treatment for alcoholism.
A pilot prescription program, signed into law by Governor Jane Dee Hull (R) establishes drug coverage for seniors with incomes between 100 and 200 percent of the federal poverty level. The program, aimed at seniors without access to Medicare managed care, requires a deductible, after which the state will pay 50 percent of prescribed medications.
Hull also promoted a bill allowing schools to get involved in the KidCare enrollment process. The new law also expands the KidCare benefit plan to the level of Medicaid benefits.
Governor Gray Davis (D) included in his executive budget a provision extending health insurance to uninsured parents with incomes up to 200 percent of the federal poverty line through California’s children’s health insurance program.
Davis also announced a statewide initiative for prostate cancer treatment for low-income and uninsured men with the disease. The governor will devote $50 million in state and tobacco settlement funds to the initiative.
Recognizing the need for enhanced rural medical care, Governor Bill Owens (R) persuaded legislators to pass a bill expanding telemedicine services; giving municipalities the authority to contract with health care providers; and creating a task force to study problems unique to rural health care.
Governor John G. Rowland (R) expanded ConnPACE to cover seniors and persons with disabilities. Eligibility levels were significantly increased from annual income limits of $15,001 to $20,000 for individuals and from $18,001 to $27,000 for couples.
Governor Ruth Ann Minner (D) supported legislation calling for more expansive patient’s rights protection. One feature of the bill calls for speedy arbitration when care is in dispute; another provides legal counsel for patients whose benefits have been wrongly denied.
Governor Jeb Bush (R) signed legislation enabling the state to negotiate additional discounts on prescription drugs for Medicaid beneficiaries and to establish a preferred drug list with prior authorization. Savings could top $214 million a year, or 15 percent of the state Medicaid drug budget. In other legislation Bush signed, $53.7 million will be directed to community-based long-term care options.
Governor Benjamin Cayetano ((D) signed into law a single insurance purchasing pool for state employees, in the hopes of strengthening the state’s negotiating leverage with health insurance carriers.
Governor Dirk Kempthorne (R) unveiled a substance abuse treatment program to focus on care and prevention in the state’s prison system and in community programs. The $5.7 million in funding comes from state revenues.
Governor George Ryan (R) signed a bill improving access to health insurance for state residents who lose employer-based insurance. Individuals will qualify under the HIPAA portion of the state’s very successful Comprehensive Health Insurance Plan (CHIP). Ryan appropriated an additional $42 million in state revenue to further strengthen and expand the plan.
Ryan also signed two bills mandating the provision of health care services to women diagnosed with breast or cervical cancer. The first bill provides treatment for uninsured women who are screened by the CDC Breast and Cervical Cancer Early Detection Program. The second amends the insurance code to include coverage for breast reconstruction in connection with a mastectomy.
A bill expanding health insurance to uninsured parents by way of the Uninsured Parents Program Initiative was signed by Governor Frank O’Bannon (D). O’Bannon also supported legislation appropriating $29 million for SCHIP and $33.6 million to Hoosier Healthwise over the 2002-2003 biennium.
Governor Tom Vilsack (D) signed the Senior Living Trust Fund appropriations bill, which provides community-based alternatives to nursing home care for elderly citizens and people with special needs. Pay raises for long-term care staff are also included in the bill.
Governor Bill Graves (R) signed off on legislation eliminating the mandatory waiting period for access to SCHIP.
Governor Mike Foster (R) approved legislation expanding health insurance coverage to children in families with incomes up to 200 percent of the federal poverty line. It is estimated 22,575 children will now be eligible for government-run health care.
Independent Governor Angus King signed into law an act creating the Healthy Maine Prescription Program, which will provide low-cost medications to low- income and disabled seniors. King also signed a data collection bill authorizing retrieval and analysis of medical claims data. He rejected single-payer legislation passed by the state legislature.
Governor Parris N. Glendening (D) allocated $6.5 million in new state funding for fiscal 2002 in order to expand the state’s prescription drug program. Enabling legislation expands the children’s program to families with incomes 300 percent of the federal poverty line, and to 250 percent of the federal poverty line for pregnant women. The law went into effect July 2001. An estimated 14,700 children can now enroll in the state SCHIP.
Acting Governor Jane Swift (R) awarded $7 million to community health centers around the state in an effort to support and strengthen efforts to improve access to health care.
EPIC, the state’s Elder Prescription Insurance Coverage plan, was signed into law by Governor John Engler (R). The plan targets low-income seniors who do not otherwise have prescription drug coverage. The program includes coverage for insulin needles and syringes for diabetics.
Engler also awarded $10 million to rural communities as part of his Rural Health Initiatives Campaign.
Governor Jesse Ventura (MN Independence) advanced his state initiative to promote health care and preventative coverage for all Minnesota children. The Cover All Kids Coalition will conduct a public awareness campaign, identify practices facilitating public health program enrollment, and eliminate access barriers to preventative services.
Governor Ronnie Musgrove (D) approved the SCHIP reauthorization bill to continue the program for low and moderate-income children.
Governor Bob Holden (D) called legislators back into a second session in a successful effort to create a new prescription plan. The governor signed legislation scrapping a previous prescription plan, whose costs had reached $85 million a year on a $20 million projection. An independent actuary hired by the legislature projected a price tag of $99.6 million for the new program.
The governor also signed legislation directing $22.2 million of the tobacco settlement fund to implement a smoking prevention program for children and adults. He also signed a measure lowering the state’s permitted blood alcohol level for drivers from 0.10 to 0.08.
Governor Judy Martz (R) secured funding for the development of the Montana Trauma System. It is described as a voluntary arrangement to provide an organized, preplanned response to trauma patients while helping maximize optimal patient outcomes in the face of limited health care resources.
Martz also secured additional funding for financially strapped nursing homes in 32 counties and secured approval for a Medicaid expansion to treat chemical dependency.
Biannual funding was increased $95 million by Governor Mike Johanns (R) for mental health and substance abuse services.
Governor Kenny C. Guinn (R) secured funding for the development of an electronic application process for the SCHIP program, Nevada Check Up, and Medicaid.
Governor Jeanne Shaheen (D) was successful in getting $3.3 million in state funding for the continued expansion of the Healthy Kids SCHIP program, which enrolled 12,000 children in a little over two years.
Acting Governor Donald T. DiFrancesco (R) signed the Breast and Cervical Treatment Act, thereby insuring treatment for uninsured women who meet a financial means test. The governor also authored and signed into law the Senior Gold Prescription Discount Act. The act provides the first state prescription drug benefit for moderate-income seniors and individuals with disabilities.
Governor George E. Pataki (R) received federal approval for a Medicaid waiver allowing the state to extend benefits to over 600,000 low-income, uninsured residents, including 267,000 uninsured adults without children.
Governor Mike Easley (D) announced the end of an enrollment freeze in the state’s SCHIP program, NC Health Choice. This opens access for an additional 5,000 children.
Governor John Hoeven (R) approved Medicaid changes to remove the asset test for families, expand coverage, simplify the application process, and improve coordination with SCHIP. Hoeven allocated $23 million to improving nursing home care and pay raises for long-term care staff.
Governor Bob Taft (R) recruited 43 health care providers to work in medically under-served communities as part of an overall effort to reduce disparities in health care delivery by 2005.
Legislation approving a medication assistance plan for low-income seniors was signed by Governor John Kitzhaber, M.D. (D). An estimated 110,000 state seniors meet eligibility requirements. Kitzhaber also negotiated a new drug formulary with the legislature. The state could save as much as $7 million over the next two years.
Before leaving the governorship to take the new federal government position of Director of the Office of Homeland Security, Tom Ridge (R) signed legislation expanding the reach of existing drug plans for the elderly.
Two drug-related measures were signed into law by Governor Lincoln Almond (R). The first bill provides for the state to pay 100 percent of prescription drug costs for eligible individuals who spend at least $1,500 in co-payments through the state program during the state’s fiscal year. The second bill added medicine for the treatment of osteoporosis to an existing list of covered drugs.
Governor Bill Janklow (R) expanded the state’s All Women Count! breast and cervical cancer screening program to include treatment for low-income and uninsured women.
Governor Don Sundquist (R) promoted an agreement extending health coverage to uninsured adult citizens. The measure also preserves the general concept of TennCare, although changes to the way the program is run are underway.
Governor Rick Perry (R) signed a bill expanding the employer-based insurance market to enroll Medicaid and SCHIP beneficiaries. Under the law, the state will subsidize the health insurance of Medicaid and SCHIP enrollees who opt to enroll in employer-based plans. The state estimates it could save $8.5 million over five years.
The state SCHIP program was bolstered by a whopping $1 billion increase in funding. As a result, the state expects to enroll 500,000 children by the end of 2003.
Perry promoted an initiative dealing with underserved residents along the Texas-Mexico border, giving them improved access to previously unavailable specialized care through telemedicine and telehealth systems.
U.S. Virgin Islands
Governor Charles Turnbull (D) appropriated tobacco settlement revenue for two new medical facilities providing critical cardiac and cancer care.
Governor Michael O. Leavitt (R) signed six bills intended to prevent death and injury caused by intoxicated drivers. The new laws demand higher levels of accountability.
Legislation was signed by Governor Gary Locke (D) enabling low- to moderate-income citizens with disabilities to work without fear of losing Medicaid benefits. The law implements the federal Ticket to Work program, which permits people with disabilities to earn up to 450 percent of the federal poverty line—about $100,000 a year—and still remain on Medicaid assistance.
Governor Bob Wise (D) signed a group pharmaceutical purchasing bill and initiated a multi-state drug purchasing pool. (See related story page ###.) Wise also enacted a Patient’s Bill of Rights providing the right to sue an HMO for negligence resulting in patient harm. Wise also signed a measure to fund skilled nursing home facilities for U.S. armed forces veterans who are also state citizens.
Governor Scott McCallum (R) advanced his own legislative agenda and signed a drug assistance bill for the state’s seniors. The new plan raises the income limit for eligibility to $20,616 for individuals and to $27,864 for couples—240 percent of the federal poverty line. McCallum expects to enroll 260,000 seniors.
Governor Jim Geringer (R) initiated long-term care reform by signing a bill allocating revenues for a study to evaluate the nursing home reimbursement formula; expand the long-term care home and community-based waiver programs; and increase the personal needs allowance from $30 to $50 a month.
The following organizations provided assistance in compiling this annual review: Stateline.org, the National Governors Association, and the National Association of Health Underwriters. For a more extensive review, go to www.nga/cda/files.001016HEALTHINT_PDF.pdf