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This column features selected short items about state health care policy.
AUSTIN, TX—Veterans of battles over health care reform and patient protection that date to the early 1990s are gearing up for another fight in the Texas legislature.
This time, the debate is over how far to go to keep Texans’ medical records private. After months of negotiations that have intensified in recent weeks, lawmakers took their first look at proposed privacy laws recently at a joint meeting of the Senate Business and Commerce and Health and Human Services committees.
On one side are doctors and consumer groups, who want tough laws to keep private medical data — ranging from patients’ lab results to their family history to their prescription records — from being disclosed without their permission.
"People are terrorized about their private health care data," said Rep. Glen Maxey (D-Austin) who filed a bill Feb. 2 that would require patient consent before medical data are used by anyone but health care providers and insurance companies. "We want to put a state protection in place."
On the other side are health insurers, drug companies, and business groups, who say new privacy restrictions would make it harder for them to control costs and do business in Texas. They are especially concerned about a proposal to give patients the right to sue any entity — including an employer — that violates the confidentiality of their medical records.
—Austin American-Statesman, Feb. 28
St. Paul, MN—Minnesota lawmakers have vowed to try again to pass a bill giving patients more power over the decisions of health maintenance organizations.
The measure passed the Senate last session but died in the House amid concerns about a provision that would allow patients to sue their insurers. It was known then as the "Patients Bill of Rights," but this session lawmakers gave the plan a new name: "The Fairness in Health Care Act."
The bill by Sen. Don Samuelson is patterned after one under consideration in Congress and a similar law in Texas that has withstood a challenge in federal court.
Among other things, the plan would require health plans to hire medical specialists licensed in Minnesota for any reviews of decisions by state physicians. Backers say under current practice, health plans can use out-of-state reviewers who are not specialists.
Associated Press, Feb. 28
SPRINGFIELD, IL—A bill to further expand a state program that helps low-income senior citizens pay for prescription drugs recently led to a partisan dogfight in an Illinois House Revenue subcommittee.
Lee Daniels, House minority leader, is sponsoring House Bill 5, which would expand Illinois’ circuit-breaker program for the poor to cover prescription drugs to treat osteoporosis and other diseases. It also would raise the income threshold to qualify more people.
Democrats had a different idea, though, and Rep. Joe Lyons of Chicago amended the Republican bill to cover all prescription drugs and remove the age barrier to qualify.
Mr. Daniels contended the change would cost the state $2 billion to $4 billion annually. Barbara Flynn Currie, House majority leader, who is not a member of the subcommittee, said the amendment would cost much less.
"I think, Rep. Lyons, you are unfortunately being caught up in some extreme negative politics that are very harmful to our senior population," Mr. Daniels said. "I think you are going to regret this move. There are 370,000 women over the age of 65 who need this state’s help because they’re suffering a crippling disease."
Providence Journal, March 1
HONOLULU—House lawmakers in Hawaii want the state to address sky-high prescription drug costs for the first time with a proposed discount program for people who pay cash for their medicine.
Officials with the state’s largest health insurer said they aren’t sure how much the program will actually save consumers, but Rep. Roy Takumi said he hopes the effort will cut participants’ drug costs by 15%.
"It’s just good public policy," said Mr. Takumi. "Should we try to have a program that allows our residents to enjoy the same savings that all of us in a drug plan now enjoy? It’s a no-brainer."
Mr. Takumi said the program would be open to anyone, but the biggest beneficiaries would be 220,000 Hawaii residents who have no drug coverage. Others who might benefit are people who exceed the limits of their drug coverage and have to pay for additional prescriptions out of pocket.
Under the bill, experts hired by the state would negotiate with pharmaceutical companies to develop a list of discounted prices for people in the program. The logic is that the consumers’ combined purchasing power would give the group leverage in the price negotiations.
—Honolulu Advertiser, March 1
KNOXVILLE, TN—The state is considering requiring a new vaccine — one that could eliminate some life-threatening childhood illnesses and painful inner-ear infections — for all children entering day care.
Marketed under the brand name Prevnar, it is a sort of kids’ version of what’s commonly called the "pneumonia vaccine’’ for adults. It attacks the seven most common kinds of pneumococcal infections that strike children under the age of 2, including deadly pneumococcus meningitis.
"We are talking about a vaccine that not only keeps a child well, but prevents [him or her] from developing absolutely devastating illnesses,’’ said Jerry Narramore, director of immunization with the state department of health.
It has been offered for several months at Metro’s Lentz Health Center by the county health department.
"It will also reduce the occurrence of the most severe sort of middle-ear infection, which, though not life-threatening, is hugely bothersome,’’ said Bill Schaffner, MD, infectious diseases specialist at Vanderbilt University Medical Center in Nashville.
In most cases, it will eliminate the need for placing tubes in a child’s ears, a common practice to promote drainage. It also will eliminate the need for multiple doses of antibiotics to cure infection.
—The Tennessean, March 6
SPRINGFIELD, IL—Senate Republicans pressed for hearings so state welfare officials and the Rev. Jesse Jackson can explain a controversial $763,000 no-bid state contract awarded to his Rainbow/PUSH Coalition.
The Public Aid Department signed the pact last summer with Jackson’s organization to promote and help enroll poor children in the state’s KidCare health insurance program. But agency officials have no way of measuring how many kids the organization has enrolled in the program.
"I don’t think you can let a $750,000 contract pass without asking for some accountability," said Sen. Steve Rauschenberger (R-Elgin), chairman of the Senate Appropriations Committee.
Rauschenberger indicated he would call Public Aid officials and perhaps Jackson himself before the Senate panel to justify the deal, which pays Rainbow/PUSH differently than other organizations that sign up KidCare recipients. Jackson’s organization receives a set amount. Other community organizations get $50 per child enrolled in KidCare.
—Chicago Sun-Times, March 7
ANNAPOLIS, MD—Maryland legislative leaders plan to ask Gov. Parris N. Glendening to add as much as $20 million to the state budget to help tens of thousands of senior citizens afford the rising cost of prescription drugs.
In the Senate, Finance Committee Chairman Thomas L. Bromwell said he expects his committee to vote on a bill to spend as much as $20 million to help 100,000 Maryland residents who lack adequate prescription drug coverage.
In the House of Delegates, Economic Matters Committee Chairman Michael E. Busch said leaders there decided to devote an extra $13 million to $16 million to prescription drug programs, with a goal of assisting 30,000 to 40,000 people.
"We’re trying to craft a program that will provide some relief for our priority, which is senior citizens," said Busch, who expects his committee to approve a bill as early as mid-March.
—Washington Post, March 7
ALBANY, NY—The sorry state of hospital finances took center stage as the Healthcare Association of New York State (HANYS) held its Lobby Day at the Empire State Plaza.
A report issued by HANYS shows that New York hospitals bled red ink to the tune of $539 million in 1999 and $149 million in 1998, while the operating and bottom-line margins at the hospitals plunged to 49th in the nation. Only Rhode Island fared worse, HANYS officials said.
"The hospitals are clearly going into critical condition,’’ said Daniel Sisto, president of HANYS, an East Greenbush-based trade group that represents more than 550 hospitals and health care facilities in the state. "The Crouse-Irving [Hospital in Syracuse] bankruptcy is symptomatic of an industry in general decline.’’
The data have prompted officials with HANYS to ask the state for $500 million to help recruit and retain health care workers.
Nurses, technicians and other caregivers are in short supply, as industry executives have not been shy in saying. "Manpower is one of the major issues that we’re facing,’’ said G.B. "Sam’’ Serrill, president of Ellis Hospital in Schenectady.
Ellis, anticipating a 2000 deficit in the millions, is closing its maternity ward and three primary-care centers. Other area institutions, including Albany Medical Center, are also bracing for bad news once auditors get through crunching last year’s numbers.
Containing labor costs is a key to reining in expenses, said Gary Lang, vice president and chief financial officer of St. Peter’s Health Care Services, parent to St. Peter’s Hospital in Albany.
—Albany Times Union, March 7