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This column features selected short items about state health care policy.
LANSING, MI—Michigan lawmakers are pushing to lower federal arsenic limits in drinking water by 80%, although 450 public water systems statewide would likely fail the new standard.
In all, uncounted private wells and about 15% of Michigan’s 3,000 municipal water systems would exceed the arsenic standard proposed by Democratic U.S. Reps. Dingell, Stupak, Conyers, and Bonior in a House bill.
Wading into a war of statistics and clouded science, the lawmakers want to reinstate a 10 parts-per-billion (ppb) arsenic maximum that appeared in the waning days of the Clinton administration.
U.S. Environmental Protection Agency (EPA) officials, directed by the Bush administration, recently moved for a nine-month delay in adopting a lower threshold for arsenic. The current standard of 50 ppb dates to 1942.
"Arsenic is a deadly poison, and this matter has been studied for 17 years. How much more do we need to study?" said Rep. John Dingell. "I’m inquiring about the legality of the EPA’s action."
A metal that occurs naturally, arsenic’s danger concerns the threat of cancers of the lung, bladder, kidney, and skin that scientists have linked to tainted water sources.
In Michigan, arsenic is commonly found in underground layers of rock, where it can join groundwater tapped by unsuspecting residents’ wells.
But citing high costs of removing arsenic, Christine Whitman, EPA director, has proposed a delay until 2002 to consider a range of standards from 3 ppb to 20 ppb.
The House bill would effectively prevent any delay and provide $2 billion in loans for rapidly revamping water systems.
"This [delay] gives us a chance to take a narrower focus," said Robin Woods, EPA arsenic specialist in Washington, DC. "We just want time to review the costs and take another look at the science behind the standards."
—Detroit News, May 3
PHOENIX—Low-income rural seniors got some help to pay for their prescription drugs recently in Arizona, but it wasn’t the widespread bailout many were expecting.
State lawmakers struggled during their recent session to create a plan to help older Arizonans, especially those in rural counties where health maintenance organizations pulled out last year, cope with the rising cost of prescription drugs.
What survived is the so-called "catastrophic" plan, backed by Rep. Deb Gullett (R-Phoenix). Seniors who are 150% to 250% above the federal poverty level ($8,590 for one person or $11,610 per couple) would have to spend from $500 to $1,000 of their own money on drugs before qualifying for a 50% discount.
"This is not a global fix; it’s a modest fix," Ms. Gullett said. "But this plan sends relief to the people with the biggest need."
The Senate approved the bill, 16-13, and sent it to Gov. Jane Hull. Ms. Gullett said the plan is a two-year stopgap until Congress can add a prescription benefit to Medicare. On Monday, the House killed a more expansive prescription drug bill that included a federally negotiated discount on prescription drugs throughout the state.
Opposed by pharmaceutical companies and budget-conscious House Republicans, the program was championed by the late Sen. Andy Nichols (D-Tucson). A similar program in Vermont is under litigation, and President Bush is unlikely to permit any new programs until the lawsuit is settled, Ms. Gullett said.
Sen. Chris Cummiskey (D-Phoenix) said he was incensed that House members killed a compromise bill containing aspects of his, Gullett’s, and Nichols’ ideas in favor of a bill with only Gullett’s "catastrophic" discount.
—The Arizona Republic, May 2
TALLAHASSEE, FL—In what would mean a savings for thousands of Floridians, pharmacists could substitute less-expensive generics for four brand-name drugs under a bill sent to the governor.
The list of affected drugs includes the popular brand-name blood thinner Coumadin. If the bill becomes law, pharmacists automatically would substitute the generic warfarin for Coumadin, unless doctors write "medically necessary" on a prescription for Coumadin.
The Senate approved the bill. Gov. Jeb Bush has not taken a position on the issue, a spokeswoman said.
Pharmacists already are required by Florida law to fill prescriptions for nearly all brand-name drugs with generic equivalents. They must use the brand-name drugs only if doctors write "medically necessary" on the prescription.
But Coumadin was among a handful of brand-name drugs on the state’s "negative formulary" list. Any brand name on that list could not be substituted.
Under the bill, Coumadin and three other drugs would be removed from the list and treated just like any other name brand drugs. Doctors who wanted their patients to receive Coumadin still could write "medically necessary" on the prescriptions.
"Two words can be placed on the prescription pad that make it crystal clear if the doctor does not want a substitution," said Sen. Ron Klein (D-Delray Beach).
—St. Petersburg Times, May 3
WASHINGTON, DC—Moving to help the 43 million Americans who lack health coverage, House and Senate budget negotiators have accepted a plan that could lead to the biggest expansion in decades in government funding and tax credits for the uninsured.
The provision, included in the compromise budget resolution the negotiators have been working on and which now is headed for congressional approval, reflects bipartisan enthusiasm for trying to significantly reduce the ranks of people without health coverage. Extending coverage has proved a stubbornly persistent problem despite the recent years of strong economic growth.
The House and Senate are expected to approve the budget resolution. House leaders had planned to pass the measure May 3, but postponed action because of a clerical error, they said. The delay came after GOP leaders made last-minute changes in another crucial area of the budget.
Some emergency funds will be cut
Although President Bush and congressional negotiators had agreed to a 5% spending increase for government discretionary programs, sources said GOP leaders decided to scale back the spending hike to the 4% the White House initially sought. The change would trim back $6 billion that had been included for natural disasters and other emergencies.
The health insurance initiative, which was accepted by House and Senate negotiators and was unaffected by the squabble concerning discretionary programs, would make available an additional $28 billion over the next decade in federal money to cover the uninsured.
Proponents advocate using it to extend health insurance to parents of children already covered by a federal program for low- and moderate-income households.
—Los Angeles Times, May 4
PHILADELPHIA—Aetna U.S. Healthcare has agreed to sell its New Jersey Medicaid and NJ FamilyCare businesses to AmeriChoice Corp. Terms were not disclosed.
The agreement affects about 118,000 low-income families including New Jersey Medicaid beneficiaries and members of the state’s FamilyCare program for uninsured children and adults, the company said.
Subject to approval by the New Jersey departments of Human Services, Health and Senior Services, and Banking and Insurance, the transaction is expected to be completed by the end of the year, Aetna U.S. Healthcare spokeswoman Jennifer King said.
Participants whose coverage is being switched will be notified in writing and be given an opportunity to switch to another health care provider if they wish, the companies said.
Aetna U.S. Healthcare’s and AmeriChoice’s networks of participating providers overlap and the companies said most members would continue to have access to their current physicians.
—Associated Press, May 4
PHOENIX—A signature from Gov. Jane Hull is all that’s needed to allow schools to help promote Arizona’s health care program for low-income children as long as they keep those efforts out of classrooms.
The Senate voted, 25-3, for a bill (Senate Bill 1087) recently that would permit districts to perform "outreach and information activities." It also states that the activities "shall not reduce or interfere with classroom instruction time and shall not be performed by teachers or in classrooms during regularly scheduled classroom hours."
While conservatives have contended that the KidsCare program is government taking on an unnecessary role, supporters say school involvement is needed to inform families about the program and the health care it provides.
Hull’s State of the State speech in January urged legislators to use schools to promote KidsCare, and she has said she looks forward to signing the bill.
The bill also cuts in half the current six-month "bare period" during which new enrollees must not have dropped private insurance before becoming eligible for KidsCare.
—Arizona Republic, May 3
RALEIGH, NC—A change in federal Medicaid reimbursements will cost North Carolina $29 million next year, putting additional pressure on lawmakers to find ways to curb costs in the program.
The change will essentially shift the federal government’s share of Medicaid from 62.47% to 61.46%, state officials said.
Although the change is made every year, the amount was larger than expected.
"The federal share goes down every year because North Carolina is becoming wealthier every year," said Dick Perruzzi, head of the state’s Division of Medical Assistance.
The formula change is based on states’ per capita income.
Medicaid is a $5.5 billion program in North Carolina. It serves about 1.2 million people in the state.
Most of the people served are at or below the federal poverty level — $17,050 for a family of four.
North Carolina will spend about $1.6 billion on the program this year, or about 10% of the state’s operating budget. Those costs will grow by roughly $500 million next year unless changes are made in the program.
—Raleigh (NC) News & Observer, May 4