States ready to tackle health care issues

State legislatures continue to outpace Congress in addressing issues important to physicians and patients.

By Susan J. Landers and Tanya Albert, amednews staff. Feb. 5, 2001. - Correction

Washington -- Legislatures in all 50 states and the District of Columbia are convening this year, and top agenda items include managed care reforms, prompt-payment law refinements and physician collective bargaining measures.

And the issues don't stop there. "We have bills related to practice liability, professional interest, public health, managed care reform and tort reform," said Virginia Latham, MD, president of the Massachusetts Medical Society.

State health care priorities
Health mandates

Thirty-eight state legislatures will continue to address and refine independent appeals processes for health plan enrollees, and 37 said health plan liability was a priority, according to a recent poll by the National Conference of State Legislatures.

The states have been a recent hotbed of health legislation activity, leaving federal lawmakers far behind. For example, most states already have patients' rights laws and prompt-pay mandates, while Congress struggles to pass similar laws.

Federal lawmakers are likely to watch their state counterparts even more closely now that states' rights advocate George W. Bush is in the White House and Wisconsin Gov. Tommy Thompson is taking the helm at the Dept. of Health and Human Services.

Coverage issues

Legislation to mandate that health plans cover specific services has been an ongoing trend over the past few years and is expected to continue, according to a survey conducted by the Health Insurance Assn. of America.

Bills requiring mental health parity, as well as coverage for clinical trial participation, contraceptives, diabetes treatment and infertility, will be debated, HIAA predicted.

The Medical Society of the State of New York is supporting legislation to mandate coverage of bone density tests and drug therapies for osteoporosis.

Sounding a cautionary note, HIAA President Chip Kahn urged legislators to consider how much such initiatives would cost. "At a time when rising health costs are projected to cause double-digit health insurance premium increases, legislatures must be extremely careful not to throw more fuel on the cost fire," he said.

Maine legislators may well heed that advice, predicted Andrew MacLean, director of governmental affairs for the Maine Medical Assn. A mental health parity bill backed by the physician group may get a cool reception in light of solvency problems faced by state health plans, he noted.

But the Maine group has more priorities, including bills on managed care contract issues. For example, it advocates eliminating clauses that require physicians who participate in one insurance product to participate in all plans offered by the insurer.

Legislatures in Massachusetts and Indiana may consider similar physician-supported bills to change managed care contract language.

A state budget deficit caused primarily by a shortfall in Medicaid funds will impact many health care bills in Maine and other states. For Maine, tobacco settlement funds, originally targeted to health care and smoking cessation programs, likely will be used to offset the shortfall -- a move opposed by state physicians.

Collective bargaining

More than a dozen state legislatures are expected to see bills this year that would give independent physicians the power to collectively bargain with insurers.

As of late January, bills had been introduced in Alaska, Indiana, Missouri and New Jersey. State legislators from Hawaii to New York are expected to offer bills as governing bodies swing into full gear.

Proponents say collective bargaining gives doctors a level playing field when they're dealing with profit-driven HMOs. The insurance industry says it would drive up health costs.

Now, federal antitrust laws allow only employed physicians and those in a joint venture or integrated arrangement to negotiate collectively with insurers. Most physicians are independent contractors. That has left states struggling to figure out the best approach to antitrust bills.

"The big question is, how far do you want to go with it?" said Rachel Morgan, an analyst with the Health Policy Tracking Service, an arm of the National Conference of State Legislatures. "It is a complicated issue, and states want to do it right."

Texas is the only state that has given doctors collective bargaining rights. And the debate continues on the national level.

New Jersey is closest to passing a law. The state Senate passed a bill in December that would let doctors and dentists collectively bargain with HMOs. Physicians would have to get the state attorney general's approval to enter negotiations, and the HMO would have to agree to talk. The bill still must go before the state Assembly this year, and proponents expect the vote to be close.

"It still doesn't put us on equal footing with the insurance industry, but it puts us a step in the right direction," said Medical Society of New Jersey President Walter J. Kahn, MD, a Red Bank ophthalmologist.

The insurance industry's argument that physician negotiations would increase health insurance costs has been a big stumbling block in getting legislation passed.

Washington, D.C., physicians came very close to having antitrust legislation. Last June, the city council approved a bill 10-2, and the mayor signed it. But in January, the city's Financial Control Board rejected it. The board studies the financial impact of bills and has the final say on whether they can become law.

The Medical Society of the District of Columbia is evaluating how a new bill might be introduced, said Executive Director K. Edward Shanbacker.

Minnesota tax battle looming

While most health care issues are common to many states, Minnesota stands alone with its tax on medical services. The Minnesota Medical Assn. is gearing up for a no-holds-barred effort to eliminate the much-hated 1.5% tax on services provided by physicians, hospitals and other health care providers. (See correction.)

MMA President Blanton Bessinger, MD, recently testified before a legislative committee on the need to abolish the tax, which supports a state-run program to provide health care for low-income residents. The physician group, which supports the program, is asking that funds be drawn either from tobacco settlement money or general revenues.

Dr. Bessinger told legislators that the tax leaves the perception that the state is hostile to physicians.

ADDITIONAL INFORMATION:

State health care priorities

A recent poll of state legislators and their staffs, governors' offices, and executive agencies highlights the 2001 health care priorities. Number of states and their plans:

45 Expanding the State Children's Health Insurance Program to parents
44 Adjusting Medicaid reimbursement rates either up or down
44 Providing basic health benefits for the working poor
41 Establishing or modifying pharmaceutical assistance programs for seniors
38 Refining managed care independent appeals processes
37 Developing a health plan report card system

Source: National Conference of State Legislatures

Health mandates

Many states expect to consider mandatory health plan coverage of several services, including:

26 Osteoporosis treatment
26 Off-label pharmaceuticals
23 Contraceptives
23 Cervical cancer screening

Source: National Conference of State Legislatures

Correction

This story incorrectly stated that Minnesota is the only state with a tax on medical services. West Virginia taxes physicians at a rate of 2% of their gross revenues to provide additional Medicaid funding. AMNews regrets the error.