|
The following defines each category and gives an example of state activities in each area.
Administration
Concerns asthma program administration. Once a program is proposed, the legislature delegates duties to an agency to perform specific tasks.
Air Quality
Addresses air quality problems—such as pollution, mold and indoor air—that are associated with asthma.
Children
Includes asthma legislation dealing with children, including infants through adolescents.
Definitions
Legislation that defines asthma and topics associated with asthma.
Duties
Specifically defines professional duties concerning any asthma-related topic.
Education
Involves legislation concerning public outreach education. Does not include "school" education.
Insurance
Includes legislation that concerns insurance coverage and policies dealing with asthma care and treatment.
Money
Appropriations and grants for asthma programs.
Medical
Includes legislation the deals with various medical treatments, conditions and care associated with asthma.
Prevention
Programs dealing with the prevention of asthma.
Research
Studies and research dealing with asthma.
School
Relates to all legislation dealing with school activities, programs, stipulations, health resources and training regarding asthma.
Target Population
Minority, ethnic and elderly asthma programs and concerns.
Tax
Includes legislation regarding tax credits for asthma-related injuries, care and donations.
Tracking/Reporting
Relates to reports, programs and studies concerning the tracking, monitoring and surveillance of asthma data.
State Legislative Activity on Asthma
As they do with any rising health concern, state legislators have acted on asthma through the introduction of legislation. A few bills, such as Illinois Senate Bill 1716, comprehensively address asthma. The bill would have required the state Department of Health to implement a statewide strategy to reduce asthma rates. Instead, many state legislatures looked at bills that permitted students to bring asthma medications to schools, made asthma a disease covered in child custody laws, or listed air pollution as a cause of asthma.
By introducing asthma legislation, legislators highlight the disease as an issue of concern. Introduction of a bill that fails in one session may lead to its passage in a following session. A failed bill may lead to a legislative or agency task force to study the issue, or it may lead to other policy actions. As is common with all legislation, only one-fourth of the asthma bills that were introduced passed; most bills died. Discussion follows of bills presented in asthma on the specified topic areas.
Administration
States introduced 59 bills related to the administration of asthma in 2002. The California Legislature introduced the most bills of any state, directing the state's administration of its asthma program. California Senate Bill 859 establishes a task force to develop a list of diseases eligible for disease management programs and services, strategies, and guidelines for implementing the policy. The task force pays specific attention to asthma. Illinois Senate Bill 552 requires the Department of Health to develop, maintain and revise a written, comprehensive, statewide asthma management plan for reducing the rate of hospitalizations due to asthma and for facilitating the effective management of asthma. Maryland House Bill 420 creates an Asthma Control Program in the Department of Health and Mental Hygiene. This program includes, but is not limited to, a plan for the prevention and control of asthma to reduce the effects of asthma on the state's population.
Air Quality
States introduced 22 bills related to air quality and asthma in 2002. Many states link poor air quality to rising asthma rates. Delaware Senate Bill 99, relating to the Clean Indoor Air Act, states that children's exposure to second-hand smoke leads to asthma. California Senate Bill 859 adds Section 4123 to the Public Resources Code relating to wildfires, stating that air quality can be bad for weeks, causing and contributing to severe health problems, including eye and lung irritation, asthma and other respiratory illnesses. Pennsylvania House Bill 171 urges the Department of Health to develop a task force to investigate the health effects of toxic mold. Health professionals have investigated possible relationships between mold contamination and outbreaks of allergies and asthma attacks.
Children
States introduced 71 bills related to children and asthma in 2002. Legislatures take special precautions when the state must address children and their issues. Virginia House Resolution 145 encourages employers to recognize the benefits of breast-feeding and set aside appropriate space for such activities; research shows that children who are not breast-fed have higher rates of mortality, asthma and other respiratory illnesses. New York Assembly Bill 1036 amends the public health law and the family court act in relation to children with special health care needs. It includes children with disabilities and defines chronic asthma as a disability. Connecticut Senate Bill 1038 requires the commissioner of Social Services to provide an environmental assessment of the homes of children who are eligible for or are receiving Medicaid. This may include environmental causes of illnesses such as asthma.
Definitions
States introduced 13 bills relating to definitions regarding asthma in 2002. Certain states define asthma for special purposes, identifying the special conditions or programs available for asthma sufferers. Colorado Senate Bill 21 defines an extraordinary medical expense to include asthma treatments. In Kentucky, Joint Resolution 170 defines "eligible drug" as any prescription maintenance drug used to treat asthma. Montana House Bill 161 revises the definition of "child with a disability" to include asthma as an "other health impairment," which means limited strength, vitality or alertness because of chronic or acute health problems.
Duties
States introduced 12 bills relating to asthma duties in 2002. Often, legislatures dictate the duties or "actions" a state agency must perform. Indiana Senate Bills 229 and 137 require a division of the state Department of Health to begin a disease management program for Medicaid recipients with asthma. Maryland House Bill 420 sought to adopt a program that creates an Asthma Control Program in the Department of Health and Mental Hygiene. The bill also requires the secretary of Health and Mental Hygiene to develop a statewide asthma plan. Mississippi House Bill 1200 directed the Department of Health to develop a statewide disease management program statewide for individuals with asthma.
Education
Educational outreach provides the public with information on the nature and extent of a disease. States introduced 15 bills relating to asthma and education in 2002.
Maine House Bill 1495, which defines stipulations and requirements for the Asthma Prevention and Control Program, includes the following language: "The Bureau of Health shall establish an asthma prevention and control program to provide leadership for and coordination of asthma prevention and intervention activities, education and training of health professionals on the current methods of diagnosing and treating asthma." Massachusetts House Bill 1393 seeks to establish a board of registered clinical exercise physiologists to develop guidelines and counseling regarding exercise programs and tests for individuals with asthma.
Insurance
States regulate the insurance industry, giving legislatures authority over the health impairments insurers must cover. States introduced 20 bills related to insurance and asthma in 2002.
Kansas Senate Bill 29 relates to insurance coverage for children. Includes coverage for annual physical exams for asthma. Maine Senate Bill 471 allows Medicaid reimbursement for certain drugs without requiring prior authorization. This allows prompt Medicaid reimbursement for certain drugs in order to aid some of the state's most vulnerable patients, including children, the poor; the elderly; and the sick and disabled who are covered by the Medicaid program. This includes Medicaid reimbursement for drugs. Missouri Senate Bill 82 relates to insurance and physician negotiations pertaining to plans, including clinical criteria for cost-effective and cost-efficient disease management programs for asthma.
Medical
States introduced 43 bills relating to medical concerns regarding asthma in 2002. Connecticut Senate Bill 162 requires managed care organizations to provide coverage for treatment and devices needed by people with asthma. Kansas House Bill 2661 concerns medical services that allow an emergency medical technician, when authorized by medical protocol, to assist a patient in the administration of auto-injection epinephrine, nitroglycerin and inhalers for asthma.
Money
Legislatures appropriate money from the state budget. Often, they dictate programs or projects they want through a line item in the budget. States introduced 35 bills regarding asthma and money in 2002.
Massachusetts House Bill 1 budgets for childhood asthma research and development plans. Iowa House Bill 732 provides appropriations for human services, which include asthma programs. Minnesota Senate Bill 1431 appropriates money from the tobacco settlement for medical education endowment funds and the creation of a "healthy kids learn" endowment fund which deals with asthma related concerns.
Prevention
Few legislatures address prevention activities, although it is becoming a more accepted agency practice. States introduced 13 bills relating to asthma prevention in 2002. In Maine, House Bill 1495 establishes the Asthma Prevention and Control Program in the Department of Human Services, Bureau of Health, and includes the following language:
The Bureau of Health shall establish an asthma prevention and control program to provide leadership for and coordination of asthma prevention and intervention activities: This shall include: 1. Monitoring of asthma prevalence at state and community levels; 2. Education and training of health professionals on the current methods of diagnosing and treating asthma; 3. Patient and family education on how to treat the disease; 4. Dissemination of information on programs shown to reduce hospitalization, ER visits and absenteeism due to asthma; 5. Consultation to and support of community asthma prevention. In addition, the program will consult with statewide organizations concerned with the treatment and prevention of asthma.
Illinois House Bill 3086 concerns joint discussions between physicians, health care providers and health care plans about cost-effective preventive health care services, including disease management programs such as asthma.
Research
State legislatures rarely appropriate funds for research activities, except in extraordinary circumstances. States introduced 21 bills relating to research and asthma in 2002. The California Legislature has considered funding for research into the environmental causes of asthma, as did New York and New Jersey. Massachusetts House Bill 5100 appropriated $143,838 for Asthma and Hazardous Substances Applied Research and Development. Massachusetts House Bill 3101 appropriates to the University of Massachusetts money to support research activities, and to investigate the association between certain ethnic groups and childhood asthma. Massachusetts House Bill 3930 establishes a study to research the presence of asthma and to make recommendations to alleviate the problem, including funding, to cities where asthma is prevalent. Nebraska Legislative Resolution 373 requires the Department of Health and Human Services to develop legislation to reduce air emissions from power plants and to require power generators to pay the true cost of emissions. Public health effects from these emissions include respiratory illnesses, including asthma.
Schools
Allowing asthma medications in schools has been a particularly sensitive topic for state legislators because it violates any drug-free schools acts or policies that prevent a child to from taking asthma medication themselves. States introduced 41 bills relating to schools and asthma in 2002.
Delaware House Bill 9 would have permitted school children to administer asthma medications, as did Georgia House Bill 472, Illinois House Bill 898, Kentucky House Bill 353 (enacted), Massachusetts House Bill 4411 (enacted) Minnesota Senate Bill 1706, New Jersey Senate Bill 1372 (enacted) and New York House Bill 9907.
Georgia House Bill 1242 amends the Georgia Safe Schools Act to create a school pest management advisory board because numerous scientific studies have linked both cancer and asthma to pesticide exposure. Hawaii House Bill 2783 encourages community agencies' at school sites to provide health care programs for children who do not have access to health care. It declares that one of the most common childhood illnesses is asthma. New Jersey Senate Bill 118 establishes a School Asthma Protocol Task Force to develop guidelines for the most appropriate and effective means of implementing a pediatric asthma reduction effort protocol statewide. Oklahoma House Bill 2208 creates the Chronic Disease School Care Act and requires schools to provide chronic disease awareness training for school employees. Includes asthma as a chronic disease.
Target Populations
Certain legislation seeks to identify the extent of asthma in specific populations. States introduced 14 bills relating to target populations and asthma in 2002. Connecticut House Bill 172 requires tracking the prevalence of asthma among different socioeconomic groups to allow for the investigation of factors contributing to the rates of asthma. Illinois Senate Bill 708 stipulates that Department of the Public Health, in conjunction with representatives of state and community-based agencies involved with asthma, develop asthma information targeted at population groups with a high risk of suffering from asthma: African Americans; Hispanics; the elderly; children; and those exposed to environmental factors associated with risk of asthma. Kentucky Senate Bill 32 relates to the Kentucky Senior Citizen Prescription Drug Assistance Act of 2002; it defines an eligible drug as any prescription maintenance drug used to treat asthma.
Taxes
Besides appropriating funds, a primary responsibility of legislatures to establish and level taxes on the public. States introduced eight bills relating to taxes and asthma in 2002.
Virginia Senate Bill 20 relates to medical-related nonprofit civic and community service that exempts from taxation items for the purpose of eliminating lung disease, including asthma. California Assembly Bill 2127 repeals obsolete provisions within the tax code and allows taxpayers to designate on their tax returns a specified amount in excess of their tax liability be transferred to the Asthma and Lung Disease Research Fund, created by this bill. It provides that a voluntary contribution designation for this fund shall not be added on the tax return until another voluntary contribution designation is removed. California Assembly Bill 866 allows for child care tax credits, which include the use of "specialized centers" that treat children with minor problems associated with asthma.
Tracking and Reporting
In a report released May 2000 by an organization called Health Track, researchers used Centers for Disease Control and Prevention data to determine that most states have no ongoing asthma monitoring program. The study found that 30 states have no timely information that describes asthma within their borders and that only seven states have "ready access" to statistics about emergency care for asthma. It also found that among the 23 states that track asthma, uncertainty exists about the adequacy of their tracking efforts. States introduced 30 bills relating to tracking of asthma in 2002.
Several states are exploring this aspect of asthma policy; 23 bills were introduced in California, Connecticut, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, Pennsylvania, Texas and Washington.
Connecticut House Bill 7505 directs the board of education to require each child to have a health assessment before he or she enrolls in public school. The assessment is to include asthma diagnosis. It also requires each school board to report annually the number of students diagnosed with asthma. The report should include demographics on the child. It also requires the school board to establish a program for the early identification and treatment of pediatric asthma. A monitoring program and statewide asthma plan should be established.
Indiana Senate Bill 244 creates the State Public Health Information Coordination Commission to coordinate the exchange of information between the Department of Environmental Management and the state Department of Health and to carry out coordination duties. It requires the commission to study and make recommendations for the improvement of the state's geographical information database program. The health database is to identify statewide disease trends, local disease trends, and gaps in available health information. Asthma is including in this type of tracking.
Statutes
Legislatures, through enacted bills (or "statutes"), direct and authorize the state agencies to administer and regulate asthma programs and policies. Even programs sponsored and funded by the federal government (i.e., the CDC) require legislative authorization of some sort, usually through the general powers of the state director of health. These general powers allow the director (through the department of health) to help prevent disease, disabilities, injuries and illness among the state's citizens.
Legislation and statutes that direct a state agency to act or that mandate common law changes come from direct legislative authority. The legislature (and the governor, who must sign or veto every law) dictates policy via legislation, which either authorizes a program, directs legal principles for the judiciary, or at least establishes a policy for the state. From this direction, the state's agencies (usually the health department in the case of asthma), the state's courts (via application of statutory law), and its citizens (via general policy) gain direction as to the state's policies and, in a sense, its beliefs about how to address a certain issue.
Regarding asthma, most states historically have allowed the state's director of health to address it through the general authority to protect the public's health. This permitted the state to accept federal funds and adopt policy (though not regulation) to address asthma. Asthma also was addressed as part of broader laws–ones that covered Medicaid or child custody–that incidentally included asthma in some manner.
As asthma rates have continued to increase, state legislatures have begun to address asthma directly, rather than as an incidental part of another law. Laws have emerged recently that exempt asthma medications from a general "drug-free school" policy, include "asthma" as a tobacco-related disease, and even as comprehensive asthma statutes, have emerged recently.
States with the most extensive asthma statutes are California, Connecticut, Georgia, New York, Texas and Virginia. Other states with laws related to asthma include Alaska, Colorado, Delaware, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah and West Virginia.
Administration
The only state with statutes under this category is California. Under the California Health and Safety Code, § 104316, 104318 and 104320, the Legislature determined that the state Department of Health Services: 1) regularly analyze asthma morbidity and mortality data, periodically assess the burden of asthma on the state's medical and economic resources, and identify populations most seriously affected by asthma; 2) survey factors known to worsen asthma, in order to estimate the relative importance of these factors; and 3) assess patterns of medical care and population-based health services, and the extent of local, regional, educational, environmental and other asthma interventions. The goal is to guide the development of public health programs and asthma policy. State law also requires the department to distribute funding to various local agencies and groups, and offer a surveillance and intervention program.
Three California statutes relate to the administration of asthma.
Air Quality
Ten states have statutorily addressed asthma as an air quality issue: Colorado, Connecticut, Michigan, New York, North Dakota, Oregon, and Rhode Island. In Michigan, North Dakota and Oregon the law simply "exempts asthma inhalers from the restricted list use of chlorofluorocarbons." Colorado identifies methyl tertiary butyl ether (MTBE) as a cause of asthma, and recommends that it be phased out of gasolines. New York simply states that air pollution causes asthma, and Rhode Island claims it is a housing related problem.
For the most part, this indicates that these legislatures use asthma as a reason to address other issues, such as air pollution, housing concerns, or the removal of MBTE.
Children
Twenty states have statutes that deal with children and asthma. Colorado lists asthma as an extraordinary expense in child custody disputes (C.R.S.), as does Maryland (Md. Code Fam. Law. 12-201). Georgia prohibits copayments for children under age 6 for asthma-related conditions (Ga. Code § 49-5-273). Illinois prohibits smoking in daycare centers (225 ILCS Stat. § 10/5.5). Louisiana requires parents who are putting a child up for private adoption to state whether families or the child has or have had asthma (La Civ. Code Art. 1125). An expert on children's asthma is required on Maryland's Children's Environmental Health Council (Md. Code Health-General 13-1504). Missouri allows school boards to permit self-administration of prescription asthma medication and inhalers for students (Mo. Rev. Stat. § 167.627), as do New Jersey, New York and Ohio. New York considers asthma to be a childhood disability (N.Y. Pub. Health Law § 2581).
Definitions
California defines asthma as a tobacco-related disease (Cal. Health and Safety Code § 104355). Montana includes asthma under the definition of "other health impairment" (Mont. Code § 20-7-401), as does Nebraska (Neb. Rev. Stat. § 79-1118.01). Oklahoma includes asthma under the definition of "physically handicapped" (Okla. Stat. Ann. tit. § 18-109.5). Pennsylvania and West Virginia define "miner's asthma" under the definition of a work-related disability allowing for compensation (77 Pa. Cons. Stat. Ann. § 27.1 and W. Va. Code § 23-4-1).
Duties
Eleven states have statutes relating to duties. California has the most substantial laws determined as "duties." The Health and Safety Code § 104316 and § 104317 specify activities to be undertaken by the Department of Health Services (DHS–such as assessment of asthma morbidity and mortality data, the burden of asthma on medical and economical resources, survey factors known to worsen asthma–to estimate importance and assess asthma intervention. Public education also is covered, including the identification of asthma diagnosis and treatment protocols.
Mass. Gen. Laws Ann. Ch. 29D § 5 creates an advisory committee that will recommend financial uses in financing tobacco control needs. This council must include a member of the Asthma Foundation of America. Minn. Stat. Ann. § 325F.18 forbids manufacturers to sell products containing urea formaldehyde, unless a written disclosure about the risks of asthma is made to the purchaser.
Education
Again, California Health and Safety Code § 104317 requires DHS to offer extensive educational outreach about asthma. Illinois stated that the practice standards adopted by the National Education and Prevention Program may be incorporated into regulation. Practice standards may include asthma requirements (ILCS § 104316). New Jersey ensures that asthma education opportunities are available annually for teachers (N.J. Stat. § 18A:40-12.9).
Insurance
Eleven statutes in seven states relate to insurance and asthma. Georgia law requires insurers to cover asthma as a medical emergency. It prohibits medical insurers from denying or limiting coverage for prescription asthma inhalants based on refill frequency and requires that no copayment be charged for children under age 6 for asthma related conditions (Ga. Code § 49-5-273, §-24-28.2, and § 33-24-59.8). In Indiana, the state makes stipulations for asthma sufferers under Medicaid.
Nevada defines "baker's asthma" as an occupational disease and allows for disability compensation when contracted through work (Nev. Rev. Stat. § 617.450). Pennsylvania and West Virginia allow compensation for "miner's asthma."
Texas allows competing physicians in the area of benefit plans to meet to discuss cost-effective disease management, including asthma (Tex. Ins. Code art. § 29.04).
Medical
Twenty-two states have enacted laws relating to medical treatment and asthma. State legislatures generally are reluctant to prescribe medical treatments, but will determine conditions for medical treatment. Delaware requires one clinic in each county within the state to be equipped to diagnose and treat asthma (16 Del. C. § 153). Georgia requires optometrists to refer patients with asthma to a licensed person for examination before certain types of optical therapy can begin (Ga. Code Ann. § 43-30-1). Kansas authorizes emergency medical technicians to assist a patient with inhalers for asthma (Kan. Stat. Ann. § 65-6121). Nevada allows hypodermic devices to be sold without prescription for the use in asthma treatment (Nev. Rev. Stat. § 454.480).
Money
Determining appropriations is the single most important duty state legislatures perform, and legislators often use appropriations language to promote a program or proposal that was not adopted by the full legislature.
California uses its budgetary role to offer tax credits for people who pay for asthma treatments or contribute to the California Lung Disease and Asthma Research Fund (Cal Rev. & Tax Code § 17052.18 and § 18831). The Georgia legislature authorized $19,000 to establish an asthma coordination program, including public education and prevention, best asthma management practices, and statewide technical training (Ga. Code § 42-3252).
Prevention
Legislatures have not often authored laws that promote prevention, but California has enacted two.
California law established a program to prevent and reduce asthma through assessment and intervention and required the DHS to establish a surveillance program for the prevention of asthma (Cal. Health and Safety § 104317-21 § 104320).
Research
No state, with the exception of California, has enacted laws mandating research on asthma.
The California Legislature required the Department of Health Services to analyze asthma morbidity and mortality data, assess the burden of asthma on medical and economical resources, survey factors known to worsen asthma to estimate their importance, assess asthma intervention and related activities, and evaluate the risks and benefits of MBTE compared to ETBE, TAME and ethanol in gasoline. This includes the comparison of the incidence of asthma before and after the level of MTBE was increased in the state's gasoline (Cal. Health and Safety § 104316 and § 25299.37.1).
Schools
Only one law has been passed in this category. California created the Children's Environmental Health Center within the state EPA to address environmental asthma (among other diseases.) within the state's EPA. It authorized the duties that are designed to protect children from environmental hazards by reassessing statutes, regulations and programs (Cal. Health and Safety Code §900).
Regarding laws that exempt asthma medications from drug-free school policies or allow students to self-medicate for asthma, Georgia, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, and Oregon allow for or address asthma medication on school grounds.
Target Population
Fourteen laws in eight states address target populations. California enacted two laws that address target populations. The first requires the Office of Health and Safety to ensure that programs keep asthma data concerning ethnic and racial statistics and that they collect strategies and programs that address multi-cultural health issues. The second establishes a California/Mexico border advisory group to examine methods to reduce the risk of childhood asthma along the U.S./Mexico border.
Illinois also adopted a comprehensive law to identify target populations with asthma. The Department of Public Health, in conjunction with representatives of state and community-based agencies involved with asthma, must develop an asthma information program targeted at population groups in Illinois with high-risk asthma, including but not limited to, the following: 1) African Americans, 2) Hispanics, 3) the elderly, 4) children, 5) those exposed to environmental factors associated with high risk of asthma, 6) those with a family history of asthma and 7) those with allergies (20 ILCS 2310/55.95).
Tax
Five California Tax and Revenue Code laws relate to asthma. Cal. Rev. & Tax Code § 17052.18 allows a tax credit of 30 percent for money paid into a qualified child care plan. It includes money spent on arrangements for children who suffer from asthma. Cal Rev. & Tax Code § 18835 places time limits on contribution credits to the Lung Disease and Asthma Research Fund. Cal Rev & Tax Code § 18832 creates the California Lung Disease and Asthma Research Fund.
Connecticut exempts asthma medication from sales tax. (Conn. Gen. Stat. § 12-412). Virginia offers a tax credit for money spent on asthma treatment (Va. Code Ann. § 58.1-609.8).
Tracking and Reporting
Five states enacted laws relating to the tracking of asthma rates. The California Legislature directed the Department of Health Services to perform surveillance of asthma, assessing the extent and nature of the disease in the state. It also requires DHS to monitor clinical and public health interventions regarding asthma treatments (Cal. Health and Safety § 104316, § 104317, § 104319, § 104320).
Texas requires the Department of Health to monitor service quality via hospitalization rates due to asthma (Tex. Health and Safety Code Ann. § 62.052). Illinois law (20 ILCS 2310/55.95) requires the state Department of Health to track population groups with high risk of suffering from asthma.
| 
