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2005 Priorities of State Health Committee Chairs

A Report from the Health Chairs Project at
The National Conference of State Legislatures

March 2005

EXECUTIVE SUMMARY

Each year, before the beginning of most state legislative sessions, NCSL polls the chairs of the key health authorization committees about their priorities for the current year.  Health committee chairs play a critical role in defining their state’s health policy agenda and are integral figures in determining the content and pace of health care legislation in their state.  Overall health care costs and funding issues, especially for Medicaid, were reported as the dominant issues for legislative agendas in FY 2005, followed by access to coverage, long-term care and prescription drugs.  Other issues - such as medical malpractice, mental health and obesity - also were mentioned by several states as key legislative issues for FY 2005. 

Costs, Budgets and Funding.  The overall challenges of controlling health expenditures and funding health care services in the face of rising costs and continued budget shortfalls in many states will likely dominate the legislative health agendas for 2005. Thirty-eight (almost two-thirds) of the 60 health chairs that responded referenced cost, budgets or funding issues among their top three priorities (see table 1). Twenty-seven of the 38 said it was their number one priority (see appendix). More specifically, health chairs expressed concerns about costs related to Medicaid, prescription drugs, affordability of private health insurance, long-term care and malpractice premiums. 

Medicaid. Thirty-three chairs (slightly more than half) reported that Medicaid will be among their committee’s top three priorities—26 of the 33 chairs listed it as their top concern. More than half of the 33 chairs cited Medicaid cost or budget issues as their primary concern.  Even though the state revenue picture has stabilized in most states, Medicaid spending continues to increase faster than state revenues.  Federal Medicaid assistance percentage (FMAP) reductions and the loss of certain intergovernmental transfers (IGTs) will present particular budget challenges in many states.   Options such as increasing co-payments, reducing optional services, restricting provider payments, and controlling fraud and abuse were mentioned as ways to control Medicaid spending.  A few states also are considering eligibility reductions to control costs.  Some chairs mentioned tax changes, including increases in cigarette taxes to raise additional revenue to support Medicaid and other chairs may be interested in pursuing significant program reforms through 1115 waivers (such as in Florida).  Although most states are focusing on minimizing Medicaid reductions, a few states—such as Massachusetts and Oklahoma—are considering Medicaid expansions in FY 2005.  Access. Improving access to coverage or care was named one of the top three priorities by 27 chairs (slightly less than half of the total) and 15 of the 27 identified it as their number one priority. Strained Medicaid budgets, a soft job market and the continued decline of employer-based coverage have kept access to insurance high on state health agendas.  In addition to broad concerns about access, legislators generally focused on either insurance coverage, availability of care for the uninsured, comprehensive reforms, or affordability.  Efforts to address these concerns range from incremental reforms to plans for universal coverage.  Specifically, chairs have mentioned tax credits, health savings accounts, options to buy into to state employee coverage, premium assistance proposals, Medicaid expansions, creation of small risk pools,  and public private partnerships (such as Dirigo in Maine).  Other strategies include a focus on safety-net providers and financing.  Some states plan to address charity care costs or expand community health centers to provide additional health care access for the indigent.

Table 1.   Issues Identified Among Top Three Chairs’ Priorities for 2005  Issue Total  Costs, Budgets and Funding* 39  Medicaid 33  Access to Coverage or Care 27  Long-Term Care and Aging 22   Prescription Drugs 19  Medical Malpractice, Patient Safety, and  Medical Errors 10 Mental Health 9 Obesity 8 Other 7   *Priorities may be counted in more than one category   Source: National Conference of State Legislatures, Health Chairs Survey. January,  2005.

Long-term care and aging.  Financing, delivery and quality of long-term care services for the elderly and disabled continues to be a major priority for many health chairs.  Long-term care was mentioned as one of the top three committee priorities by 21 chairs  (although only nine of the 21 said it was their number one priority). Most of the focus here will be on striking a better balance between the provision of institutional care and home and community-based services.  However, other key concerns and challenges include nursing home quality, nursing home bankruptcies, options to expand long-term care insurance, and a shortage of health care workers in the long-term care area.  Several states have created legislative long-term care task forces to examine these issues and develop recommendations. 

Prescription drugs. Not surprisingly, prescription drugs were mentioned as a key priority by almost one-third (19) of the total responding chairs (60). However, it was the top priority for only three of the 19. Most of these chairs are concerned about the increased costs of prescription drugs, especially under Medicaid, and about implementation issues related to Part D of the new Medicare Modernization Act.

As they prepare for implementation of the Part D prescription drug benefit, states face  fiscal challenges related to the “clawback”—the amount each state is required to pay toward the cost of the Medicare drug benefit for dual eligibles.  Most states believe their clawback payments will exceed the amount they would have paid for drug coverage for duals through Medicaid. They also face administrative and consumer education challenges.  Among the most important tasks are ensuring a smooth transition to the new Part D benefit for those who are eligible for both Medicaid and Medicare.  Due to the significant differences between the Medicaid drug benefit and the Part D benefit, states will debate whether to supplement the Medicare benefit coverage and what shape any supplementation will take. The Medicaid prescription drug program and State Pharmaceutical Assistance Programs will change dramatically when the Medicare Part D drug benefit begins in 2006. States are seeking to shape that change during their 2005 legislative sessions.  In particular, as Medicare Part D becomes the primary payer for prescription drugs for the elderly and most people with disabilities, states face a host of challenges as they help people make the transition to Medicare from Medicaid or from state pharmaceutical assistance coverage.  The state also will face decisions about whether and for whom to fill in coverage or payment gaps left by the Medicare program.

In addition, several chairs want to extend pharmacy discounts to younger people who lack prescription drug coverage and to whom such coverage previously has not been available. 

Medical malpractice concerns—as well as medical errors and patient safety—were key priorities for 10 of the health chairs.  The availability and affordability of medical malpractice insurance continues to be of concern to health chairs.  Efforts such as malpractice or tort reform and medical review panels are likely to surface on the legislative agendas of several states in 2005. 

Mental health is a key priority concern for nine of the 60 chairs who responded to the survey.   Almost one in five adults and children suffer from a mental disorder or serious emotional disturbance.  However, the majority of people who need mental health services do not receive treatment.  Cost and access to services remain important issues in many states, especially in light of recent budget cuts to health programs.  Many survey responses focused on creative solutions states are developing to provide mental health services with fewer resources—such as expanding community-based programs, investing in evidence-based programs and restructuring financing mechanisms—to increase cost-effectiveness and encourage interagency collaboration.

The biggest change this year is the emergence of obesity as a priority for a significant minority of reporting chairs. Eight of the 60 chairs reported it as a key committee priority; two of the eight listed it as their top priority.  Obesity in the U.S. population has been increasing steadily during the past decade. Almost one in three U.S. adults is considered obese, based on objectively measured weight. Obesity is linked to higher health care costs than smoking or drinking, and it plays a major role in disability at all ages.  Some chairs mentioned a push for healthier foods in schools and requiring physical education in schools as options to help address childhood obesity.

Methodology

Early in January 2005, NCSL’s Health Chairs Project* sent a one-page, open-ended questionnaire to the 110-plus health committee chairs in the 50 states, the District of Columbia and the U.S. territories. (Several legislative chambers have more than one committee with jurisdiction over health legislation.) We asked each chair to identify (and elaborate on) the top three health priorities likely to be addressed by their committee in 2005. Moreover, each chair was asked to provide some detail about the kinds of options or solutions their committee will likely consider when addressing its top priority.  A summary of priority rankings by state is included as appendix A.

Sixty committee chairs, representing a total of 41 states and one territory, responded (see appendix B). Responses came from chairs in both chambers of the legislature in 14 states. In 27 states, only one chair responded to the survey. In a few instances, information was derived through a conversation with a chair either by phone or at a recent meeting of state legislators. The political breakdown of the responding chairs was almost exactly even: 30 Republican, 28 Democrat, one non partisan (Nebraska) and one independent (Virgin Islands).

*The Health Chairs Project is funded under a contract from The Henry J. Kaiser Family Foundation.

FINDINGS AND ANALYSIS

Costs, Budgets and Financing

KEY FINDINGS: Controlling health care expenditures, especially for Medicaid, and maintaining adequate funding for essential health care programs in the face of rising costs and ongoing budget constraints will be the greatest challenge for most legislatures in 2005.

In the face of tightening budgets, the rising cost of health care continues to be of great concern to state health policymakers.  Thirty-nine of sixty chairs—almost two-thirds of the total who responded to the survey—placed health care cost, budget or financing issues among their top three committee priorities for the current legislative session. For 27 of the 39 chairs, it was their top concern.

In 2005, for the third year in a row, the challenge of paying for health care—especially Medicaid—in the face of rising costs and budget deficits will likely dominate legislative health agendas. (Twenty-two chairs representing 18 states identified Medicaid funding, costs or budget issues among their top three priorities; 16 of the 22 said it was their top priority.) Senator Compton in Idaho spoke for many of his colleagues when he singled out “addressing the steep increase in Medicaid needs” as his committee’s number one concern. He explained that “ … as with most states the numbers of people requesting assistance and the aggregate costs for that assistance have risen steeply in the past few years. Our state, like most others, has had a shortfall in receipts and an increase in expenses. Trying to stretch our budget to address all the needs of our constituency will be a challenge.”

Concern about health care costs for private payers is down slightly from last year’s survey. Ten chairs from nine states mentioned it as one of their three main priorities; it was the top priority issues for five chairs. Senator Carol Roessler of Wisconsin expressed very well the mood of her colleagues who share her concern: “Health care costs are soaring. This is impacting employers’ ability to provide coverage and individuals’ ability to pay premiums on their policies.” A related concern, the cost of care for the indigent and uninsured populations, was listed as one of the top three priorities by five other chairs.

Five chairs, again fewer than last year, singled out costs and funding issues for long-term care and nursing homes as one of their key concerns. Seven chairs pointed to  prescription drug costs as a major focus, although it was the number one priority for only one. Medical malpractice premium increases were mentioned as a major priority by only two chairs.

Medicaid

KEY FINDINGS: Cost increases and budget shortfalls continue to plague many state Medicaid programs, but fewer states than last year are considering options to reduce eligibility or reimbursement or to limit services. Many chairs reported strategies designed to at least maintain, if not expand, current Medicaid coverage by slowing program growth through encouraging appropriate use of services and other program efficiencies. A few chairs are interested in significant Medicaid reform.

The Impetus for Reform

Because revenue streams are growing at a slower rate than medical inflation and more people are becoming eligible for Medicaid, many states are grappling with shortfalls.  At the same time, other states are looking to expand recipient pools.  The top-to-bottom review of the Medicaid system is likely to be high on state agendas for the 2005 session, with some seeking to make profound changes.

All told, 33 chairs identified Medicaid as a priority, and 27 indicated Medicaid activity is their highest priority.  When discussing Medicaid, chairs cited the challenge of reconciling increased service needs with revenues that are growing more slowly. National data show Medicaid spending increases of approximately 10 percent annually in recent years.  Even though the state revenue picture is stabilizing in most states, average annual increases are increasing  FMAP reductions, which will present particular budget challenges in some states; in others, the loss of certain intergovernmental transfers will be problematic. In the face of these challenges, chairs expressed a commitment to maintaining Medicaid eligibility for those who now are on the rolls.  Some states said that certain Medicaid benefits may need to be trimmed or that those with higher incomes may be asked to share some of the costs. Others expressed a commitment to finding additional funds to extend Medicaid coverage to more people. 

 Deeming the growth in Medicaid “non-sustainable,” Representative Peter Batula of New Hampshire called for reform: “Without an income or sales tax, we must … find upwards of $500 million just to stay on a level program field.” A few other chairs reported daunting shortfalls in Medicaid by 2015:  $1.5 billion in Pennsylvania, $250 million in Wisconsin and $50.4 billion in Florida. “Trying to slow our budget for Medicaid” is a key priority for Senator Jim Jensen of Nebraska. The “rate of increase of [Medicaid] costs [is] staggering,” commented Wyoming House committee chair Doug Osborn. Hence, Medicaid will be among his committee’s top three priorities.

“Medicaid is a big issue this year,” declared Florida House Elder and Long-Term Care Committee chair Representative Hugh Gibson III. The program “ … affects every area of heath care from youth to seniors.” He said his committee will closely scrutinize efforts to reel in Medicaid fraud and abuse. Representative Holly Benson, who chairs the Health and Family Council which has overlapping jurisdiction for Medicaid, agrees with her colleague. Medicaid reform is also at the top of her list. “Medicaid spending has grown by 62 percent over the last five years and will reach $50.4 billion by 2015. Budget pressures plus a term-limited governor are forcing the issue.” Both committees are expected to give a lot of attention to the governor’s Medicaid reform plan. (Under the proposed plan, Medicaid participants are expected to make choices about the benefits they receive and who provides those benefits. Health care providers will create benefit packages that will fall into a combination of three components: basic care, catastrophic care and flexible spending. Participants—with the help of choice counselors—will choose the plan that best meets their needs. Medicaid beneficiaries will be entitled to a “premium” amount that they would use to purchase a set of benefits of their choosing from a plan of their choice.)

Federal and State Funding

The high percentage of elderly on the rolls, high medical costs—particularly drugs—for the disabled, and the reduction in the state’s FMAP combine to make Medicaid reform the number one priority for North Dakota House committee chair Representative Clara Sue Price. Her committee intends to look at a comprehensive set of recommendations (“A Ten Point Plan”) for reforming the state’s Medicaid system. Alaska Senate committee chair Fred Dyson says that addressing a reduction in his state’s Federal Medical Assistance Percentage will be a key focus of his committee this year.

Kentucky House committee chair Tom Burch reported “ … continued funding of Medicaid to sustain current coverage” to be his committee’s top agenda item. According to the chairman, Kentucky has “ … a population more sick than the national average and a poorer citizenry, and Medicaid is facing a shortfall of $750 million to $1billion for FY 2006.” He and his committee will be looking at tax modernization to provide long-term funding solutions. They also plan to consider expanding the cigarette tax, and taxes on slot machines and casino gambling.

Oklahoma House committee chair Representative Thad Balkman indicated his committee’s biggest issue will be to deal with the reduction of state FMAP from 70.18 percent in FY 2005 to 67.91 percent in FY 2006. This will “ … impact Oklahoma by more than $63 million in FY 2006.”  He said his committee will “ … try to find sufficient cost savings and efficiencies in other areas of state government to fund this deficit.”

Several chairs pointed to the loss of intergovernmental transfers (IGTs) for FY 2006 and  budget shortfalls as major problems facing their committees and legislature. Representative Christine Kauffmann of Montana says her chamber will consider the effects of proposed federal Medicaid changes.  She says some of the proposals for administrative reform, including restrictions on allowable uses of Medicaid funds received as part of an intergovernmental transfer (IGT), " … have caused great concern for county governments in Montana and may dissuade counties from participating in IGTs.”  Representative Kauffman notes that, in Montana, " … many small county-administered nursing homes depend on the IGT and changes in it could create a significant hardship."  She also is concerned about proposals to cap federal Medicaid administrative funds or federal Medicaid funds for services. "It is highly unlikely that state funding would be increased to cover significant federal funding reductions," she says.   

Senator Maggie Tinsman of Iowa said that a no new tax sentiment is still quite strong, so they are hoping for an infusion of dollars from increased cigarette tax revenue to help address any budgetary shortfalls.  An aging population with high poverty levels is a key reason West Virginia Senate committee chair Prezioso identified “Medicaid Funding” as his top issue. To address the funding challenge, his committee will look to strategies for leveraging state funds to maximize federal participation and funneling existing funds to areas where the highest “at risk” populations’ needs are met first.

Balancing Cost Cutting with Increased Need

“Addressing the steep increase in Medicaid needs” is Idaho Senate committee chair Dick Compton’s top priority.  According to Compton, “ … the numbers of people requesting assistance and the aggregate costs for that assistance have risen steeply in the past few years.” Idaho, “ … like most others has had a shortfall in receipts and an increase in expenses. Trying to stretch our budget to address all the needs of our constituency will be a challenge.” The chairman said his committee will consider copayments for some Medicaid services to encourage enrollees to visit their primary health care provider instead of more expensive emergency rooms or urgent care centers; and enhanced use of mental health courts to help keep some Medicaid patients out of the correctional system and institutional settings.

Indiana Senate chair Patricia Miller listed Medicaid budget and health care costs as her committee’s top two issues. Her committee will be looking at such options as reducing optional services and provider payments and controlling fraud and abuse.

“Finding reasonable budget balancing solutions in the face of a variety of proposed cuts by the governor” will be the number one priority of Maine’s House committee, according to its chairperson, Representative Hannah Pingree.  “Medicaid savings and Medicaid redesign” top  the list of her counterpart, Senator Arthur Mayo, as well. Pingree singled out as particularly significant proposed cuts by the governor in mental health and mental retardation and reductions in benefits for one of the key Medicaid waiver programs. Mayo referred to cost overruns “plaguing the program” and the pressures from the provider lobby about “underpayment.”

In Oregon, both committee chairs, Senator Morisette and Representative Dalto, agreed they will be dealing with proposed restrictions in both eligibility and services for the Oregon Health Plan. Preserving the current level of benefits under the program, according to Senator Morisette, may be impossible, given the state’s $800 million shortfall and federal funding cuts. Representative Dalto indicated  his committee will “review benefits” under the Oregon Health Plan.

Pennsylvania may be forced to consider both program cuts and reductions, given the state’s $1.5 billion budgetary shortfall—due primarily to escalating Medicaid costs—said Senate committee chair Jake Corman. His committee will be “ … looking at reductions in benefits and services; reimbursement reductions; revenue enhancements; and program efficiencies.” He continued, “[We] need to address health care costs by addressing behavioral causes—[emphasizing] prevention and wellness.”

Both Wisconsin committee chairs, Senator Carol Roessler and Representative Curt Gielow, will be dealing with Medicaid cost escalations, shortfalls and reform. According to Senator Roessler, “The state is facing a $230 million Medicaid deficit. There is a strong need to explore [how] the state can reform the Medicaid program without compromising services, but yet, in a way that reduces cost.” Representative Gielow chairs a Special Committee on Medicaid Reform that will “review programs in detail and seek innovative options.”

Avoiding Cuts, Seeking Expansions

“Medicaid” is at the top of the priority list for Senator Dede Feldman’s committee in New Mexico. “We underfunded [Medicaid] by $40 million last year; Medicaid reforms are just kicking in and we’re about $13 million short this year. We have a three to one match, [so] any federal cutbacks will have serious effects.”  Moreover, she added that the dual-eligibles will have fewer benefits and more cost sharing in 2006.

Assemblyman Richard Gottfried, chair of New York’s Assembly Health Committee, declared “defeating governor’s cuts” on Medicaid as his top priority. In his view, “Major Medicaid cuts would undermine the health care system and hurt recipients.” At the same time, there are increased pressures “ … from counties and New York City to have the state pick up the ‘local share’ of Medicaid cost the state requires them to pay.” He expressed hope of finding revenue—especially from upper income brackets—to avoid the cuts.

Gottfried’s counterpart, Senator Kemp Hannon, listed “Medicaid expenditures” as his top priority. He, too, is concerned about the pressing burden of Medicaid on localities, and his committee will examine options for a state takeover of the local share of Medicaid, which, according to Senator Hannon, will “present new fiscal challenges to the state.”

Massachusetts Senate Committee Chair Richard Moore indicated his committee will be looking to expand Medicaid eligibility as part of a more general effort to reduce the level of uninsured in his state. Oklahoma Senate Chair Bernest Cain hopes to expand Medicaid though efforts to encourage small businesses to cover low-income employees.

Access to Care and Coverage

KEY FINDING: The continuing decline of employer-based coverage is motivating efforts by many chairs to consider reforming  or restructuring the private marketplace to make health insurance more available and affordable, particularly for small businesses and individuals.

Strained Medicaid budgets, a soft job market and the continued decline of employer-based coverage have kept access to insurance high on state health agendas.  Access—availability and affordability of care and coverage—was listed as a high  priority by chairs from more than half the states  that responded (27 chairs in 23 states) and as the top priority by 15 chairs in 14 states.  In addition to broad concerns about access, legislators generally focused on either insurance coverage (14 chairs in 13 states, first in nine), availability of care for the uninsured (nine chairs and states, top priority for seven in seven), comprehensive reforms (eight chairs in six states, top priority for three), or affordability (10 chairs in nine states, top for five in four).   Table 1 below lists the states where chairs cited access, coverage or affordability (other than for the public programs Medicaid and SCHIP) as a top priority.

More than half the chairs with access priorities focused on making coverage available or keeping it affordable for small businesses, individuals or other specific groups.  Among the strategies to stem the erosion of coverage for individuals and small groups were health savings accounts (Alaska, Kansas, Michigan, Minnesota), consumer-driven purchasing (Ohio, Wisconsin), risk pools (Montana, Wisconsin), tax credits (Wisconsin, New Mexico), an individual health market (New Jersey), and buy-in to public employee groups (New Mexico, Washington).

A majority of  the people who are struggling to find and keep coverage are working poor, with incomes below 200 percent of the federal poverty level.  States can smooth the transition from public coverage to private insurance with premium assistance programs (Connecticut, Kansas, Oklahoma) and Medicaid expansions that blend public and private funding streams.  Some legislators are considering comprehensive programs or universal coverage or are working on incremental steps toward sweeping objectives.  For example, Maine will continue to revise Dirigo Health, and legislators in Hawaii, Massachusetts, New Mexico and New York mentioned the possibility that their committees would deal with far-reaching or multi-faceted coverage proposals. 

For the indigent uninsured, chairs in nine states (top priority for seven chairs in seven states) are concerned about access to care as well as coverage.  Approaches include increasing the availability of safety net providers (Maryland), improving safety net finances to avoid cost shifting (Montana), and reducing the state’s reliance on charity care (New Jersey).  Access to specialists is of particular concern; this may be improved through contracts (Maryland) or information technology to extend the reach of specialists (Texas).

Legislators are quick to point out the tie between rising costs and lost coverage and look for ways to truly lower costs, recognizing that uncompensated care for the uninsured or artificially low prices will simply be shifted to other payers.  Affordability frequently was cited, together with access concerns. Chairs in Minnesota and Utah pointed out that inflation was eroding coverage, while a Florida chair made the complementary point: Rising numbers of uninsured drove costs throughout the system.

Private Insurance Coverage

Small businesses and individuals seeking coverage alone face volatile and unaffordable prices or plans with such high cost-sharing that they offer little protection. Small businesses, lacking the market clout of large employers, may not be able to participate in cost-trimming measures—disease management and health savings accounts—that are being marketed to large plans.  Legislators who are looking for ways to improve access are considering encouraging health savings accounts (HSAs), creating new pools, or opening publicly funded groups such as state employee health plans or Medicaid to uninsured individuals.

Alaska Senator Fred Dyson also registered strong interest in promoting “consumer driven” health financing options such as personal care accounts (PCAs), which are funded by larger firms, and HSAs, which belong to individuals.  The problem of health care costs and small businesses will be a major agenda item for the Michigan Senate Health Committee, according to committee chair Beverly Hammerstrom. One proposed solution her committee will be looking at in depth is HSAs.

A similar concern is held by the two health chairs in the Kansas legislature. In the House, Representative James Morrison listed “health accessibility, affordability and availability” as his committee’s chief priority. His Senate counterpart, committee chair Senator Jim Barnett, highlighted the stress on small business caused by the steep rise in the cost of health insurance premiums. He sees these costs as a major contributor to the state’s uninsured population 11 percent and includes encouraging HSAs as a response.

Montana Representative Christine Kaufman placed concerns for the  uninsured—now 19 percent to 20 percent of the state’s population—and expansion of health care coverage at the top of her committee’s agenda for 2005.  Premium increases are making insurance unaffordable for employers, who are dropping dependent coverage or increasing cost sharing to the point that individuals cannot maintain it.  Rising premiums also are forcing people out of the state’s high-risk pool.  A successful 2004 tobacco tax initiative included a provision for tax rebates for small employers who provide insurance, and the Legislature will consider bills to implement this program.

Washington House committee chair Representative Eileen Cody singled out the problems of increased costs in the individual and small group health insurance markets. Her committee will entertain legislation to permit individuals and small groups to buy into the state employee benefit plan.

New Oklahoma House committee chair Representative Thad Balkman reports that more than 700,000 Oklahomans have no form of health insurance. Moreover, approximately 106,000 of uninsured Oklahomans earn less than 185 percent of the federal poverty level and work for small businesses. His committee will consider legislation to create a premium assistance program to provide health insurance for small businesses and employers. 

Expanding the availability and affordability of health insurance for small business also is the top priority of Connecticut Senate chair Senator Chris Murphy. He asserts that the cost and lack of affordability of health insurance is the number one concern of the business community. Ten percent of Connecticut residents lack health insurance coverage, according to the chairman. He expects his committee to examine a new premium assistance program for small businesses, plus legislation that would allow individuals to buy into the Medicaid program.    

Expanding Access

In Maine, the joint health committee will devote considerable attention to working out several details of the state’s Dirigo Health initiative. (Dirigo Health was enacted in June 2003 with the overarching goal of achieving universal coverage for all Maine residents by 2009. It was enacted to address the problems of the uninsured, with a major focus on restructuring the expensive and ineffective small health insurance market in the state. An important component is a public-private partnership designed to help Maine’s small businesses offer coverage to their employees.  It also will cover the self-employed and individuals in the group product.) According to House committee chair Representative Hannah Pingree, “There are some ‘kinks’ that need to be worked out, including the affordability and the marketing of the plan. But also many of the other components, such as the hospital commission and the state health plan, [are] scheduled to come back to us.”

Illinois House committee chair Representative Mary Flowers echoed that the cost of health-care coverage is her main concern.  She said that her committee will be considering legislation similar to Maine’s Dirigo initiative.  Representative Flowers created a special subcommittee, Health Illinois, to work on the issue and to draft legislation.

Hawaii House committee chair Representative Dennis Arakaki registered concern about the rapidly growing rate of uninsured in his state and the increasing cost of providing health insurance; he listed “universal health” among his top priorities. His counterpart, Senator Roz Baker, pointed out that, despite the fact that the state has an employer mandate, 10 percent of the population remains without health insurance. In addition to financing, however, she said that a large part of the access problem in her state is workforce related, i.e., shortage of key providers, especially in rural areas.

Senator Richard Moore, who chairs the health committee in the Massachusetts Senate, said that expanding access to care and reducing the number of uninsured (currently at 7 percent in the state) are priorities for his committee and the governor. However, “ … the governor wants to eliminate [the uninsured] without increasing cost, [which is] not realistic [given] concern about raising taxes.” The Senate committee will address a number of possible solutions, including expanding Medicaid eligibility, subsidizing employer and employee insurance costs, and/or mandating that most businesses pay into a fund if they do not provide insurance.

In New Mexico, Senate health committee chair Senator Dede Feldman reports that her committee will examine recommendations for incremental expansions from the governor’s task force on uninsured. Some of the alternatives that will likely be proposed are offering tax credits to encourage employers to purchase health insurance; permitting non-profit groups and small businesses to buy into the state employee health plan; and allowing 20-year-olds who are not students to join their parent’s plan until they reach age 25.

Finally, concerns about the uninsured also extend to some of the U.S. territories. Senator Usie Richards, who chairs the health committee in the Virgin Islands Legislature, listed “reimbursement for the uninsured and under-insured” as his committee’s key issue. The majority of private sector employees have limited or no health insurance due to the seasonal employment of the tourism industry, he noted. The committee will examine legislation to provide incentives for health insurance carriers to underwrite policies for the private sector.

Care for the Uninsured

Access for the uninsured is clearly the number one priority for Maryland House committee chair Delegate John Hurson. “We’ve sat here for years not addressing the uninsured,” Hurson said. (About 700,000 Maryland residents, 15 percent of the population, lack health insurance coverage.) Through his committee, the chairman will push for the creation of more community health centers in Maryland to provide primary care for the uninsured and for payments to certain specialists to care for the uninsured in clinics. Funding is expected to come from the state’s tobacco settlement and from a mandated contribution from CareFirst Blue Cross Blue Shield. If those sources prove inadequate, an assessment on hospitals might be forthcoming.

“Delivering and maintaining access to medical services” across a sparsely populated state is a challenge in Montana as well, according to House committee chair Representative Christine Kaufman, who cited maintaining quality and access for public health programs as her committee’s second priority.  “Making sure the public system is adequately funded to maintain access and quality helps ensure that all Montanans have access to health care, and it also helps limit cost shifting from the public sector to private health-care payers,” she said.  Medicaid pays for more than 40 percent of all births in Montana, even though Montana Medicaid eligibility is near federal minimums. “Public health care is a vitally important component of the entire state health care system.” 

“The uninsured” is this year’s top committee priority, according to New Jersey committee chair Senator Joseph Vitale, although how best to move from a system that emphasizes access of care to greater coverage remains unclear.   “Charity care costs are rising exponentially and we need to reduce dependence. [We] need to maximize federal dollars to pay for care to the uninsured population,” by expanding coverage in public programs.  Assembly committee chair Assemblywoman Loretta Weinberg agrees with her counterpart, listing “growing uninsured” as her committee’s top issue. The committee will hold hearings on the problem of the uninsured and will consider expanding family care and reassessing the individual health insurance market.

“Texas has a growing indigent population, putting a financial drain on counties and public hospitals,” declared Representative Jodie Laubenberg, who chairs the House Health Committee. Hence, her committee’s main concern will be the provision of quality indigent health care to those most in need, but “always within budget constraints.” She expressed optimism about the possibilities of “telemedicine” for providing health care in areas where specialty care is limited and to populations that may not otherwise have access.

Containing Costs

Cost containment is integrated with many of the access proposals and also received some attention on its own.   “Health insurance costs” is a major worry of Wyoming Senate committee chair Senator Charles Scott. “The average person is having increasing difficulty affording costs. Multiple approaches to the problem include [decreasing] prescription drug costs, dealing with cost shifting and malpractice reform.”

Representative Fran Bradley, who chairs a health committee in the Minnesota House, talks about how “ … double digit health care inflation [is] eroding affordability, diminishing access and putting pressure on public programs.” This is why health care cost containment in the private market and reducing inflation in the state’s Health and Human Services budget are his two main priorities. He listed a number of options that will command the committee’s attention this year, including health savings account tax compliance; a $1 increase in the cigarette tax; more emphasis on evidence-based medicine and disease management; greater cost transparency, especially for prescription drugs; and medical malpractice reforms.

Senator Allen Christensen and Representative Brad Last  of Utah, concerned about the cost effect of a single chain’s market dominance, hope to reduce costs by increasing competition among providers.  They propose “any willing provider” legislation as a way to address problems of “availability, access and cost.”

Everything old is new again, as illustrated by a cost containment strategy reminiscent of the origins of managed care early in the last century.  The Wisconsin Senate Health Committee will likely consider major incentives for businesses to provide preventive care in-house, e.g., on-site nurses.

Coverage and cost are particularly closely twined for the uninsured.  In Florida, House committee chair Representative Holly Benson listed the “uninsured” as her committee’s number two priority. “The uninsured continue to drive all other costs, and we continue to look for ways to ease that pressure.”   Assemblywoman Sheila Leslie of Nevada cites  “access to health care” and breaks it down to “hospital cost containment and health insurance.” Idaho Senate committee chair Senator Dick Compton singled out “health insurance and managed care availability and affordability” as his committee’s third highest concern.  He went on to add: “Rising health insurance costs are not unique to our state and will have to be addressed at the federal level.”

Long-Term Care and Aging

KEY FINDINGS: Financing, delivery and quality of long-term care services for the elderly and disabled continues to be a major priority for many health chairs. Most of the attention in 2005 will be on making home and community-based services more available.

The financing, delivery and quality of long-term care services for the elderly and disabled populations were identified as important priorities by 21 chairs from 16 states.  States are actively rebalancing their delivery systems so that consumers of all ages with disabilities can receive more services in their homes and communities.  At the same time, health leaders are committed to maintaining high-quality institutions that meet the needs of their increasingly frail residents. With public resources for long-term care services in short supply, states are seeking to bring more private resources into the financing arena through promotion of long-term care insurance.

In Hawaii, long-term care reform is the number one priority of the chairs of both the House and the Senate health committees. House chair Representative Dennis Arakaki is concerned that, although Hawaii continues to have one of the highest life expectancies in the nation, the provision of in-home family caregiving is on the decline and the cost of nursing home care is “breaking the budget.” His counterpart, Senator Roz Baker, said,  “Hawaii lacks sufficient long-term care infrastructure (beds, options, caregivers, funding) for a population that is aging three times faster than the national average.  Most want to age in place and not go to an institution.”  Her committee will examine a comprehensive range of strategies, including tax credits for long-term care insurance; a managed care waiver for the aged, blind and disabled population under Medicaid; regulation of assisted living; tax credits for family caregivers; and revamping existing legislation to promote more home and community-based services.

Senator Elizabeth Roberts of Rhode Island noted that, “ … the recent failures of nursing facilities have shed light on needed improvements in state regulatory capacity and tools.” Senator Roberts says Rhode Island is “ … looking for assistance from NCSL to identify some solutions that are working in other states.” Her counterpart in the House, Representative Joseph McNamara, identified “nursing home oversight” as his committee’s number one priority. His committee will be developing legislation to implement more than 40 recommendations for improving nursing home quality and state oversight. These recommendations come from a report issued in November 2004 by the Nursing Facility Closure Task Force of the Long-Term Care Coordinating Council, which was  convened by the lieutenant governor following the closure and bankruptcy of a substandard nursing home in the state. Recommendations under consideration include requiring nursing homes to submit annual financial statements sufficient to determine their financial condition so the state can review them and flag financially rocky nursing homes; requiring nursing homes to advise the state of any significant downturn in their financial condition; requiring notification of families and residents anytime there is a finding of immediate jeopardy of residents’ health and safety, substandard quality of care or a finding of actual harm; and encouraging nursing homes to establish independent family councils that would be allowed to advocate on behalf of patients.

Arizona Senate committee chair Senator Carolyn Allen expects her committee to examine the implications and costs of closing long-term care facilities in her state.  Similarly, Senate committee chair Senator Chris Murphy of Connecticut is concerned that dozens of nursing homes in his state are going bankrupt. He indicated that the state may be forced to employ a provider fee to help attract additional revenue.

In Colorado, House committee chair Representative Betty Boyd is interested in long-term care reform. She believes that a “change in culture” is needed, with much greater attention given to the role of the consumer/resident.

Florida House committee chair Representative Hugh Gibson also is concerned about consumers’ needs.  His number one priority will be to address the needs of Floridians with long-term disabilities who are in need of care, with special attention given to strategies that will enable them to remain in their homes, thereby reducing or forestalling the need for institutional care.

Two chairs in Iowa (Senator Maggie Tinsman and Representative Linda Upmeyer) are of equal minds in wanting to see their state’s long-term care system restructured to become a system of long-term living. Such a system would be characterized in part by an expansion in choices for care and services for the elderly and disabled. A legislative task force is charged with addressing long-term living and is at work to develop a uniform assessment tool that will help steer more funds toward home and community-based services. Other options that will be examined include expanding care management in the communities, consolidating all state senior services into a single department, and promoting long-term living insurance.

Developing a home and community-based system plan for long-term care for “baby boomers” is a major agenda item for Senator Jim Jensen, Nebraska’s Health committee chair. Senator Beverly Hammerstrom of Michigan also listed long-term care reform among her committee’s priorities. The committee is expected to deal with proposed legislation and recommendations emanating from a soon-to-be released report by the state’s Long-Term Care Task Force.

Costs figure significantly in at least three states’ priorities.  In New Hampshire, a large part of the House committee’s efforts to reform Medicaid will focus on the cost of long-term care, says committee chair Representative Peter Batula. His committee will consider a number of options, including reducing the number of nursing home beds in the state by 30 percent during the next few years and promoting more options for home and community-based services. It also will consider strategies to train welfare recipients to help fill the growing shortage of health care workers, including workers in the long-term care arena.

In Oregon, a major concern will be maintaining funding for the state’s Project Independence —a state-only financed program designed to keep elderly residents in their homes, said Senate committee chair Senator William Morrisette. The program recently has been targeted for severe cuts.

Long-term care is New York Senate committee chair Senator Kemp Hannon’s number two priority. He is concerned with “the over reliance on government, through Medicaid, to finance long-term care” and therefore will be looking at the promotion of long-term care insurance and other products.

Of note, Massachusetts has established a substantially new and different committee structure for 2005. The old “Joint Committee on Health Care” has been replaced by four committees, one of which is a Committee on Elder Affairs. The new committee will address the needs and interests of senior citizens in the state that cut across an array of subjects, from health care to regulatory licensing.  The co-chairs are Senator Susan Tucker and Representative Robert Correia.

Prescription Drugs

KEY FINDINGS: Many chairs expect significant challenges in helping people who are dually eligible for Medicare and Medicaid make the transition from Medicaid prescription drug coverage to Medicare coverage.

Keeping prescription drugs affordable and accessible and implementing the new Medicare drug benefit are important in 2005.  Nineteen health chairs expect prescription drugs to be a key area of attention in this legislative session.  States face a set of fiscal, administrative and consumer education challenges as they prepare for implementation of the Medicare Part D prescription drug benefit.  Among the most important tasks are ensuring a smooth transition to the new Part D benefit for those who are eligible for both Medicaid and Medicare.  Due to the significant differences between the Medicaid drug benefit and the Part D benefit, states will debate whether to supplement the Medicare benefit coverage and what shape any supplementation will take. Several chairs want to extend discounts to younger people who lack prescription drug coverage and to whom such coverage has previously not been available. 

The Medicaid prescription drug program and state pharmaceutical assistance programs will change dramatically when the Medicare Part D drug benefit begins in 2006. States are seeking to shape that change during their 2005 legislative sessions.  In particular, as Medicare Part D becomes the primary payer for prescription drugs for the elderly and most people with disabilities, states face a host of challenges as they help people make the transition to Medicare from Medicaid or from state pharmaceutical assistance coverage.  States also will face decisions about whether and for whom to fill in coverage or payment gaps left by the Medicare program.

Representative Hannah Pingree of Maine wants to focus on “ … how the state can continue to facilitate access to prescription drugs and deal with the Medicare benefit.”

Representative Linda Upmeyer of Iowa expects to give priority to prudent planning for helping eligible people make the transition to the Medicare benefit.  She wants the state to be ready to deal with conflicts between the drugs covered in Part D drug plan formularies and those now available to individuals with state coverage. Along the same lines, Senator George Vitale of New Jersey wants to ensure the “best transition possible” for those who are moving from Medicaid or the state pharmaceutical assistance programs.  Likewise, Senator Dede Feldman of New Mexico expects her chamber to take up prescription drug issues to respond to concerns  that “dual eligibles will have fewer benefits and more cost sharing” after they move to Medicare Part D.

Representative Christine Kaufmann of Montana sees her state as similar to others in planning for the significant changes that are taking place due to the Medicare Modernization Act.  “While provision of a prescription drug benefit for Medicare beneficiaries is very valuable,” she said, “the unknowns associated with implementation of the benefit are daunting.”  She cited significant new workloads, administrative burdens, and the cost of the required state “clawback” payment as challenges.  Also, she said, “ … the human cost could be significant if people do not enroll in a drug  plan or if a plan formulary changes to exclude drugs that a person needs.”

Senator Kemp Hannon of New York sounded a similar theme, since he is concerned about  coordinating the new Medicare Part D program with the state’s existing EPIC (Elderly Pharmaceutical Insurance Coverage) program. According to the senator, the state’s EPIC program “ … has provided significant pharmaceutical coverage for low-income-seniors; however, many fear the complexities and the costs associated with the new Medicare Part D program. Coordinating EPIC to work with the new Medicare program in a way that provides cost savings to the state and reassurances … to seniors will be a challenge.”

A number of state leaders are seeking a solution for  people who have no drug coverage. According to Representative Jay Bradford, reducing costs for those with no coverage remains a major issue in Arkansas. He would like to enact a discount program for people who have no insurance coverage modeled on Maine’s rebate–driven program. Assemblyman Richard Gottfried of New York has similar interests. “We need a prescription drug discount plan for people with no coverage,” he said. Senator Betty Boyd of Colorado said that the Medicaid agency should develop a preferred drug list and join a multi-state state purchasing pool in order to continue to obtain good prescription drug prices for its remaining Medicaid beneficiaries after Medicare beneficiaries are no longer part of the program. In a similar vein, Assemblyman Gottfried of New York noted that his state should “have a preferred drug list (PDL)” in Medicaid, and Senator Feldman expects to give attention to “PDL implementation.”

Legislators in many states—including Arkansas, Florida, Kansas, New York and West Virginia—see a myriad of other important issues with prescription drugs in 2005. Representative Eileen Cody of Washington aims to focus on “decreasing costs of pharmaceuticals.”  In Maine, Representative Pingree sees 2005 as “including some serious decision about the future of our drug programs” and requiring attention to access in rural areas where pharmacies are leaving the business.  Appropriate regulation of pharmaceutical benefits managers (PBMs) is an issue of interest in New Mexico.

 

Medical Malpractice/Patient Safety and Medical Errors

KEY FINDINGS: The medical malpractice “crisis” remains real and unresolved for at least 10 states. Chairs are beginning to examine strategies for improving patient safety and reducing medical errors.

The availability and affordability of medical malpractice insurance continues to be of concern to health chairs. Issues of patient safety and medical errors also are becoming more important for a few chairs. Ten chairs from nine states identified either malpractice and/or patient safety as top priorities for 2005.

Representative Peter Batula of New Hampshire seeks to “reduce medical errors.”  In Illinois, Representative Mary Flowers will focus on “reporting and discipline.”  Both Health Committee chairs in Wyoming, Senator Charles Scott and Representative Doug Osborn, agreed that malpractice or tort reform will be major issues for their committees this year.  According to Representative Osborn, Wyoming voters last year rejected caps on non-economic damages but approved the creation of a medical review panel.  The task now is to define the scope and responsibilities of the review panel. Osborn’s counterpart in the Senate, Charles Scott, believes that malpractice reforms are essential to check and turn around the growing shortage of doctors in Wyoming. His committee plans to “put some teeth” into the new review panel and also to create a long-term Medical Errors Commission as “ … an exclusive remedy replacement for the tort liability system.”

Other chairs that mentioned malpractice reform as high on their agendas include Senator Carolyn Allen of Arizona; Representative Peggy Sayers of Connecticut; Senator Don Thomas, M.D. of Georgia; Senator Richard Moore of Massachusetts; Representative Wayne Cooper, M.D. of Missouri; Senator Jake Corman of Pennsylvania; and Representative Fran Bradley of Minnesota.

Mental Health

KEY FINDING: Access to and cost of mental health services will be major agenda items in about one-fourth of the states.

Almost one in five adults and children suffer from a mental disorder or serious emotional disturbance, respectively.  However, the majority of people who need mental health services do not receive treatment.  Cost and access to services remain important issues in many states, especially in light of recent budget cuts to health programs. 

Nine chairs from nine different states listed mental health issues among their top priorities. Many survey responses focused on creative solutions states are developing to provide mental health services with fewer resources, such as expanding community-based programs, investing in evidence-based programs, and restructuring financing mechanisms to increase cost-effectiveness and encourage interagency collaboration.

A number of states plan to develop community-based care.  Representative Billy Dalto commented that, in Oregon, there is “ … overcrowding at psychiatric hospitals, but weak community supports for the mentally ill.”  Nebraska also is making a transition from institutions to community-based facilities, and Senator Jim Jenson noted, “We are in the process of closing two of the three state mental hospitals.” 

Many states are implementing new financing mechanisms.  For example, Representative Jodie Laubenberg of Texas described a pilot program in north Texas that is testing the effectiveness of a fee-for-service program, in lieu of  a community-grant system.  Representative Eileen Cody said that Washington is considering an increase in competitive bidding from private service organizations and an effort to coordinate physical and mental health services.   Both Representative Mary Flowers of Illinois and Representative Clara Sue Price of North Dakota plan to focus on concerns about over- or under-prescribing of  psychotropic drugs for children and adults.  In Delaware, Delegate Pam Maier hopes to increase mental health services to “youth, prisoners and moms on drugs.”  Senator Beverly Hammerstrom plans to work on  mental health parity in Michigan with a pilot program that will assess the actual costs of providing equal coverage for mental health conditions. Minnesota House committee chair Fran Bradley indicated that his committee will be looking at “community mental health service options as we downsize regional treatment centers.” 

Worthy of note is the new Joint Standing Committee on Mental Health and Substance Abuse created by the Massachusetts Legislature.  This committee is a result of greater public understanding that mental health is just as important as physical health and that attending to the health-related issues that stem from substance abuse is in the best interests of the commonwealth. The co-chairs are Senator Steven Tolman and Representative Ruth Balser.

Obesity

KEY FINDING: Obesity, especially childhood obesity, and its consequent public health and cost implications are capturing the attention of more chairs.

Obesity in the U.S. population has been increasing steadily during the past decade or so. Almost one in three U.S. adults are considered obese based on objectively measured weight. Obesity is linked to higher health care costs than smoking or drinking, and it plays a major role in disability at all ages. These facts and their implications have clearly begun to capture the attention of state health policymakers; health chairs from seven states listed obesity among their top three concerns. 

Senator Jim Barnett names “prevention issues—smoking and obesity” as a priority in Kansas.  Similarly, Iowa Senator Maggie Tinsman listed both “tobacco and obesity” as priorities. She said that, although they are “ … not necessarily connected, they both need emphasizing. Prevention is key—but how to do this,” remains the question. “Promoting healthy lifestyles and reducing obesity” are among the top priorities of Delaware House committee chair Pam Maier. Both Delegate Don Perdue of West Virginia and Representative Tom Burch of Kentucky want to see an increase in  exercise among school children. Burch  also plans to push for healthier foods in schools. He said he believes “ … our lack of physical fitness and poor nutrition have produced an overweight adolescent, teen and adult population. We are at risk for many diseases because of obesity, and they have a huge cost on our health care system.”

In Oklahoma, Senator Bernest Cain’s committee will consider legislation to carry out a number of recommendations for reducing obesity put forth by a three-year task force on children’s health. Chief among the recommendations are requiring physical education in most schools, and removing all non-nutritious foods from vending machines in elementary schools and requiring healthy alternatives in vending machines in all other schools.

In part, as a strategy to address childhood obesity, Representative Joe E. Brown of South Carolina will push for legislation to enable self-regulation and treatment of diabetes in schools. He also wants to place trained diabetes care providers in schools to help students who are unable to monitor or treat themselves.

“Hawaii has one of the highest rates of childhood obesity … in the country,” and Representative Dennis Arakaki hopes to combat this with a “ … comprehensive approach by caregivers, health care providers and educators for changes in family choices.” Arakaki’s counterpart in the Senate, Roz Baker, also is concerned about promoting more healthy lifestyles; she is interested in focusing on chronic disease management as one approach.

Other Health Issues of Interest

Senator Fred Dyson of Alaska reported a strong interest in promoting “consumer-driven options” such as personal care accounts (PCAs) and health savings accounts (HSAs). On a similar theme, Representative Jim Raussen related that the “ … health-care system in Ohio is complex and  needs more transparency for consumers so  they can make informed decisions on health care.” His committee will consider a Health Care Consumer’s Right to Know bill that would make available on the Health Department’s Web site a variety of information about hospital costs and quality.

Arizona Senator Carolyn Allen’s top priority is looking into potential abuses in the organ/tissue donation arena. “Welfare reform” is at the top of Arkansas House Committee Chair Jay Bradford’s list. “Stem cell research” was among the top priorities of both health committee chairs in Connecticut. It also was Missouri Representative Wayne Cooper’s number one priority.

A number of chairs named children’s health as a major concern. “Lowering the state’s infant mortality rate” was the first priority mentioned by Delaware House committee chair Representative Pam Maier. Missouri committee chair Representative Wayne Cooper identified “teen smoking” as a major issue for his committee. Representative Linda Upmeyer’s committee in Iowa will examine early childhood issues, including subsidized preschool and subsidized day care. Representative Tom Burch of Kentucky also mentioned early childhood development as an important committee issue. According to the chair, “Too many children still do not receive testing for metabolic diseases and treatment and services for developmental disabilities at an early age. We need to maintain or increase funding during this difficult economic time.”

A few states are seeking to expand substance abuse prevention and treatment programs.   Oklahoma Representative Thad Balkman plans to expand drug courts, and Representative Linda Upmeyer supports new child welfare and shelters in Iowa to respond to the threats posed by methamphetamine. “Meth” was listed as his committee’s number two priority by Wyoming House committee chair Representative Doug Osborn. Representative Osborn, who reported that meth is involved in 80 percent of the crimes committed in Wyoming, wants to see more substance abuse treatment  and court capacity. Finally, Oregon House committee chair Dalto’s committee intends to look into the problem of insufficient alcohol and drug treatment programs.

Representative James Morrison of Kansas was the only chair to mention “medical ethics” as a possible legislative priority.

The health care workforce is the focus for several health leaders. Senator Richard Moore’s committee in Massachusetts will address the state’s nursing shortage. There is pressure from the nurses’ unions to adopt a California model of mandatory nurse staffing ratios, but Senator Moore does not believe that approach will help to solve the supply problem, especially the shortage of nursing school faculty. A nursing shortage as well as a shortage of allied health care providers exists in Wyoming, according to Senate committee chair Senator Charles Scott. His committee will consider major changes to the state’s education and practice acts. There is an extreme shortage of neurologists, psychiatrists and obstetricians in rural areas of New Mexico as well, according to Senate committee chair Senator Dede Feldman. “We’ve been using loans and tax incentives, but [there hasn’t been] much impact.”

New Jersey House committee chair Assemblywoman Loretta Weinberg was one of the few chairs to list “improving quality of health care” as a major issue. She reported that medical errors are growing, and that New Jersey ranks near the bottom in various listings of quality indicators. Health care quality was also on Rhode Island Senator Roberts’ list. She indicated her committee will examine ways to better use information systems and data reporting to address quality.

Interestingly, “bioterrorism preparedness” showed up as a major priority on the list of only one chair: Senator Jake Corman of Pennsylvania. Rhode Island House Chair Joseph McNamara was the only chair to flag “cancer screening” as a key issue.  Improving services for those with diabetes, asthma and HIV/AIDS and STDs are priorities of Representative Joe E. Brown in South Carolina. And, finally, “competition in health care delivery” was Utah House committee chair Representative Brad Last’s top priority. He intends to create a task force to study the effects of market dominance and to identify options for limiting the vertical integration of insurers, hospitals and providers.

Appendix A. Committee Chairs’ Issue Priority Rankings

Chair’s State	Medicaid	Prescription Drugs	Malpractice, Patient Safety/ Medical Errors	Access to Coverage or Care	Long-Term Care and Aging	Mental Health	Obesity	Costs, Budgets and Financing	Other*
AK	3			1
AZ					3				x1
AR		2			3			2(B)
CO		1			3			1(B)
CT			3			2		3(C)	x2
CT	1			1	3
DE					2		3		x3
FL	2				1			1(E), 2(A)
FL	1							1(A), 2
GA			1					1(C)
HI				3	2		1	2(E)
HI				2	1
ID	1			3	3			1(A), 3(D)
IL				2				1(D)
IN	1							1(A), 2
IA	2				1			1(E), 2(A)
IA		2			1			1(E)
KS		2		1			3	1(D), 2(B)
KS		2		1				1(D)
KY	1						2
ME	1	3		2				1(A)
ME	1			3				1(A)
MD		2		1				2(B)
MD	1	3			1			1(A), 2(B)
MA	1		3	1
MI				2	3	1		2(D)
MN	2		1	1				1(D), 2(A)
MO			2						x2
MT	1	3		1				3(B)
NE	3				2	1		3(A)
NV		3		2		1		2(D)
NV		1
NH	1		3		1			1(A), 2
NJ	1	3						1(A)

Chair’s State	Medicaid	Prescription Drugs	Malpractice, Patient Safety/Medical Errors	Access to Coverage or Care	Long-Term Care and Aging	Mental Health	Obesity	Costs, Budgets and Financing	Other*
NJ	1		2	1
NM	1	2		1
NY	1	3						3(B)
NY	1	3			2			1(A), 2(E)
ND				1			3
ND	1	2				3		1(A)
OH						2			x4
OK	1			1	2		3
OK	1			2				1(A)
OR	1				2
OR	1					2
PA	1		2					1(A)
RI		2			1
RI					1
SC							1		x5
TX				1		2		1
UT	1			2				1(A), 3
UT	2							2(A), 2(D)	x6
WA				2		1		2D, 3
WV	1	3						1(A)
WV		1					2
WI	1			2				1(A)
WI	2			1				1,1(D),2(A)
WY	1		1					1(A)
WY			1	3				3, 3(D)
VI				1	3
Totals
	33	19	10	27	21	9	8	39	7

Source: National Conference of State Legislatures Health Chairs Survey, January, 2005.

Appendix B.  Health Chairs who Responded to Priorities Survey