Health Chairs Project Survey of State Health Priorities for 2004
INTRODUCTION
In a recent survey of legislative priorities, 25 chairs of state health committees, representing 20 states, named their top three priorities for the 2004 session. Medicaid financing and budget shortfalls dominate the agenda as they have since 2002. After Medicaid (12 chairs) and prescription drug program (3 chairs) funding concerns, chairs frequently mentioned long term care (5 chairs), access for the uninsured (9 chairs), and mental health (4 chairs) issues as priorities for 2004.
ISSUE |
|
|
| |
|
Number of Chairs |
| Health Care Costs and Finanacing: |
|
|
| |
Medicaid |
14 |
| |
Prescription Drugs |
3 |
| |
General |
8 |
| |
Total |
25 |
| Access to Health Care/Insurance |
|
9 |
| Heath Care Workforce and Providers |
|
6 |
| Aging, Long-Term Care, and Nursing Homes |
|
5 |
| Mental Health and Substance Abuse |
|
4 |
| Conventional Public Health and Disease Prevention/Management |
|
4 |
| Quality of Care |
|
4 |
| Medical Malpractice |
|
3 |
| Administrative Reorganization |
|
2 |
| Oral Health |
|
1 |
METHODOLOGY
The Health Chairs survey was conducted by the Health Chairs Project, a collaboration between the National Conference of State Legislatures (NCSL) and the Schneider Institute for Health Policy at Brandeis University with generous support from the Henry J. Kaiser Family Foundation.
Health committee chairs (chairs of standing health care authorization and finance committees, chairs of health subcommittees and health-related committees) help dictate state health policy agendas and their work can often result in federal consideration of salient issues and affect national approaches to health care matters. Since the states are frequently harbingers of the emerging nation-wide problems, the innovation and obstacles of state legislators are integral in the establishment of health care initiatives and legislation. Consequently, the experiences of health chairs offer a critical lens through which to examine urgent and imminent health policy trends.
FINDINGS AND ANALYSIS
Health Care Costs and Financing
Prescription drug prices, Medicaid funding and budget shortfalls were the most frequently mentioned examples of 2004’s primary focus for legislators, health care costs and financing. The responses of health committee chairs indicate an overarching theme of economic limitation and concern for resulting program cuts to accommodate states’ tightening budgets.
Medicaid was the most commonly referenced priority for 2004: “Funding Medicaid” (Senator Pat Miller, IN), “Medicaid cost containment and reorganization, (Representative Tom Kane, ME), “Budget crisis and escalating Medicaid costs” (Representative Jennifer Weiss, NC). Fourteen of the twenty-five (56%) health chairs responding to the survey named Medicaid specifically as one of their top three priorities for 2004. This is an increase from last year, when 51% of survey respondents named Medicaid financing in this category. Medicaid’s financial implications overlap with issues of access. As legislators search for ways to ease Medicaid’s burden on budgets, it is likely that its rolls will be thinned. “We do not want to cut eligible groups or services, but that might happen,” said Maggie Tinsman of IA. “The South Carolina Medicaid program has not been funded for the past several years with non recurring funds and enrollment continues to rise,” said Senator David Thomas of SC.
The continuing fiscal difficulties of states in the face of rising costs are troubling for more than Medicaid. Senator Rosalyn Baker of Hawaii cited prescription drug cost as her top priority: “[We’d like to] follow Maine’s lead in passing a prescription drug plan...residents cannot afford prescription drugs.” Maine’s Representative Tom Kane mentioned implementation of that drug plan as a priority for 2004.
Many legislators summed up their feelings about the year ahead by naming the umbrella issue of funding and budget shortfalls in their survey responses. “The people and their government don’t have any more money to spend on healthcare.” (Senator Jerry O’Neil, MO) Senator Pat Miller from IN said, “The state is facing a financing deadline with tough decisions ahead.” Representative Kane from ME said, “How we manage the deficit will have significant impact on our health and Human Service agenda.”
Health Care Access and the Uninsured
Legislators cited the issue of uninsured people second most frequently: “Decreasing the number of individuals without health insurance” (Representative Dennis Araraki, HI); “Health insurance for the uninsured.” (Senator David Thomas, SC) Besides Hawaii and South Carolina, legislators from Maryland, Indiana, Minnesota, Missouri, and New Hampshire (20%) responded that issues of access would be on their agendas in 2004. For Hawaii, oral health in particular will be a concern, and for Indiana, the high-risk pool will be of interest. This is the first year that the high-risk pool has been mentioned.
Eight chairs in eight states count the issue of access and the uninsured as a personal priority as well as an imminent policy demand.
Health Care Workforce and Providers
Workforce and provider issues were mentioned by six states. South Dakota and Missouri agree that the health care workforce should be on the policy agenda for 2004.
Oklahoma has lost Trauma I status for its main teaching hospital, according to Senator Bernest Cain. In Minnesota, the issue of surgical centers will be on 2004’s agenda. Senator Tom Fisher of North Dakota mentioned “home and community-based services.” Several legislators mentioned home-care as a solution to policy problems for states. Fisher’s fellow North Dakota legislator Representative Clara Sue Price hopes to increase funding for “aging in place – SPED” in order to “reduce the cost of Medicaid.”
Long-Term Care
Chairs in six states out of twenty (25%) named long-term care as a major focus for 2004 compared with twenty-two percent last year. Nebraska’s Senator Jim Jensen cited funding for long-term care, while Senator Tom Fisher of North Dakota specified “home and community based services.” Pennsylvania’s Senator Howard Mowery, Jr. indicated that the licensing and funding of assisted living would be on the agenda for his committee.
Aside from its presence of the state legislative agenda, nine chairs in eight states count long term care issues as a personal priority. Senator Jim Jensen of Nebraska is hoping to prepare for the health of baby boomers as they age. In Pennsylvania, Senator Harold Mowery, Jr. hopes to focus on prescription drugs for the elderly.
Mental Health
Mental health continues to increase in importance to legislators this year. Twenty percent identified mental health as a top priority, compared with seventeen percent last year and only eleven percent in 2002. Oklahoma emphasized funding of mental health programs, and Nebraska, for which mental health was the number one priority, called the shift from institutional to community board service the main focus of this issue. Senator Beverly Hammerstrom spotlighted both mental health parity and mental health waivers oversight as priorities for Michigan.
For legislators in Iowa, Michigan, and Oklahoma, mental health policy is an individual concern. Representative Joe Eddins of Oklahoma hopes to examine mental health as it relates to corrections in his state; Senator Beverly Hammerstrom of Michigan believes mental health parity to be a pressing issue.
Public Health and Prevention
Public health and prevention are next in the rank of priorities for 2004, named by four states. Senator Becky Loury of Minnesota mentioned ground water protection, STDs, and family planning cuts as prime public health concerns. Oregon linked public health with medical errors. Issues of prevention are concerns for legislators from Oregon and Hawaii, who cite obesity in particular; Hawaii’s Representative Dennis Araraki specifies an interest in childhood obesity. Missouri’s Senator Jerry O’Neil says “improving lifestyles” as a goal for 2004.
Four individuals from four states hope to focus personal energy on advancing public health and prevention legislation. Representative Clara Sue Price aims specifically for smoking cessation in her state, North Dakota; South Dakota’s Representative Donald Van Etten also cites tobacco as a public health threat. Representative Doug Osborn of Wyoming agrees that tobacco is a public health issue, and adds methamphetamine and alcohol abuse as areas of interest.
Administrative Reorganization
Two states that responded to the survey consider administrative reorganization in the wake of budget constraints a top priority for 2004. This is an increase from 2003’s seven percent. Maine will be working on the merging of the Department of Human Services and the Department of Behavioral and Developmental Services. North Dakota mentioned that duplication of services through the Department of Human Services and County Social Services is an issue. Oklahoma has lost Trauma I status for its main teaching hospital, according to Senator Bernest Cain.
Quality of Care
Quality of care was also mentioned in four states: Oregon, Wyoming, Massachusetts, and Indiana. Wyoming’s Representative Doug Osborn cited health information technology as it relates to quality of care. Senator Bill Morrisette of Oregon expressed concern about “medical errors,” while Massachusetts’ Senator Richard Moore noted interest in “quality of health care reporting.”
2004 Health Care Priorities Survey (from NCSL’s Health Policy Tracking Service):
1. Access to health insurance
2. Medicaid pharmaceutical costs
3. Pharmaceutical assistance programs
4. Medicaid budget shortfall
5. Nursing home quality and safety
6. Nutrition and obesity
7. Childhood diabetes
8. Nursing home reimbursement rates
9. Assisted living regulations
10. Drug purchasing pools
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