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Volume 27, Issue 461 |
February 20, 2006 |
State of the States: Tackling Meth, Medicaid Reform
By Anna C. Spencer
Disaster preparedness, education and Medicaid reform were the central themes running through the 33 State of the State Speeches delivered by governors through February 17th. Last year proved to be upbeat economically for many states, but a certain frugality remains following the deep deficits states faced three years ago. “Our strong economy has produced billions of dollars of unexpected revenues. . .but we cannot make the mistakes of the past,” said California Gov. Arnold Schwarzenegger. “So this year must continue to be the year of reform. Because one thing I know: autopilot spending will fly us into the ground, not into the future.”
The implementation of the Medicare Part D prescription drug benefit on Jan. 1st, 2006 loomed on the horizon throughout 2005 as states grappled with how to best cover dual-eligibles, resolve administrative stumbling blocks and, in some cases, prepare for new financial outlays. While the rate of growth in Medicaid spending slowed, it still outpaces state revenues. As a result states continue to wrestle with implementing reforms, while maintaining coverage for the most vulnerable citizens.
Dubbed a “monster” by Arkansas Gov. Mike Huckabee, Medicaid is on the brink of major reforms. “If left unchecked the old program (Medicaid) would literally bankrupt state government within a matter of years,” said Missouri Gov. Matt Blunt. “Missourians know that simply throwing money at the problem without any other changes would not have solved the problem.”
A growing number of states are overhauling their Medicaid programs in an effort to restrain costs, while improving care. Since Medicaid pays for the care of almost half the nation’s 1.4 million nursing home patients, reforming the delivery of long-term care is at the top of many lists. Nebraska Gov. Dave Heineman directed his Health and Human Services Department to begin taking the steps necessary to provide home- and community-based Medicaid services to beneficiaries as an alternative to institutional care.
Similarly, incoming Virginia Gov. Tim Kaine noted that nearly 75 percent of his state’s Medicaid budget is spent on long-term care for the elderly and disabled “through a patchwork system without the benefit of care coordination or case management.” Accordingly, Kaine has directed the Department of Medical Assistance Services to “develop a plan which will serve as the blueprint for moving towards an integrated, acute and long-term care delivery system for elderly and disabled Medicaid recipients.”
Health Information Technology is gathering momentum as a way to reduce costs and improve the quality of health care. Colorado Gov. Bill Owens wants to use telemedicine to incorporate disease management into the care of chronically ill Medicaid beneficiaries. “If we can make the system more efficient, the result will be better health care for our poorest citizens and a more sustainable system going forward,” Owens said.
In Missouri, Blunt created the Healthcare Information Technology Task Force and charged it with recommending ways “to harness technology to make better care decisions for patients, leading to better results at reduced costs.”
Other governors are creating commissions to monitor health-care quality and make recommendations for improvements in care delivery. New Hampshire Gov. John Lynch – who wants New Hampshire to be one of the healthiest states in the nation – created the “Citizen's Health Initiative” to develop criteria to evaluate and monitor the quality of care; reduce medical errors and duplication through electronic medical records; and make it easier for people to get information about health care quality and costs.
Gov. George Pataki of New York in 2005 committed $1 billion to technology improvements and upgrades for New York's hospitals. As part of this, Pataki proposed “an unprecedented bio-tech research challenge grant initiative” that is expected to leverage $600 million in public/private matching funds and capitalize on the strength of institutions like Sloan Kettering, Mt. Sinai and Cornell.
The Meth Monster
More than a dozen governors listed methamphetamine production and abuse as their biggest illicit drug problem. “It’s our number one illegal drug threat,” said Alabama Gov. Bob Riley.
The easily manufactured, highly addictive drug has created a host of problems for criminal justice, child welfare departments and health care. Meth “destroys lives, attacks families, and undermines communities,” said Georgia Gov. Sonny Purdue. Governors pledged money for enforcement and rehabilitation programs, formed task forces to address the issue and outlined harsher penalties for meth manufacturers and individuals caught using the drug.
As of October 2005, 40 states had enacted legislation limiting access to pseudoephedrine, the main ingredient (found in over-the-counter cold medicines) used to make methamphetamine. As a result, the number of home-based meth labs has declined dramatically, according to numerous state attorneys general. Idaho Gov. Dirk Kempthorne noted that his state’s “anti-meth initiative shut down 760 labs” in 2005. Nebraska’s Heineman reported a 60 percent decrease in meth labs during the first 90 days after he signed a bill that restricts the sale of pseudoephdrine products and stiffens penalties for the production and distribution of the drug.
Several governors promised to pursue stronger anti-meth legislation in 2006. Arizona Gov. Janet Napolitano asked the Legislature to send her “a tough meth bill” that she can sign into law. New Mexico Gov. Bill Richardson promised to increase penalties for the sale of meth, as well as to “create a statewide registry of meth-affected properties so that homebuyers, homeowners and neighbors don’t unknowingly endanger themselves or their families.”
Some governors also focused on treatment and prevention. Hawaii Gov. Linda Lingle proposed $10.2 million to expand the “About Face” and “Healthy Lifestyles” programs for at-risk youth and needy adults to keep young people away from drugs and promote healthy living. New Mexico’s Richardson pledged to make treatment more available “so people have the chance to overcome the terrible grip of addiction.”
Health Promotion/Disease Prevention
Still on the agenda is reducing childhood obesity. California’s Schwarzenegger praised Sen. Martha Escutia for persevering in her six-year effort to rid public schools of high fat/high sugar foods in school vending machines. Schwarzenegger called on the public “to have the same perseverance, that same stamina, that same commitment, to help our children, to help our families, to help our communities and our state.”
Along with eliminating junk food from schools, governors are keenly away of the important of increasing and promoting physical activity among youth. Idaho’s Kempthorne faulted video games for replacing “normal after-school activity for our youth,” and called on the Legislature to revitalize and strengthen physical education around the state.
Likewise, Kentucky Gov. Ernie Fletcher, who is a physician, wants to expand “Get Healthy Kentucky!”, an initiative launched by the First Lady in 2004 to improve the health of all Kentuckians. He noted that Kentucky is among the seven states with the highest rates of obesity, diabetes and heart disease, and said that the state ranked “dead last” in rates of smoking and lung cancer. Fletcher’s goal: decrease the rates of obesity and smoking and increase physical activity levels to better than the national average by the next decade.
Despite the fact that most states are not using monies from the Master Tobacco Settlement Agreement to fund smoking prevention and cessation programs, several governors listed smoking prevention as a priority for the coming year. Notwithstanding objections from the Legislature, Iowa Gov. Thomas Vilsack proposed increasing taxes on tobacco products. “I understand that there are many in this chamber that do not agree with that increase, but the public supports it . .because [they know that] the research shows that when tobacco products cost more, fewer people smoke and fewer people start smoking,” Vilsack said.
Missouri’s Blunt said that the tobacco settlement funds have been “misused” and proposed investing $1 million in 2006 on smoking prevention and cessation programs. In the end, he noted, “we all pay the costs of smoking through increased insurance premiums, social welfare for smokers and most significantly through the loss of family and friends afflicted with cancer.”
Some states have reaped the benefits of their anti-smoking investments. Maine Gov. John Baldacci remarked that his state had received “straight A’s” from the National Lung Association for success in reducing teenage smoking, which as been cut in half since 1997. For FY 2006, the Legislature appropriated $15 million for tobacco prevention and control.
The devastation of Hurricane Katrina served as a warning bell to states to cement state emergency preparedness and disaster response plans. Governors were unwavering in their view that states are best equipped to create their own response plans. “The most effective response is one that starts at the local level and grows with the support of surrounding communities, the state and then the federal government,” Florida Gov. Jeb Bush said in a press release (his SOS speech is slated for March 7). Alabama’s Riley echoed, “Congress should avoid attempts to 'federalize' planning and response activities. . .communities must have the flexibility to shape their preparedness and emergency response efforts.”
Christopher Coleman contributed to this report.
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