A federal judge last week kept providers at arm's length from California voters' endorsement of a ballot proposition denying all but emergency healthcare to illegal immigrants.
The order by U.S. District Judge Matthew Byrne postponed enforcement of Proposition 187 at least until a hearing can be scheduled this week. Meanwhile, Gov. Pete Wilson ordered the state Department of Health Services to issue emergency rules implementing the proposition, which he strongly supported on his way to being elected to a second term.
The proposition forbids providers from treating patients who are in the country illegally, and it puts the onus on providers to determine a patient's citizenship before treatment, according to an interpretation by the California Medical Association.
Proposition 187 also makes illegal residents ineligible for public school education.
California voters, however, soundly rejected Proposition 186, which would have created a state-run single-payer healthcare system replacing most private health insurance and government programs to provide healthcare for all residents beginning in 1996.
In the absence of state regulations implementing Proposition 187, California's health services department advised providers "to do business as usual," said a spokeswoman for the state medical association.
"Our concern is about the immediate confusion" caused by the referendum's passage, she said. "We are urging physicians to continue to treat patients and patients to continue to seek care."
The spokeswoman also said the CMA was concerned that, since the initiative is "in violation of multiple federal laws," physicians who abide by it may be exposed to malpractice liability.
Mr. Wilson addressed criticism of the proposition's potential encroachment on federal anti-discrimination laws by recommending that physicians and other service providers ask for proof of citizenship from all residents. If a resident's illegal status is confirmed, a provider is required by law to report the person to state authorities.
But that would violate federal Medicaid provisions forbidding providers from refusing treatment to undocumented patients, the CMA said. The association last week was preparing to contest the proposition on 12 constitutional and statutory grounds, including the Eighth Amendment's ban on cruel and unusual punishment.
Before the election, hundreds of physicians at several hospitals signed pledges that they would not abide by the initiative's ban on providing healthcare to undocumented aliens.
Elsewhere around the country last week, Georgia voters rejected an amendment to the state constitution that would have allowed legislators to consider approving anti-competitive mergers of hospitals and other providers, as long as benefits outweigh disadvantages. The Georgia Hospital Association and the Medical Association of Georgia supported the amendment while the insurance industry and several large companies opposed it.
In Arkansas, a 2-cent tax on soft-drink cans was retained as a source of funding for the Medicaid program. Voters elected to keep the tax despite the nearly $4 million spent by soft-drink companies to eliminate it, said Phil Matthews, senior vice president of the Arkansas Hospital Association.
The Committee to Preserve the Medicaid Trust Fund, which included many provider groups, spent $550,000 in the fight to keep the tax, which raises $35 million for Medicaid. That amount is matched by federal contributions.
Initiatives in other states also affecting healthcare:
Oregon.Voters in the state endorsed Measure 16, which would legalize physician-assisted suicide. The measure would allow patients to request a lethal dose of medication from their physicians and would give physicians the right to comply.
"It will be a fairly narrow bill," said Daniel Field, attorney for the Oregon Association of Hospitals and Health Systems. The patient must be diagnosed with a terminal illness with six months or less to live. The measure requires a second opinion from a diagnosing physician, a 15-day waiting period and three separate requests from the patient, he said. Catholic hospitals in Oregon strongly opposed the measure, but the hospital association and the state medical association remained neutral, as did all other hospitals in the state.
Colorado.Voters defeated three ballot proposals affecting healthcare:
A proposal to allow injured workers to choose their physicians was defeated, with 66.4% of voters opposed. Opponents, including managed-care companies and hospitals, said the idea would undermine managed care and raise workers' compensation costs.
A 50-cents-per-pack cigarette tax was defeated by 62.1% of voters. Some proceeds would have gone to public health and indigent-care programs.
Sweeping changes in the initiative and petition process were rejected, with 76.5% of voters opposed. Public hospitals were opposed, fearing the changes would impede their decisionmaking.
Kansas.A proposal to close 18-bed Miami County Hospital was defeated by 74 votes. The vote was 3,996 to 3,922. Proponents wanted the hospital closed and its assets used for other Miami County projects. The referendum was a potential obstacle to a controversial lease agreement with 130-bed Olathe Medical Center in neighboring Johnson County (Oct. 10, p. 26).
Washington.Voters in Sedro Woolley said they want to disaffiliate their United General Hospital from Skagit Valley Hospital in Mount Vernon and convert it to an acute-care facility with 24-hour emergency service. But they failed to pass a tax hike to fund the conversion.
The results give no clear direction to the board of the hospital district, which was to meet last week in executive session to discuss the matter. The hospitals affiliated in 1991, and United General was made into an outpatient diagnostic facility with a 12-hour urgent-care center (Sept. 19, p. 12).