Massachusetts HMOs--and ostensibly private health insurers nationwide--scored a victory last week when voters in the state narrowly defeated a sweeping health insurance reform plan that would have guaranteed coverage for all residents, limited HMO spending on nonpatient care and imposed patient protections.
Despite leading in public opinion polls in the weeks before the vote, Question 5 was defeated by a margin of 52% to 48%, or less than 110,000 votes.
The measure was among several controversial initiatives considered by voters in various states who went to the polls last week. A state-by-state roundup of the results follows.
Health insurance companies and HMOs contributed heavily to a "No on 5" campaign that spent millions to defeat the Massachusetts measure, which would have required the state Legislature to pass a plan for universal healthcare coverage by July 2002. Stephen Allen, a spokesman for the "No on 5" campaign said before the vote that the measure would mean that HMOs as they are known now would cease to exist in the state.
Question 5 would have allowed patients to have complete freedom in selecting providers and would have capped administrative expenses and other nonhealth spending at 10% of healthcare premiums.
Richard Averbuch, spokesman for the Massachusetts Hospital Association, which took no stand on the initiative, said, "The fact that the question got the kind of support it did indicates that the people of Massachusetts care very strongly about issues such as universal access and ensuring patient's rights."
Other states with healthcare ballot measures were:
A majority of voters approved two measures dictating how to spend the state's $3 billion in proceeds from the national tobacco settlement. Only Proposition 204, which won the most support with 63% approval, will go into effect. It expands coverage of the state's Medicaid managed-care program to 100% of the federal poverty limit instead of the current 34%.
Proposition 200 received fewer votes and has been canceled. Approved by 58% of voters, it would have dedicated all the money to a variety of healthcare programs. It was supported by the Arizona Hospital and Healthcare Association.
By 64% of the ballots, voters passed an initiative to earmark $1.6 billion in tobacco settlement proceeds for preventive healthcare and research. Provider groups, including the Arkansas Hospital Association, supported the proposal.
Voters in Ventura County defeated Measure O, which would have divvied up the county's $10 million-per-year share of the national tobacco settlement among its eight private hospitals. The vote was 68% to 32%.
In Orange County, voters approved Measure H, which directs the bulk of the county's $30 million share toward healthcare, smoking cessation and public safety programs. Voters there rejected 54% to 46% a competing initiative, Measure G, which would have used 40% of the funds to pay down debt that lingered from the county's 1994 bankruptcy filing.
Colorado voters approved the medical use of marijuana last week, bucking opposition from the Colorado Health and Hospital Association and most of the state's political leadership.
The medical marijuana measure passed with 53.6% approval. It allows patients, typically with a chronic illness, to register with the state to legally possess and use marijuana if their doctors provide a written statement that they would likely benefit from smoking cannabis.
An initiative to legalize physician-assisted suicide was narrowly defeated, with 51% of the state's residents voting against the controversial proposal. If the initiative had passed, Maine would have become the second state, after Oregon, to permit physicians to end their patients' lives. During the campaign, each side spent more than $1 million advertising on behalf of their positions.
Voters approved a measure to create a trust fund for health programs with 40% of the state's tobacco settlement. Voters approved the measure, 73% to 27%. It was developed by a coalition of about 30 groups--including the American Cancer Society, Blue Cross and Blue Shield of Montana, and Montana Medical Benefit Plan--prompting critics to argue the bill benefited those organizations most. It was supported by the state's largest hospital lobby, MHA-An Association of Health Care Providers.
Voters approved 65% to 35% a measure to amend the state's constitution to allow marijuana to be used to treat AIDS, glaucoma, epilepsy and other disorders, as well as guarantee a steady supply to patients. An identical measure was passed by a wide margin last year, but state law required a second vote for certification.
Ohio voters passed four tax levies supporting local hospitals. The measures included:
* A five-year, 0.5% sales tax for capital improvements which will produce $600,000 to $800,000 annually at publicly owned, 49-bed Adams County Hospital in West Union.
* A $2.5 million, five-year replacement levy for 75-bed Morrow County Hospital in Mount Gilead.
* A 0.5-mill, five-year replacement levy for 150-bed Greene Memorial Hospital in Xenia.
* A 3-mill, five-year levy generating $650,000 annually to support an ambulance service operated by 91-bed Oberlin Medical Center that serves four townships, the city of Oberlin and the village of Kipton.
A trust fund for the state's nearly $1.9 billion in tobacco settlement proceeds will be established under a measure approved with 69% of the vote. Creation of the fund, which is earmarked for cancer research, tobacco use prevention and cessation and other social services programs, was supported by the Oklahoma Hospital Association and other provider groups.
Voters defeated two ballot measures that addressed how the state should use the $75 million it will receive annually from the national tobacco settlement, leaving the money up for grabs when the state Legislature resumes in January. Both measures were supported by only 44% of voters.
Measure 4, sponsored by the Oregon Association of Hospitals and Health Systems, would have used earnings from the settlement fund to provide low-income residents with health insurance.
Measure 89, referred by last year's Legislature, would have used the settlement for county health programs, low-income housing, transportation for seniors and the disabled, anti-smoking efforts, health research and shelter care for victims of domestic violence.
--With Ed Lovern, Ron Shinkman,
Mark Taylor and Jeff Tieman