Finding new ways to cover the uninsured, fighting over tobacco fund settlements, distributing medicinal marijuana and making do with less are among the major public health issues of 2001.
Several states are mulling expansions of their State Children's Health Insurance Programs, or SCHIPs, to include parents of eligible children. California is in the forefront, having recently passed legislation to expand its program. State officials are now preparing an application to the federal government for a federal waiver that would allow the program to cover parents.
"HCFA will have to consider this question very carefully," says Mohammad Akhter, M.D., executive director of the Washington-based American Public Health Association. "National data has shown that until you get the parents (enrolled in an insurance program) it's very hard to get the children in."
California is also at the forefront of a more dubious trend -- bruising battles over how to spend the $195 billion in national tobacco settlement funds being paid to reimburse states for Medicaid costs related to treating smoking-related illnesses. In California, which will receive $25 billion in settlement funds, some local governments are eager to use part of the money to cover general budget shortfalls, often infuriating healthcare providers who believe they're entitled to all of the money. Legal fights have erupted in Ventura and Orange counties over the disbursement of funds.
"On the one hand, I have sympathy for (financially strapped county governments), but these monies were supposed to be for healthcare over and above what is already (budgeted)," says Paul Torrens, professor of health services at the UCLA School of Public Health.
Medical marijuana is also a hot topic, as voters in several states have passed ballot initiatives allowing the use of the drug for medical treatments. Nevada, which passed such an initiative last November, is grappling with establishing a disbursement system that won't upset federal law enforcement agencies generally opposed to such programs.
In California's San Mateo County, government-grown marijuana will be distributed to a select group of AIDS patients to help study its effects. Potential benefits include pain relief and increase in appetite. It's the first-ever such program in the United States. San Mateo County officials believe it will pave the way toward a county-sponsored series of tests to gather conclusive evidence about the medicinal benefits of marijuana.
Meanwhile, public health systems will continue to tighten their belts. In Los Angeles County, where a third of its 8 million residents are uninsured and two bailouts from the federal government have been required in recent years to keep the Department of Health Services afloat, public health officials are embarking on programs to pare $91 million in costs over the next five years. The department will also continue to expand outpatient services while subcontracting for them from the private sector.