On Nov. 5, voters in a handful of states will cast their ballots for at least a dozen local healthcare issues. But for many initiatives, providers are turning their attention to elections of state and federal officials.
State ballot measures range from universal healthcare to proposals involving ownership of healthcare facilities.
Arizona has several measures on the ballot. Voters will consider Proposition 303, which would increase the tax on tobacco products. If passed, the tax increase would help fund the state's emergency services, reimbursement for uncompensated care, primary-care services and trauma center readiness. The money also would help cover healthcare costs for low-income residents and fund antismoking efforts. The state's residents also will vote on Proposition 203, a legislative initiative that would modify the Drug Medicalization Prevention and Control Act of 1996, which allows physicians to prescribe controlled substances such as marijuana for medicinal use.
Voters also will decide Proposition 201. Known as the Fair Gaming Act, the initiative would allow horse and dog racetracks to operate slot machines, with proceeds divided among state programs that include providing medical assistance in rural areas and reducing the cost of prescription drugs for seniors.
Oregon voters will consider Measure 23, which would create universal health coverage for all state residents, regardless of income, based on an increase in personal income and payroll taxes. A 15-member board would direct the plan. The Oregon Association of Hospitals and Health Systems opposes the measure because the program would cost $12 billion per year, which is double the state's current budget, says association spokeswoman Karen Normandin. "It's just not correctly financed," she says.
In Louisiana, voters will weigh in on Amendment 9, which would allow the state to invest in the stock market up to 35% of a Medicaid trust fund specifically created for the state's elderly. They also will decide on Amendment 3, which would allow the state to use funds from protected areas in the state's budget to address a midyear crisis rather than taking funds from Medicaid and education.
Colorado residents will consider Referendum B, a legislative initiative that would change the state's constitution to allow local governments to jointly own healthcare services or facilities with private companies and individuals.
Targeting tort reform
The medical malpractice crisis-which has hit states such as Mississippi, Nevada, Pennsylvania and West Virginia especially hard-isn't a target of ballot referendums but has become a critical campaign issue in many states. Steven Summer, chief executive officer of the West Virginia Hospital Association, says his organization is focused on races involving state and federal lawmakers as it works to forward tort reform proposals.
He says his association is paying close attention to candidates who would favor adopting a law similar to California's tort reform-which places caps on certain awards for damages-in an effort to stop hospitals from shuttering services and prevent physicians from leaving because of escalating insurance premiums.
Gubernatorial candidates also have made healthcare issues central in their races, with prescription drugs and Medicaid leading the list.
In Wisconsin, Republican Gov. Scott McCallum, who replaced HHS Secretary Tommy Thompson, faces a challenge from Democrat Jim Doyle, the state's attorney general. McCallum has highlighted SeniorCare, launched during his tenure. The program aims to provide prescription-drug coverage for more than 250,000 low-income seniors who are not enrolled in Medicaid. Doyle has outlined a plan to help control insurance premiums and prescription-drug costs, reduce the number of uninsured, expand long-term-care opportunities for seniors and improve Wisconsin's public health efforts.
In Tennessee, U.S. Rep. Van Hilleary, a Republican, and former Nashville Mayor Phil Bredesen, a Democrat, are campaigning on changes to TennCare, a state-sponsored managed-care program, in their bid for the open governor's seat. Created in 1994, TennCare resembles Medicaid and provides healthcare for 1.4 million Tennessee residents . Both are looking to overhaul the system and clamp down on eligibility. "It's probably the second most important issue behind education," says Craig Becker, president of the Tennessee Hospital Association, who says he is watching the race closely for changes to the program's funding. Tennessee residents also will vote on starting a state lottery to help fund state healthcare initiatives.
In Oregon, Gov. John Kitzhaber, M.D., is leaving office at year-end, creating an open seat. The state's health plan, which covers more than 400,000 low-income residents and sets priorities on a list of eligible services, operates under a $621 million budget. The plan is likely to play a role in the governor's race as the state faces increasing budget deficits. Democrat nominee Ted Kulongoski, a former state Supreme Court judge, favors expanding the plan to cover all children up to age 18. Republican nominee Kevin Mannix, a lawyer and former state senator, would re-engineer the program to encompass the working uninsured.
In Rhode Island, which also has a shrinking budget, the prescription-drug issue is prominent in the open governor's race. Democrat Myrth York's prescription-drug plan aims to get pharmaceutical companies to reduce prices to help increase the state's prescription-drug purchasing power; to educate consumers about discounted medicines; and to fight tax benefits that add to the inflated cost of medicines. York faces Republican Donald Carcieri, who has focused on fiscal responsibility and education issues.