Although healthcare issues did not appear to be at the top of voters' lists of priorities last week, several states passed measures that will affect local hospitals and healthcare programs.
"Health was on the mind of policymakers and citizen advocates, but it wasn't a dominant theme," said Richard Cauchi, healthcare program manager at the National Conference of State Legislatures in Denver.
Hospitals and doctors scored victories in California, Arizona and Montana, for example, when voters approved measures pumping millions of dollars annually into healthcare initiatives, but hospital executives in Missouri and Michigan were not as lucky after voters rejected similar tax increases.
Also, in an election that included questions of drug policy reform and the legalization of marijuana, healthcare executives in Arkansas and Louisiana were overjoyed to learn they will not see funding cuts.
Emergency rooms and trauma centers in Los Angeles County will receive $168 million annually beginning next year after voters approved Measure B, a proposal that raises property taxes by 3 cents per square foot. The money also will be used for bioterrorism preparedness.
Supporters of Measure B, who raised about $2 million, said the money is needed to prevent the closing of two public hospitals, 320-bed Harbor-UCLA Medical Center and 226-bed Olive View-UCLA Medical Center, which were losing money. They are also hoping the new funding will encourage several hospitals in the county to provide trauma services where none currently exist.
During the campaign, supporters noted that the number of trauma centers in the county dropped to 13 today from 22 in 1985. Opponents contended that the burden of funding trauma care should rest with the state, not with county taxpayers.
In Arizona, voters approved a 60-cent increase in the state tax on cigarettes, which will generate $62 million annually in revenue for healthcare. The funding will be used for subsidies to hospital emergency rooms, medical research and healthcare for the poor.
In Montana, voters approved a measure that would require the state to spend part of its $30 million annual share of the tobacco settlement on tobacco-prevention and healthcare programs. Approximately 32% of the share will be spent on antismoking programs and 17% will be earmarked for the Montana Comprehensive Health Association and the State Children's Health Insurance Plan.
The results weren't as rosy in Missouri, where voters rejected a 55-cent increase in the cigarette tax. The proposition would have used revenue from the tax to boost reimbursement rates for doctors and trauma centers. Proponents estimated the tax would have generated $342 million in revenue, with 43% being spent on healthcare programs, 29% on emergency and trauma care, and 14% on medical research. Some 7% would have gone to tobacco prevention programs with the remaining 7% going to grants for early childhood care and education. The revenue also would have expanded the state Medicaid program.
Voters in Michigan also defeated a healthcare measure by deciding against spending most of the state's annual $300 million tobacco settlement on hospitals, nursing homes and smoking-prevention programs. Under Proposal 4, the state would have spent $151.8 million per year on not-for-profit hospitals, nursing homes, hospices and the Healthy Michigan Foundation. The state also would have spent $102 million on antitobacco programs and $42 million on a senior citizen prescription drug program.
Some large hospital systems opposed the measure because they said it favored high-revenue hospitals over those that treat a higher percentage of low-income patients.
In Arkansas, voters shot down a referendum that would have repealed the sales tax on food and over-the-counter medicine. The Arkansas Hospital Association estimated the measure would have crippled the state's Medicaid program by eliminating $400 million to $600 million annually from the general revenue fund. Medicaid would have lost an estimated $200 million annually, the state hospital association said.
"It would have had a significant impact on how to fund Medicaid services," said Paul Cunningham, senior vice president of the association. If the referendum proposal had passed, the state probably would have considered cuts in payment or eligibility, he said.
The hospital association joined 68 other groups that were opposed to the referendum measure. "We had mounted an intense public education program," Cunningham said. "It paid off. Everybody felt good."
Meanwhile, healthcare administrators in Louisiana will be protected against sizable state budget cuts after voters approved Amendment 3, which limits healthcare cuts to 5% in the state's Department of Health and Hospitals, which includes the Medicaid budget. Previously, healthcare and higher education were not constitutionally protected from budget cuts.
"We have been sustaining hits of sometimes double (5%) or more in recent years," said Lynn Nicholas, president and chief executive officer of the Louisiana Hospital Association, which spearheaded a grass-roots campaign in favor of the amendment. "Healthcare takes the brunt of those cuts."
The state's Medicaid budget will see a $48 million cut in 2002, a 4% drop from the previous year. With the loss of federal matching funds, Louisiana will miss out on $168 million in funding. Beginning next year, those cuts will not exceed 5%, she said. "It is great news," Nicholas said. "Our state's Medicaid is underfunded relative to other states."