The anger and economic distress voters expressed in the midterm congressional results bled through to a variety of ballot measures affecting healthcare.
Election results mixed for insurance mandates
In two states, Arizona and Oklahoma, voters supported constitutional amendments referred by their legislatures aimed at the knees of President Barack Obama’s healthcare reform law. The measures purport to block the portions of the Patient Protection and Affordable Care Act that will require most Americans to have basic health insurance and compel employers to provide minimum coverage or pay a penalty.
Hospitals in those states declined to take sides on the amendments. In Arizona, where 55% of the voters supported an amendment, the actual impact “remains to be seen because it will ultimately be determined in the courts, as its authors intended,” Laurie Liles, president and CEO of the Arizona Hospital and Healthcare Association said in a statement.
Banner Health, a Phoenix-based system that owns 11 hospitals in the state, will carry on with its efforts to prepare for changes in the pipeline under the reform law, according to a written response to a query about the election’s outcome. “We strongly believe that such preparation is prudent and responsible at this time, but understand that the highly political environment that surrounds healthcare reform will continue,” the system said.
Voters in Colorado, by a 53% majority, rejected a similar constitutional amendment.
The impact of such amendments—one was approved in Missouri in August—and laws and resolutions passed by lawmakers in Georgia, Idaho, Louisiana, Virginia and Utah, may be purely political. “Either the individual mandate is unconstitutional or it isn’t,” said Timothy Jost, a professor at Washington and Lee University Law School who penned an article on the topic published in the New England Journal of Medicine. “If Congress has the power to adopt an individual mandate, then under the Supremacy Clause it is binding on all Americans, regardless,” he said. “That is what we fought the Civil War over and was established by a whole series of court decisions during the civil rights era.”
Federal courts are already chewing on that question in a number of lawsuits brought against the law, including one in Pensacola, Fla., joined by 19 state attorneys general.
Jost said the Colorado vote is evidence that Americans don’t universally oppose even the most controversial part of the law.
In Oklahoma, 65% of the voters last week supported an amendment rejecting the law’s mandates. But Oklahoma Hospital Association President Craig Jones said neither hospitals nor the public was very focused on that issue.
A bigger concern, Jones said, was a question on the ballot that would have amended the state constitution to guarantee that public schools were funded at least as well as those in surrounding states. Lawmakers would have been forced to redirect funding from Medicaid and other health programs to fund education, so the hospital association joined a coalition campaigning against the amendment. “We had an obligation to make people understand if this passed there were consequences,” he said. It was soundly defeated.
It was not a stretch to persuade voters anywhere last week to oppose measures involving spending or taxes. They weren’t in the mood.
In Georgia, they voted 53% to 47% against constitutional amendment raising an estimated $80 million for trauma centers with a $10 annual fee tacked on to vehicle registration. At 520-bed Memorial Health in Savannah, one of two trauma centers in the southern half of the state, the funding could have meant an additional $5 million to $7 million in state support, spokeswoman Becky Keightley said, noting that the broader goal was to encourage more hospitals to provide trauma care.
The Washington State Hospital Association unsuccessfully threw its weight against two ballot initiatives aimed at reining in taxes. By a margin of nearly 30 percentage points, voters supported an initiative that will require the state Legislature to muster two-thirds majorities or seek voter approval in order to raise taxes for any purpose. Washington lawmakers suspended a similar 2007 initiative this year as they tried to close a $2.8 billion budget deficit.
Another initiative opposed by the hospital association but approved by Washington voters last week rolls back taxes on candy, soda and bottled water adopted this year in order to avert cuts to Medicaid and other programs.
Medical marijuana didn’t fare much better. Measures in Oregon and South Dakota were defeated and another in Arizona was too close to call at deadline. <
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