Public Health, Rx Bills Top State Agendas


Bioterrorism and public health measures arising from the threat of further terrorist attacks loom as high priority issues for states to address this year. They come to the forefront at a time when there may not be enough money in state coffers to support other new healthcare programs or expansions.

Lawmakers will also be busy this year debating bills to address rising prescription drug costs. fine-tuning Medicaid programs to stay within budget, revamping nursing home care oversight and stepping up mental health care coverage.

One issue states won't really look at this year is managed care, experts say. "It's fallen off the face of the earth. Most of the states have done everything they want on managed care," says Lee Dixon of the National Conference of State Legislatures' (NCSL) Health Policy Tracking Service, a group that unveiled a 50-state legislative priority survey last month

Forty-six states have already enacted a patient's bill of rights, a package of measures that gives more legal power to health care consumers.

Lawmakers in 18 state legislatures have introduced bioterror-related measures so far this year. California, Illinois, Tennessee, Missouri and New York will consider sweeping emergency health powers acts, while West Virginia legislators will debate what's being called a Bioterrorism Threat Reduction Act, a measure designed to monitor people who use biological agents and provide criminal and civil penalties for violations.

Twenty-one states are mulling prescription drug legislation that targets rising costs.

Alabama policymakers want to regulate pharmacy benefit managers -- companies that oversee drug benefit programs for state employee health plans and other businesses. In Colorado, lawmakers will discuss limiting what drugs can be prescribed for Medicaid patients and prison inmates while New Mexico aims to require drug companies to report certain product prices to the state's human services agency.

Oklahoma's Angela Monson, who chairs the state Senate Finance Committee and serves on the Appropriations Subcommittee on Health and Social Services says the "giant" issue looming in her state is money for Medicaid. "That will consume the majority of our time," she says.

Monson says oral health, public health, pharmacy cost issues and getting the state into compliance with federal insurance regulations will take up some time, too.

"Money will restrict a lot of new activity, but we'll work on dental care for kids and uninsured adults, and the state's response to bioterrorism in the health arena, not just in public safety," she says.

In New York, lawmakers got out of the blocks early, and okayed a massive health care package in mid-January. Gov. George Pataki subsequently signed the measure, which is known as the Health Care Workforce Recruitment and Retention Act, into law on January 25.

The initiative, which targets health care worker shortages, doles out hundreds of millions of dollars to hospitals, nursing homes, personal care services and community health centers over the next three years. It provides money to expand the state's Medicaid program to cover breast and cervical cancer treatment for poor women and health care for working disabled people. The elderly benefit as well, by getting expanded prescription drug coverage.

How is New York coming up with the money, in light of budget shortfalls? The plan calls for an increase in the cigarette tax , upping the price per pack in New York by 39 cents to $1.50, the highest in the nation.

"Having done so much of the work so quickly will allow us to look at other things like long-term care insurance... and the state's emergency response to bioterrorism," Senate Health Committee chairman Kemp Hannon says.

Other hot topics to watch in the states this year include medical malpractice, and nursing home liability for accidents and deaths. West Virginia okayed a medical malpractice measure which set up a state-run insurance system last December. Pennsylvania and Nevada are among the states already looking at the issue this year. 


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