Overview

Legislation

News

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Overview

This month’s State Policy Focus is devoted to state legislation relating to healthcare for the uninsured. There has been a great deal of legislative activity in this area in 2007, and this report provides a snapshot of the larger-scale reforms proposed in the state legislatures this year. Expansions of the State Children’s Health Insurance Program (SCHIP) have not been included unless they are part of a larger initiative to cover the uninsured.

The National Council and the National Alliance on Mental Illness (NAMI), through a grant from the Robert Wood Johnson Foundation, have begun a project to examine state programs and plans to cover the uninsured and the mental health and addiction treatment benefits they offer. We will be providing all members with an update on this project in early 2008.

Thirty-seven states filed 132 pieces of legislation relating to healthcare for the uninsured in 2007. A total of 14 such bills were enacted in Colorado, Hawaii, Indiana, Louisiana, Minnesota, Missouri, Montana, Oregon, Rhode Island and Washington.

Illinois, Massachusetts, Michigan, New York, Ohio and Pennsylvania are still in session and currently have 19 bills pending. While legislative sessions have adjourned in Alaska, California, Delaware, Georgia, Hawaii, Iowa, Maine, Minnesota, North Carolina, Rhode Island, Tennessee, Vermont and Washington, a total of 57 pieces of legislation concerning the uninsured will carry over to 2008.

California Republican Gov. Arnold Schwarzenegger vetoed one bill, AB 8. Consideration of the governor’s veto is currently pending.

A total of 35 bills on this topic died in Connecticut, Florida, Indiana, Kentucky, Maine, Maryland, Missouri, Montana, North Dakota, New Mexico, Oregon, Texas, Virginia and West Virginia.

Allison Fort

Policy Associate

Tammy Seltzer

Director of State Policy

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Legislation

Colorado SB 211 was signed by Democratic Gov. Bill Ritter on May 31. This bill creates a 15-member advisory committee to develop and oversee the implementation of a plan to provide health coverage for all low-income children by the end of 2010. The committee will:

• Make recommendations for changes in legislation and rules to increase enrollment of children in Medicaid and SCHIP.
• Analyze enrollment and reenrollment barriers to Medicaid and SCHIP, and methods to overcome the barriers.
• Investigate the feasibility of expanding the sites with direct access to the state system for enrollment in Medicaid and SCHIP.
• Investigate the feasibility of centralizing enrollment in Medicaid and SCHIP.
• Analyze methods to improve communication among the State Department, the Department of Human Services and county departments of social services.
• Investigate the feasibility of sharing income eligibility information and verification with other benefit programs.
• Review quarterly enrollment data for Medicaid and SCHIP by county or geographic region.

The committee is scheduled to terminate on July 1, 2012.

SB 211 also requires the state Health Department, no later than January 1, 2008 and by January 1 each year thereafter, to submit a report to the Health and Human Services committees of the Senate and House on measures of access to and quality of health care for children eligible for programs developed by this bill.

The Health Department will also develop standards and methods for collecting, analyzing and disclosing information regarding clinical performance, including immunization rates, medical home standards, clinical care guidelines, care coordination, case management, disease management, and coordination and integration of mental health services. The department will review the data collected, assess the health outcomes for programs administered by the department, and report to the Senate and House Health and Human Services committees on or before July 1, 2008.

Hawaii HB 1008 was signed by Republican Gov. Linda Lingle on June 30. This bill creates the Hawaii infant health care program. This program provides continuous, quality health care services to uninsured newborn children between one day and 30 days. The program also provides up to $10,000 of health care assistance per eligible infant.

HB 1008 also establishes a pilot program, entitled the Hawaii children’s health care program, to provide health care coverage to uninsured children. The coverage will be provided through a public-private partnership between the Department of Human Services (DHS) and one or more managed care plan that offers accident and health or sickness insurance plans.

To qualify for this pilot program, a child will need to be at least 31 days to less than 19 years old, and have been uninsured continually for at least six months, provided that infants between 31 days and six months would have been uninsured continually since birth. The child will also have to be ineligible for any other state or federal health care coverage.

DHS and the managed care plan will share equally in the cost of the premium for each child enrolled in the pilot program and will pay the state’s share of the premiums under the pilot program on a quarterly basis.

The managed care plan will be responsible for determining the eligibility of the Hawaii children’s health care program applicants and of enrolling applicants in the pilot program. The managed care plan will need to provide a quarterly report to DHS and the legislature on the number of children enrolled in the pilot program.

Other private organizations will be allowed to partner with the state to offer coverage to uninsured children, provided that the plan benefits will be equal to or better than those offered through the pilot program established by the state and a managed care plan.

HB 1008 also requires DHS to provide state-funded medical assistance free-of-charge to persons younger than 19 whose family income is at or below 300 percent of the federal poverty level (FPL). The person must be a legal permanent resident and/or non-immigrants from the Trust Territories of the Pacific Islands, who are otherwise eligible for benefits under the state’s Medicaid programs, including QUEST and SCHIP, but are ineligible due to restricted eligibility rules.

The department will need to provide medical assistance under QUEST-Net at no charge to children 19 or younger whose family income is at or above 250 percent FPL, but does not exceed 300 percent FPL, and who are otherwise eligible for QUEST-Net benefits.

The bill will appropriate, the following amounts out of general revenue:

• $150,000 for fiscal year (FY) 2007-2008 and $250,000 for FY 2008-2009 for the Hawaii infant health care program.
• $700,000 for FY 2007-2008 and $900,000 for FY 2008-2009 for the Hawaii children’s health care program.
• $109,000 for FY 2007-2008 and $218,000 for FY 2008-2009 for state-funded medical assistance.
• $350,000 for FY 2007-2008 and $700,000 for FY 2008-2009 to provide medical assistance under QUEST-Net.

This bill became effective on July 1, 2007. The pilot programs are scheduled to terminate on June 30, 2010.

Hawaii HR 136 was adopted by the House on April 12. The resolution urges the U.S. Congress to enact H.R. 676, the United States National Health Insurance Act.

Indiana HB 1678 was signed by Republican Gov. Mitch Daniels on May 10. The bill became Public Law 218. This bill establishes the Indiana check-up plan and the Indiana check-up plan trust fund. The plan includes the following services: mental health care, inpatient hospital, prescription drug coverage, emergency room, physician office, diagnostic, outpatient, comprehensive disease management, home health, urgent care center, preventative care, family planning, hospice and substance abuse services.

To be eligible for participation in the plan an individual needs to be a U.S citizen and a resident of Indiana for at least 12 months who is at least 18 years of age and less than 65 years of age. The annual household income can not exceed 200 percent FPL. The individual can not be eligible for health insurance coverage through their employer and can not have had health insurance coverage for at least six months.

The Indiana check-up plan trust fund was established to administer a plan which provides health insurance coverage for low income residents of the state. The fund will provide co-payments, preventative care services and premiums for individuals enrolled in the plan. The plan will also fund tobacco use prevention and cessation programs, childhood immunization programs and other health care initiatives designed to promote the general health and well being of Indiana residents.

HB 1678 also establishes a plan task force. The Indiana check-up plan task force will:

• Study, monitor, provide guidance, and make recommendations to the state concerning the Indiana check-up plan.
• Develop methods to increase availability of affordable coverage for health care services for all Indiana residents.
• Develop an education and orientation program for individuals participating in the plan.

The task force will need to report findings and make recommendations to the governor and to the legislative council, in an electronic format, no later than November 1, 2008. A final report will need to be submitted no later than November 1, 2009. The task force is scheduled to expire on December 31, 2009.

To fund the plan the state will increase the cigarette tax by 44 percent. Twenty-seven percent of the money received from the increase will go toward the check-up plan.

This bill also provides the following:

• Increases the CHIP eligibility family income limit from 200 percent of the FPL to 300 percent FPL.
• Continuous eligibility of a child under Medicaid and the children’s health insurance program (CHIP) until the child becomes three years of age.
• Allows an employer to take a tax credit for making a health benefit plan available to their employees for the for the first two taxable years that the employer makes the health benefit plan available.
• Requires the Department of Health to establish standards for and certify a small employer qualified wellness program.
• Allows a small employer to receive a tax credit for providing qualified wellness programs.
• Requires health insurers and health maintenance organizations to cover children up to 24 years old upon request.
• Allows certain small employers to join together to purchase group health insurance and allows the insurance commissioner and the office of the secretary of family and social services to develop a program to provide for such purchases.
• Requires the Indiana comprehensive health insurance association to administer plan benefits for high risk individuals insured under the plan.
• Requires application for necessary federal Medicaid approvals, including approval for presumptive eligibility for certain pregnant women and implementation of the plan.

Louisiana HB 542 was signed by Democratic Gov. Kathleen Blanco on July 10 and became Act 407. This bill creates the Louisiana Children and Youth Health Insurance Program within the Department of Health and Hospitals. The department will have the same powers and authority to administer the program as provided to it in connection with the administration of the Medicaid program and LaCHIP, and will coordinate the program with the existing children’s health programs it operates.

To be eligible for the program, HB 542 requires a child be ineligible for medical assistance under the Medicaid program or benefits under LaCHIP and where the family income is between 200 percent and 300 percent FPL.

The child must also meet at least one of the following requirements:

• Be without health insurance for a period of time set forth in rules promulgated by the department.
• Have a parent who has lost employment and health insurance, which leaves the child without available, affordable dependent health insurance coverage, until such time as affordable employer-sponsored dependent health insurance coverage is again available for the child as set forth in rules promulgated by the department.
• Be a newborn whose responsible party does not have available, affordable private or employer-sponsored health insurance.
• Have lost medical benefits under the Medicaid program or LaCHIP within one year of applying for coverage under this program.

An eligible child will remain eligible for the program for 12 months, but will lose eligibility if the required premiums are not paid in a timely manner or if the child is in the custody of a juvenile or an adult detention facility.

HB 542 requires the department to promulgate rules regarding hardship provisions annual renewals of eligibility for the program, reenrollment, grace period, notice requirements and hearing procedures. The department will also need to determine the availability and affordability of private or employer sponsored health insurance, with consideration of such factors as the percentage of income needed to purchase individual or family health insurance, the availability of employer subsidies and other relevant factors.

The department is required to use the same simplified enrollment processes and application form that are used for the Medicaid program and LaCHIP. In addition, the department will need to provide a secure system and authorize an application to be submitted by electronic transmission via the Internet, make presumptive eligibility determinations for children as provided by federal guidelines, and contract with local entities throughout the state to assist with outreach and enrollment activities.

The department is required to establish requirements concerning monthly premiums, co-payments, and coinsurance for health care services. This cost sharing will need to be on a sliding scale based on family income up to 300 percent FPL. There will be no co-payment required for well-baby or well-child health care, including but not limited to age-appropriate immunization as required under state and federal law.

The department also will have the authority to:

• Collect required premiums from the family or responsible party for a child receiving benefits.
• Notify the family or responsible party of a child who is paying a premium of any changes in such premium or co-payment requirements.
• Refuse payment of services for nonpayment of premium.
• Monitor the availability and retention of employer-sponsored dependent health insurance coverage to promote retention of private or employer-sponsored health insurance and timely access to health care services.

HB 542 became effective immediately.

Minnesota HF 1078 was signed by Republican Gov. Tim Pawlenty on May 25. The bill became Chapter 147 of the Laws of 2007. HF 1078 allows the Commissioner of Health to provide planning grants to up to three community partnerships. The grants will be used to develop a comprehensive proposal to provide affordable health care services to uninsured and underinsured individuals with chronic health conditions through an integrated community partnership system. A community partnership requesting a planning grant must submit a planning proposal that includes:

• Methods for identifying potential uninsured or underinsured individuals and patients who have or who are at risk of developing a chronic health condition.
• Methods to integrate and coordinate medical, mental health and chemical health services with services provided through county social services, corrections, public health, school districts and health care providers.
• Providing early intervention and prevention activities.
• Methods to identify and support accountability across public and private systems, including means to measure outcomes and economic savings from providing services through an integrated system.

The commissioner will give preference to planning proposals that have broad community support and provide services to uninsured or underinsured individuals of every age who have or are at risk of developing multiple, co-occurring chronic conditions. Proposals that also have integrated or coordinated resources from multiple sources and demonstrate how administrative costs for health plan companies and providers can be reduced through greater simplification, coordination, consolidation, standardization, reducing billing errors or other methods will also receive preference.

Proposals needed to be submitted to the commissioner by December 15, 2007. The commissioner will need to submit a report to the legislature by February 15, 2008, that  identifies the community partnerships that received a planning grant and summarizes the planned initiatives submitted to the commissioner.

Missouri Republican Gov. Matt Blunt signed SB 577 on July 2. This bill establishes the MO HealthNet program which will replace the state’s Medicaid program. The goal of the program is to shift the focus of state-funded health care to prevention and early detection of diseases. MO HealthNet will:

• Set up health care homes at existing facilities to serve as a central point of contact for patients, and help patients create personalized long-term health plans.
• Restore dental and vision care for Medicaid beneficiaries.
• Restore coverage for necessary medical equipment for adults, such as canes, catheters and hospital beds.
• Restore coverage for up to 13,500 children who were cut from the program two years ago. Premiums for children will be between three and five percent of a parent’s annual income.
• Create a health program for uninsured women with annual incomes up to 185 percent FPL. The program will provide cancer screenings and family planning services, such as pelvic exams and Pap tests, to about 80,000 women.
• Reinstate coverage for about 3,200 disabled workers.
• Raise payments to medical providers up to the federal maximum within four years.
• Extend health care to 970 former foster children ages 18 to 21.
• Authorizes 100 percent of the amount paid for non-reimbursed qualified long-term care insurance premiums to be deducted from a taxpayer’s Missouri taxable income to the extent the amount is not already included in the taxpayer’s itemized deductions. 
• Add psychiatrists, psychologists and other mental health providers, such as professional counselors and social workers, to the list of providers eligible for assistance through the Primary Care Resource Initiative for Missouri (PRIMO) program.
• Promulgate rules governing the practice of telehealth in the MO HealthNet program.
• Revise laws surrounding Medicaid fraud.
• Provide that individuals with more than $500,000 in home equity will no longer qualify for long-term care services under MO HealthNet.
• Develop a premium offset pilot project to make standardized health insurance coverage available to qualified individuals.
• Create the Missouri Healthcare Access Fund to be used to expand healthcare services in state and federally designated areas with healthcare shortages.

Montana HJ 48 was adopted and filed with the Secretary of State on May 4. This joint resolution requires the Legislative Council to designate an appropriate interim committee to study and make recommendations on reforms of the Montana health insurance and health care systems, including publicly funded health care programs. The study must address the creation of a system of universal, portable, affordable health insurance coverage for all Montanans that involves private health insurance issuers, and incorporates existing public programs and ways to improve the quality, affordability and delivery of health care.

The committee must examine the concept of a health insurance exchange and how such a concept could be implemented in Montana. The study, including presentation and review requirements, must be concluded no later than September 15, 2008.

Oregon SB 3 was signed by Democratic Gov. Ted Kulongoski on July 17 and became Chapter 788 of the Laws of 2007. This bill creates the Oregon Healthy Kids Program, which will provide affordable, accessible health care for Oregon’s children. The program will be comprised of:

• Medical assistance administered by the Department of Human Services provided to children under the state programs funded by Medicaid, Medicare and SCHIP.
• A private health option administered by the Office of Private Health Partnerships.
• A statewide Healthy Kids Advice Line.
• A statewide Healthy Kids Healthcare Access Line.

With the enactment of this bill, a child is eligible for enrollment in SCHIP if the household income of the child’s family is no more than 200 percent FPL, and the child has been uninsured for a minimum of 60 consecutive days immediately preceding enrollment.

The Office of Private Health Partnerships will be created to administer a private health option to expand private health care coverage for Oregon’s children. The office will contract with carriers to provide health benefit plans that must offer benefit packages comparable to those provided by medical assistance programs and must cover mental health, vision and dental services. The plans cannot exclude coverage of pre-existing conditions. The plans may also impose co-payments or co-insurance amounts that are based upon criteria adopted by the office.

The office must provide a subsidy for a health benefit plan for a child whose family’s household income is more than 200 percent but no more than 300 percent FPL. The amount of the subsidy will be based on household income, family size and other factors established by the office. The office will adopt rules that allow families with household incomes that are more than 300 percent FPL to purchase health benefit plans offered through the private health option.

Oregon SB 329 was signed by Governor Kulongoski on June 28 and became Chapter 697 of the Laws of 2007. The bill became effective immediately. The intent of the Healthy Oregon Act is to develop an Oregon Health Fund program comprehensive plan that meets the intended goals of the program to:

• Cover the current uninsured population in Oregon through the expansion of the state Medicaid program, the Oregon State Children’s Health Insurance Program and the Family Health Insurance Assistance Program.
• Reform the health care delivery system to maximize federal and other public resources without compromising proven programs supported by federal law that ensure to vulnerable populations access to efficient and high quality care.
• Ensure that all Oregonians have timely access to and participate in a health benefit plan that provides high quality, effective, safe, patient-centered, evidence-based and affordable health care delivered at the lowest cost.
• Develop a method to finance the coverage of a defined set of essential health services for Oregonians that is not necessarily tied directly to employment.
• Allow the potential for employees, employers, individuals and unions to participate in the program, or to purchase primary coverage or offer, purchase or bargain for coverage of benefits beyond the defined set of essential health services.
• Allow for a system of public and private health care partnerships that integrate public involvement and oversight, consumer choice and competition within the health care market.
• Use proven models of health care benefits, service delivery and payments that control costs and over-utilization, with emphasis on preventive care and chronic disease management using evidence-based outcomes and a health benefit model that promotes a primary care medical home.
• Provide services for dignified end-of-life care.
• Restructure the health care system so that payments for services are fair and proportionate among various populations, health care programs and providers.
• Fund a high quality and transparent health care delivery system that will be held to high standards of transparency and accountability and allows users and purchasers to know what they are receiving for their money.
• Ensure that funding for health care is equitable and affordable for all Oregon residents, especially the uninsured.
• Ensure that annual inflation in the cost of providing access to essential health care services does not exceed the increase in the cost of living for the previous calendar year.

SB 329 establishes the seven member governor appointed Oregon Health Fund Board.

The board will establish a committee to examine the impact of federal law requirements on reducing the number of Oregonians without health insurance, improving their access to health care and achieving the goals of the “Healthy Oregon Act.” The committee will particularly need to focus on barriers to reducing the number of uninsured Oregonians, including but not limited to:

• Medicaid requirements such as eligibility categories and household income limits.
• Federal tax code policies regarding self-insurance and portability of health insurance.
• Emergency Medical Treatment and Active Labor Act regulations that make the delivery of health care more costly and less efficient.
• Medicare policies that result in Oregon’s health care providers receiving significantly less than the national average Medicare reimbursement rate.
  
  

The committee will survey providers, consumers and administrators and determine how this and other Medicare policies and procedures affect costs, quality and access. The committee will assess how an increase in Medicare reimbursement rates to Oregon providers would benefit Oregon in health care costs, quality and access to services including access for persons with disabilities and long term care. With the approval of the Board, the committee will report its findings to the Oregon congressional delegation no later than July 31, 2008.

The Oregon Health Fund Board will finalize the comprehensive plan developed by the committee and present the plan to the governor, the House Speaker and the Senate President no later than October 1, 2008.

Rhode Island HB 6529, which was vetoed by Republican Gov. Donald Carcieri on July 3, was overridden by the House and Senate on October 30, 2007. The bill became Chapter 516 of the Laws of 2007.

HB 6529 amends Chapter 66.2.1 of the General Laws which was renamed the Rhode Island Best RX Prescription Drug Discount Program for the Uninsured. To be eligible for the discount program a person must:

• Be a resident of the state.
• Be over the age of 60 and ineligible for Medicare Part D.
• Receive Social Security Disability Insurance benefits.
• Be uninsured for prescription drugs and have an annual family income at or below 300 percent FPL.

HB 6529 also establishes the Rhode Island Best Rx Program Advisory Commission. The Commission will be responsible for the marketing, education and promotion of the discount program, set administrative fees and advise the General Assembly on the operation of the program.

Washington Gov. Christine Gregoire signed SB 5093 on March 13. The bill became Chapter 5 of the Laws of 2007. SB 5093 will expand access to state health care for low-income children by providing free or state subsidized coverage to any family making 300 percent FPL. Currently, in order to qualify for state health care benefits, children must live in families whose annual income is 250 percent FPL. Proponents believe that this new measure will provide coverage for an additional 38,000 children over the next two years.

Washington SB 5930, a bill relating to high quality, affordable health care was signed by Governor Gregoire on May 2. The bill became Chapter 259 of the Laws of 2007. SB 5930 touches upon the following issues:

• The use of state purchasing to improve health care quality.
• Prevention and management of chronic illness.
• Cost and quality information for consumers and providers.
• Reducing unnecessary emergency room use.
• Reduce health care administrative costs.
• Coverage for dependents to age 25.
• Sustainability and access to public programs.
• Reinsurance and the Washington State Health Insurance Pool.
• Prevention and health plan promotion.
• Prescription monitoring program.
• Strategic health planning.
• Public health.

The following are some of the highlights from the bill.

SB 5930 requires the Health Care Authority and the Department of Social Services to develop a five year plan to change reimbursement within state purchased health care programs. The plan will reward quality health outcomes rather than simply paying for the receipt of particular services or procedures. The plan will also pay for care that reflects patient preference and is of proven value. It will require the use of evidence-based standards of care where available, tie provider rate increases to measurable improvements in access to quality care, direct enrollees to quality care systems, better support primary care and provide a medical home to all enrollees.

The plan will also need to pay for e-mail consultations, telemedicine, and telehealth when doing so reduces the overall cost of care, and identify any existing barriers and opportunities to support implementation, including needed changes to state or federal law.

SB 5930 establishes the Washington state quality forum within the Health Care Authority. The forum will collaborate with the Puget Sound Health Alliance and other local organizations. The forum will collect and disseminate research regarding health care quality, evidence-based medicine, and patient safety to promote best practices, in collaboration with the technology assessment program and the prescription drug program. It will coordinate the collection of health care quality data among state health care purchasing agencies, adopt a set of measures to evaluate and compare health care cost and quality and provider performance, identify and disseminate information regarding variations in clinical practice patterns across the state. The forum will need to produce an annual quality report detailing clinical practice patterns identified to purchasers, providers, insurers, and policy makers.

Dependents younger than 25 will also receive health care coverage under this bill. SB 5930 will require any plan offered to employees under this chapter the option of covering any unmarried dependent younger than 25.

The eligible dependent will need to be age 20 to 23 and not a registered student at an accredited secondary school, college, university, vocational or nursing school or the dependent must have a disability, a developmental disability, mental illness, or mental retardation and be incapable of self-support to receive the same premiums and payment structure. A dependent who is 24 years of age will be required to pay the full cost of the coverage.

This bill also requires that any disability, group or blanket disability insurance contract, individual or group health care service plan contract and individual or group health maintenance agreement, offer the option of covering any unmarried dependent younger than 25.

SB 5930 also requires the Department of Social and Health Services to seek necessary federal waivers and state plan amendments to expand coverage and leverage federal and state resources for the state’s basic health program, for the medical assistance program and the state’s children’s health insurance program. The department will need to propose options including:

• Offering alternative benefit designs to promote high quality care, improve health outcomes, and encourage cost-effective treatment options, including benefit designs that discourage the use of emergency rooms for non-emergent care, and redirect savings to finance additional coverage.
• Creation of a health opportunity account demonstration program for individuals eligible for transitional medical benefits.
• Promoting private health insurance plans and premium subsidies to purchase employer-sponsored insurance wherever possible, including federal approval to expand the department’s employer-sponsored insurance premium assistance program to enrollees covered through the state's children's health insurance program.
  
  

The department, in collaboration with the Washington State Health Care Authority, will also need to ensure that enrollees are not simultaneously enrolled in the state’s basic health program, the medical assistance program or the state’s children’s health insurance program to ensure coverage for the maximum number of people within available funds. When the department determines that it is cost-effective to enroll a person eligible for medical assistance into an employer-sponsored health plan, the carrier is required to permit the enrollment of the person in the health plan for which he or she is otherwise eligible without regard to any open enrollment period restrictions.

Illinois, Massachusetts, Michigan, New York, Ohio and Pennsylvania have 19 bills pending. Illinois HB 1534 and SB 5 would create a children’s health insurance task force and the Margaret Smith Illinois Covered Act respectively. These bills would make recommendations relating to access to quality, affordable, comprehensive health insurance for all Illinoisans.

Massachusetts HB 1137 will establish the Massachusetts Health Care Trust. The Health Care Trust will provide continuous and affordable coverage for individuals and families in the state without regard to financial status, ethnicity, gender, previous health problems or geographic location. HB 1148 would require health care facilities to establish self-pay patient programs and provide information on the program. This bill is designed to prevent uninsured consumers from being charged more for needed services than consumers who are insured. HB 1897 would establish an assistance program for the treatment of all substance dependent persons who are not otherwise eligible for assistance under any other program and who lack private health insurance coverage or have health insurance coverage which does not cover all necessary treatment.

Michigan SB 278 would create the “Michigan helping ensure affordable and reliable treatment (MI-HEART) act.” This act would promote the availability and affordability of health coverage in this state and help facilitate the purchase of that coverage.

New York AB 4520 is designed to ensure that uninsured persons discharged from mental hospitals have continuous access to medications. The bill would also expand the medical assistance presumptive eligibility program to include persons without insurance who are discharged from psychiatric inpatient care. SB 3107 would establish the New York health plan which would provide universal health coverage for all residents, and access to and choice of health care providers. SB 3168 would create a task force on universal long term care insurance to develop a plan for the financing and provisions for universal long term care insurance for all New Yorkers.

Identical Ohio bills, HB 186 and SB 168, would establish and operate the Ohio Health Care Plan to provide universal health care coverage to all Ohio residents. SB 251 would create a pilot program to award $5 million in grants to programs that provide access to health care for the uninsured.

Similar Pennsylvania bills, HB 700, HB 1870 and SB 1117, would establish the Cover All Pennsylvanians (CAP) health insurance program. The bill would assist small business employers in covering their uninsured employees and provide affordable coverage for uninsured adult Pennsylvanians. HB 1660 would create the Pennsylvania Health Care Plan, a comprehensive health care system which includes eligibility for access to universal healthcare coverage. HB 2005 would allow a health insurer, at the option of a child’s parents, to renew, deliver or execute a policy for a child through the age of 29 provided that the child is not married, has no dependents, is a resident of the state and is not covered by another health insurance policy. HR 334 would establish a task force to study affordable health care insurance, health care access and quality health care services as they relate to providing health care to uninsured citizens. The task force would explore all potential funding sources so the Commonwealth of can guarantee health insurance coverage for all of its residents.

The following states have adjourned but will carry over 57 pieces of legislation to 2008: Alaska, California, Delaware, Georgia, Hawaii, Iowa, Maine, Minnesota, North Carolina, Rhode Island, Tennessee, Vermont and Washington. Some of the bills are as follows:

• Identical Alaska bills HB 242 and SB 160 would establish a health care program to ensure insurance coverage for essential health services for all residents of the state. The bills would also establish the Alaska Health Care Board to define essential health care services, certify health care plans that provide essential health care services, and to administer the Alaska health care program and the Alaska health care fund.
• Hawaii HB 56 would establish the Hawaii health commission which would need to develop a health plan to provide healthcare coverage for all individuals in the state.
• Maine LD 1072 would establish the Maine Health Care Plan, a universal health care system to provide security through high-quality, affordable health care for the people of the state.
• Identical Minnesota bills HF 479 and SF 102 would require the Commissioner of Health Care Access to design a universal health care system to ensure all Minnesotans receive high quality health care, regardless of their income.
• North Carolina HB 1897 would create the North Carolina Health Care for All Planning Commission to conduct a comprehensive review of the current health care system in the state and make recommendations to the General Assembly on moving from a fragmented system to an integrated system of public and private health care services so all residents have access to appropriate health care on a regular basis.
• Rhode Island HB 5610 would appropriate $3.6 million to community health centers to enable them to continue delivery of primary care services to the uninsured.
• Identical Tennessee bills HB 715 and SB 563, would create and administer a pool of funds to be used to make special payments to community service providers who provide behavioral health services to those persons in need of such services who are uninsured or medically indigent.
• Identical Tennessee bills, HB 813 and SB 662, would create a program to provide improved statewide access to timely and appropriate behavioral health services for uninsured individuals who are in need of such services but are not determined to be experiencing a psychiatric crisis.
• Vermont SB 182 would provide access to Catamount Health for underinsured individuals and those employed by farms and small businesses.
• Washington HB 2098 would provide a plan to develop high quality, affordable health care to Washingtonians based on the recommendations of the blue ribbon commission on health care costs and access.

News

California Republican Gov. Arnold Schwarzenegger and Democratic Assembly Speaker Fabian Núñez have reached a tentative agreement on a $14 billion plan to overhaul California’s health care system, officials said on December 14.

Daniel Zingale, a senior adviser to Governor Schwarzenegger, said the leaders “have agreed on the framework of health care reform that will go before voters” in November 2008, the Los Angeles Times reports. Under the compromise plan, nearly all residents would be required to obtain health care coverage.

Residents with incomes up to 250 percent of the federal poverty level (FPL) would receive state subsidies for coverage, and residents with incomes up to 400 percent FPL would be able to fully deduct any health care premium costs that exceed 5.5 percent of their incomes. In addition, residents who retire before they qualify for Medicare at age 65 would receive tax credits to prevent them from spending more than 10 percent of their savings on health insurance. Low-income residents would be exempt from the coverage mandate if they would be required to spend more than five percent of their income on minimal coverage and do not qualify for public programs.

The plan would extend coverage to children in families with incomes up to 300 percent FPL, regardless of immigration status. In addition, insurers would be prohibited from denying coverage to residents because of pre-existing medical conditions and would have to spend at least 85 percent of premiums on medical care. The state Assembly is scheduled to vote on the bill today.

Schwarzenegger and Núñez also revised how much employers would be required to pay toward health coverage. Under a new sliding scale, businesses would pay the following:

• Those with payrolls up to $250,000 would contribute one percent of payroll toward coverage.
• Those with payrolls from $250,000 to $1 million would contribute four percent toward coverage.
• Those with payrolls from $1 million to $15 million would contribute six percent.
• Those with payrolls greater than $15 million would contribute 6.5 percent.

In addition, Schwarzenegger has agreed to Núñez’s proposal to partially finance a health care system overhaul by increasing the state’s tobacco tax. Núñez supports a $2 tobacco tax increase, while Schwarzenegger favors a $1.50 increase. Democratic Senate President Pro Tempore Don Perata said a proposed tobacco tax increase is “flawed only because big tobacco has a huge amount of money” to spend on defeating the measure, reported the Sacramento Bee.

The plan also would be funded through a 4 percent tax on hospital revenue in an effort to secure matching federal funds and boost reimbursements for services. In addition, the plan expects about $5 billion in new federal funding, mostly for Medi-Cal.

The legislation does not contain the taxes or other measures that would provide the $14 million in funding needed for the overhaul. Those revenue provisions would go before the voters on the November 2008 ballot, and the bill would not take effect unless state residents approve that measure.

Núñez said that an overhaul bill must be approved by the Democratic-controlled Legislature and signed by Schwarzenegger by Friday to secure enough time to qualify a financing measure for the November 2008 ballot.

Senator Perata, however, told Democratic lawmakers earlier this month that they would not have to return to the Capitol until next year. Núñez said it is “possible to get something on the ballot before November without doing it this week.” Perata said he believes lawmakers should not vote on a health care plan until the state determines how much funding will be cut from health programs such as Medi-Cal to help reduce a projected $14 billion state budget shortfall.

Schwarzenegger acknowledged that state spending will be cut “across the board,” including from Medi-Cal’s budget, but noted that the health care plan would boost Medi-Cal funding. The governor also argued that the plan would not require money from the general fund and would prevent some budget cuts.

Pennsylvania Democratic Gov. Ed Rendell has proposed a new funding source for a plan that would provide health insurance for the nearly 800,000 uninsured adults in the state. According to the Pittsburgh Post-Gazette, Governor Rendell’s Cover All Pennsylvanians initiative had “fallen flat” in part because of a proposed three percent tax on the payrolls of businesses that do not offer coverage to their employees. The Pennsylvania House Insurance Committee approved SB 1137 last week and the full House is expected to vote on the legislation early next week.

Rendell’s new funding plan would use half of the revenue from the State’s Health Care Provider Retention Account, which is funded by 25 cents of the state’s $1.35-per-pack cigarette tax and is projected to reach $414 million by December 31. The account was created to offset medical malpractice costs, but fewer malpractice lawsuits and lower malpractice insurance premiums have led to a surplus in the account. Rendell would pay for the coverage expansion through a 10-cents-per-pack increase in the state cigarette tax, which would generate an estimated $65 million annually, and a first-time tax on the sale of cigars and smokeless tobacco, which could generate $50 million annually. The governor would also use $40 million from a fund that pays for the care of people involved in catastrophic automobile accidents.