Managed care liability, uninsured, and tobacco top list of priorities in 2000 state legislative sessions
Managed care liability, uninsured, and tobacco top list of priorities in 2000 state legislative sessions
While perennial issues such as Medicaid, the Children’s Health Insurance Program, and caring for the uninsured will appear in most state houses in upcoming legislative sessions, lawmakers also plan to tackle problems that were largely unknown five years ago, says a survey by the National Conference of State Legislatures (NCSL) in Washington, DC.
Regulation of Internet dispensing of drugs is likely to come up in 19 states, and confidentiality concerns surrounding digital signatures or electronic records is an issue in about one-quarter.
A lightning rod’
Though the 1990s was the "decade of managed care reform," there’s still some work to be done," says NCSL. Of the 48 states responding to the survey, 44 expect to address in the next session some aspect of managed care, most notably insurer liability or quality.
Georgia, Texas, and California are the only states with laws holding health plans accountable for the care provided to their members, but the issue remains the "lightning rod" for concerns about access and quality in managed care, says Lee Dixon, director of the NCSL Health Policy Tracking Service. States unwilling to assign liability to health plans still may consider measures such as stronger grievance procedures, he says.
Tobacco settlement funds — now flowing freely to the states — promise to make budget negotiations even more high profile than usual.
"Certainly, tobacco is going to be a leading issue, just as it was in 1999," he says. Their coffers are full, but "states are not really going overboard on spending," says Mr. Dixon. "I still think they’re taking a cautious approach and thinking, These are flush days, but it might not always be this way.’"
The growing interest in tobacco securitization, a method of borrowing against future settlement payments, reflects this wariness.
"Many state legislators are concerned about what’s going to happen to the industry — how stable are these dollars? Many states are thinking about securitization [to] transfer the risk to somebody else and have the state get its money upfront," he says. (See related story, p. 1.)
While recognizing that the number of violent incidents involving youth has decreased in recent years, the NCSL notes that the degree of violence in such acts has risen. In the upcoming sessions, 25 states are expected to consider measures to toughen penalties for violence on school grounds, increase funding for mental health programs, increase safety on school grounds, and increase coordination among relevant government agencies.
On the heels of a successful push in California, laws that would mandate minimum nursing staff ratios have caught the imagination of legislators around the country. Some 21 states expect to consider such mandates in the upcoming session, compared to the five that took up the issue last year. California, the only state which enacted a minimum staffing ratio, is expected to extend the effective date of the legislation from Jan. 1, 2001 to Jan. 1, 2002 to allow time for the regulatory and technical tasks involved in implementation. (See State Health Watch, December 1999, p. 5.)
The full survey is available for $35 plus $2 shipping and handling from the National Conference of State Legislatures at (202) 624-5400.
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