Health Care Reform Around the Nation: Oct. 29, 2007

Delaware has approved a new rule that will require prescriptions for Medicaid beneficiaries to be written on tamper-resistant prescription drug pads, the Wilmington News Journal reports.

Enforcement of the rule will begin in April 2008, after which Medicaid beneficiaries will not be able to fill prescriptions that are not written on the tamper-proof pads. Doctors will be required to pay for the pads, which cost twice as much as nontamper-proof pads.

The prescription pads by April will need to have one tamper-proof characteristic. By October 2008, each pad will need to have three tamper-proof characteristics, according to the rule. The state plans to use the time between now and April to alert physicians of the rule change.

Delaware passed the rule after Congress in May inserted a similar provision in a war spending bill. The federal law was set to take effect Oct. 1, but implementation was delayed until April (Ratyanke, Wilmington News Journal, 10/22).

Georgia Sen. David Shafer (R) in a letter to Department of Community Health Commissioner Rhonda Medows wrote that almost every hospital in the state is getting a portion of the $400 million disproportionate share hospital funding meant only for facilities that provide a large amount of care to low-income and uninsured residents, the Atlanta Journal-Constitution reports.

Shafer wrote that some hospitals that "actually provide disproportionate indigent care are being shortchanged tens of millions of dollars." According to Shafer, expansions in the program have allowed hospitals that provide almost no care to the uninsured to receive money from the fund, turning it into an "across-the-board subsidy for the health care delivery system."

DCH spokesperson Amanda Seals said that cutting funding for some hospitals "would have the potential for contributing to the collapse of hospitals in several communities [that] would not have enough time to develop alternative plans for their communities to have hospital access."

DCH officials have proposed a new formula to distribute the funding, but Shafer says it is not enough (Salzer, Atlanta Journal-Constitution, 10/23).

The Maryland General Assembly during a special session that begins Monday will consider a proposal that would provide $500 million to extend Medicaid coverage to more than 100,000 uninsured residents, the Baltimore Sun reports.

Under the proposal, the Medicaid income eligibility threshold for adults would be expanded from 40% of the federal poverty level to 116% of the poverty level and the state would offer subsidies to small businesses, according to legislative leaders (Smitherman, Baltimore Sun, 10/24).

Maryland Gov. Martin O'Malley (D) has proposed funding the plan by increasing the state sales tax from 5% to 6%, cutting the property tax by three cents per $100 in assessed value, doubling the cigarette tax to $2 per pack and other tax reforms, according to the Sun (Drew, Baltimore Sun, 10/24). He also has proposed legalizing slot machines to generate funds for health care programs.

O'Malley expects that the series of tax increases would generate $2 billion. The state by 2012 would contribute $250 million annually to expand coverage, with the rest coming from federal matching funds.

O'Malley will present the health care package during the special session, which was called to address the state's projected $1.7 billion deficit (Smitherman, Baltimore Sun, 10/24).

The Wisconsin Legislature on Tuesday approved a $57.2 billion state budget that would increase the cigarette tax by $1 per pack and does not include proposed tax increases on hospitals, the Milwaukee Journal Sentinel reports (Forster et al., Milwaukee Journal Sentinel, 10/23).

Gov. Jim Doyle (D) originally had proposed increasing the cigarette tax by $1.25 per pack.

The tax increase would be used to expand health coverage to nearly all children in the state through the new BadgerCare Plus program (Walters et al., Milwaukee Journal Sentinel, 10/19). The proposed budget also would provide $30 million to smoking prevention programs (AP/New York Times, 10/21).

In addition, the budget increases by at least $25 million a one-time transfer of $175 million from a fund that helps pay legal awards in medical malpractice lawsuits. The Wisconsin Medical Society has filed a lawsuit to block the transfer (Walters et al., Milwaukee Journal Sentinel, 10/19).

In other Wisconsin news, state Sen. Jim Sullivan (D) said Healthy Wisconsin, a $15.2 billion proposal by state Senate Democrats to create universal health coverage in the state, has been abandoned, but it could lead to a bipartisan health care reform plan in the state Legislature, the Journal Sentinel reports. Healthy Wisconsin had been a sticking point in the budget discussions, but in September, Democrats agreed to remove it and reintroduce it as separate legislation.

However, state Sen. John Erpenbach (D) said the proposal "in some form is coming back," and it will be modified and reintroduced in the state Senate (Rinard, Milwaukee Journal Sentinel, 10/19).