STATE LEGISLATURES: Survey Highlights Priorities For ’99
Managed care reform, long-term care and children's health care are likely to be the hottest health care issues in statehouses next year, according to the National Conference of State Legislatures. The NCSL's Health Policy Tracking Service found that those three issues were named most often in a poll of state legislatures, governor's offices and executive agencies. The annual poll showed that 31 states expect to consider HMO liability, 22 states expect to consider legislation establishing an independent appeal process for denials of care, and 15 states expect to consider "any willing provider" legislation. Other issues likely to receive attention include medical records confidentiality, drug formulary regulation, mental health parity and insuring indigent and high-risk populations.
Driven by aging populations and highlighted by several prominent elder-care scandals, almost every state expects to consider some aspect of long-term care for the elderly and disabled. Of the 45 states where long-term care services are expected to be on the agenda, 32 are expected to consider legislation on assisted living and nursing facilities and 26 states expect to address the availability of prescription drugs for the elderly. A significant percentage of states expect to consider bills that would extend prescription-writing rights or otherwise expand the scope of practice of non-physicians: 24 states to nurse practitioners, 14 states to pharmacists, 13 states to midwives, 12 states to psychologists and 11 states to physician assistants.
What About The Kids?
Now that almost every state has submitted a children's health plan under the federal CHIP program, many expect to undertake further efforts in that direction -- 40 states plan to consider CHIP enhancements or changes. Many states rushed to enact "placeholder" plans while they took the time to design more far- reaching programs. Twenty-three states are planning to take up school-based health service legislation, 19 expect to consider bills on teenage pregnancy and 11 expect to consider mandatory coverage of hearing screenings for newborns. Also, following the lead of Wisconsin's BadgerCare, more states may attempt to bundle family health plans along with CHIP programs in an attempt to insure more of those who earn too much to qualify for Medicaid but too little to afford private health insurance.
On the horizon of emerging issues, the HPTS predicts that mandated coverage of contraceptives, currently available only to federal employees and citizens of Maryland and Texas, will be an increasingly common issue before state legislatures -- 25 states said they expect to consider contraception bills in 1999. School-based health clinics and pediatric mental health services are also expected to grow in importance (Adam Pasick, California Healthline).