November 15, 2004 Legislation

Legislative Ballot Issues



Medicare Rules Finalized



Legislative Ballot Issues

California has rejected the mandatory health insurance proposition that was business unfriendly. This had been previously passed by the ex Governor Davis and his Democratic cronies.  Governor Terminator got it on the ballot.

It should be noted that the People's Republic of Massachusetts is now considering the play or pay rules for small business.  This had been repealed in the Republic in the mid 1990s.

California has passed the stem cell research proposition.  This will spend 3 Billion dollars for the study of stem cells not allowed under the federal rules.  It should draw a significant amount of new business to the state to offset the cost of $6 Billion after repayment of the bonds.

California did not pass a tax on telephone service that would have been used to fund hospital EDs and Trauma Centers.

California did pass a tax of 1% on those who make over $1 million per year to fund mental health services. The potential problem is the legislature may transfer any funds for these programs to other programs.  In a down economic cycle there may be no money for funding.  This was seen when the legislature took money away from education when Lotto came in.

The California voters passed a bond proposition to help the state's 13 children's hospitals modernize and pass the seismic retrofit law.  This provided $750 million for this cause.  It will be repaid from the general funds allowing less for other projects. This was one of the few losses for the Guv.

In San Diego County, California, the locals voted to tax themselves on their homes to build a new hospital, to upgrade two hospitals and add medical clinics in the area.  The pro people spent over $1.25 million on the initiative. 

All three physician attorney propositions on the Florida ballot passed.  The physicians won the reduction of fees for attorneys on a sliding scale basis in med mal cases.  The attorneys won the two propositions that would state if a physician lost three malpractice cases they would lose their license and that the public would get to see records of adverse medical incidents at facilities and by providers including those that cause injury or death if patient privacy is kept.  The latter two propositions could really hinder peer review and have more physicians drop risky procedures. They have been challenged in the courts as against public policy of peer review.

Nevada voters came through.  They passed the stronger med mal reforms that the legislature wouldn't.  This gives Nevada basically the same laws as California.  At the same time the voters voted down the dismantling of the med mal liability reforms that had already passed.  The lawyers took it in the ear and other places on both counts.  This will still need to be approved by the Nevada Supreme Court as was done in California.  With the reelection of President Bush and the strengthening of the Republicans in both of the Congressional Houses, it is possible to see a national med mal policy that is equivalent to California's.

Montana voted in medical marijuana.  Oregon rejected a major expansion of their medical marijuana bill.  Alaska, which also has a medical marijuana bill, rejected complete decriminalization of the weed.  In the Midwest, voters in Ann Arbor, Michigan and Columbia, Missouri, both college towns, voted in a medical marijuana law.  The medical marijuana measure will slowly come in in all states with ballot propositions.

Voters in Oklahoma, Colorado and Montana all voted major increases in cigarette taxes.  The money will go to paying for Medicaid and smoking prevention programs.

In Illinois, the Supreme Court has changed as a direct consequence of the med mal problems of the state.  The physicians are still attempting to get through the Democratic lawyer driven legislature a bill to lessen med mal premiums with caps on non-economic damages.  This election will improve the chances of passage of the bill through the courts if it ever gets there.  In the meantime the Supreme Court will continue to change, justice by justice.  

The opposite occurred in two other states.  Oregon and Wyoming both had losses in the election for capping non economic damages.  Oregon is now work with the legislature to get the same protections for the non Medicaid physicians as for those that take it.  Wyoming will work with the legislature to attempt to pass tort reform piecemeal, starting with putting attorney fees on a sliding scale. What did pass was was an act to form a panel to week out frivolous med mal suits. 

It was a terrible election for San Francisco Mayor Newsom.  He got blamed for all the same sex marriage bans that went in through out the country.  He also lost his pull at the polls to increase taxes.  The loss of the increased taxes means the cut in city programs.  This in the health section means a reduction in hours at the health clinics.  The Board would need to also decide what other services to cut.  Hopefully one will be the availability of transgender surgery for free to city employees.     Top


South Carolina is considering the processing of all new medical licensees with criminal background checks.  Those who already licensed will be checked only if they come up for discipline.  The article does not state what will happen if they find someone with a criminal background many years in the past.  The costs for the new physicians would be paid by the applicants.  The cost for the now licensed physicians would be paid by the medical board.         Top 


The Joint Commission several weeks ago paid surprise visits to the LA County hospitals.  They found enough problems with Harbor-UCLA to downgrade their status but not to disaccredit them.  The other hospitals were found to be compliant. 

The first step necessary in the closure of the Drew/King trauma unit, a public meeting, is on November 15.  After that the closure will occur.

Governor Schwarzenegger has proposed and the Department of Health has issued emergency regulations retreating on the ill thought out California nurse patient ratio law.  With the closure of hospitals partially because of the law, the Guv is proposing to delay the implementation of the more restrictive ratios to 1/1/08.  Also the emergency department would be exempt from the rules since it is impossible to get more nurses when there is an influx of patients.  If you take the nurses from the floor, those patients will be shortchanged and it will be too late to get travelers or off duty nurses to come in.  

The Department of Health has inspected 28 facilities to determine compliance with the nurse ration law.  This is a small number of the 451 acute care hospitals in the state.  They found in 15 of the 28 inspections the hospitals did not comply with the poorly thought out law.  There were no fines.

The nurses union will challenge the ruling.  Nothing ventured, nothing gained.       Top

Medicare Rules Finalized

The 2005 Medicare payment rules have been finalized.  The rules change the way oncologists will be paid for the drugs and their infusions.  The physicians will be paid 106% of the prices paid for the drugs.  The physicians will also be paid extra for preparation of the drugs, the time supervising the infusion and for the infusion if a second drug.  Also all physicians will get a 1.5% increase in fees for services and will be paid for some new services.  This may end up to be about a 4% increase.  The hospitals will get a 3.3% inflationary increase and more money for outliers.        Top


Everybody knows about the problems with he flu vaccine but there is also a major problem with the childhood vaccines.  Three of the four manufacturers of children's vaccines have stopped making any.  The reason is a SEC accounting ruling not allowing the companies to state they are sold until the vaccines are actually delivered o the CDC.  What happens is that the vaccines go to a stockpile and if they don't go from there to the CDC due to lapse of expiration and are destroyed.  Those that are stockpiled and destroyed are not counted as sold since the CDC never uses them.  This means the companies show less money on their balance sheet.  There are no reserve vaccines for pneumococcus or DTaP.  MMP remains fully stocked.        Top


Anthem has purchased Wellpoint, the for profit Blue Cross.  The California Insurance Commissioner has given his blessing after Anthem doubled its offer to the state for the purchase.  Under the agreement, Anthem will give California $200 million for general healthcare improvements, $35 million for clinics in underserved communities, $15 million for nurse training and more if executive compensation from the merger exceeds $265 million.  I do not know what constitutes compensation.

Medicare preventive services start 1/05.  These include a one time welcome to Medicare physical, screenings for diabetes, hearing and vision, cholesterol, and blood pressure.  It already covers screening for breast and colon cancer and osteoporosis.  The new screening will be via Part B.  The premium for this will increase from $66.60 per month to $78.20.   

Governor Bredesen of Tennessee has announced the closure of the failed TennCare experiment.  This is the Tennessee expensive version  of Medicaid.  The rationale for this are the legal advocates who continued to push for more coverage from the failed program.  The advocates went to court to expand the 12 doctor visits per year, 45 days in the hospital per year six prescriptions a month and 10 lab or x-rays per year.  Previously the bankrupt system covered unlimited visits etc., more than Medicaid.     Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.