February 1997

An Interview with Rep. Joseph Palamara

by Lisa D. Baragar

With winter break, the governor’s state of the state address, and the executive budget presentation out of the way, Michigan legislators are moving into high gear and beginning to tackle today’s most pertinent health care issues, including for-profit hospital acquisitions, the Youth Tobacco Act, and a wealth of children’s and seniors’ issues.

Leading the way on these matters in the Michigan House of Representatives is Rep. Joseph Palamara (D-Wyandotte), the new chair of the House Health Policy Committee. Public Sector Consultants recently spoke with Representative Palamara, who reflected on his seven-term tenure as a committee member and spoke about his expectations as committee chair.

Cooperation is the Key

Representative Palamara characterizes his fourteen years as a member of the House Health Policy Committee as enjoyable: He likes the challenge of dealing with many complex health issues and working with others who share the common goal of improving the state’s health care system. "The thing that impresses me most about the committee," he says, "is the high level of cooperation. There are very few issues that have passed on a straight party-line vote."

As chair, the representative is dedicated to fostering continued bipartisanship. He wants members to resolve differences they have on matters before they enter the committee room rather than after, and he believes that members are willing to listen to each other’s ideas and discuss them fairly.

He is confident that the fact that his Senate counterpart is a Republican will not impede this goal: Representative Palamara describes Dale Sugars, who chairs the Senate Committee on Health Policy and Senior Citizens, and the members of the Senate committee as intelligent, hardworking people with agendas similar to his own. "The fact that [in the Senate] three members are Republicans and two are Democrats makes no difference to me," he adds. "The bottom line is that we all will work together."

So far, the greatest challenge Representative Palamara has faced since accepting his chairmanship is keeping up with the number of calls and letters he receives from constituents and others concerned about health policy. "Quite frankly," he confided, "the volume is overwhelming."

Patient Bill of Rights

Before becoming health policy chair, Representative Palamara worked with other legislators to pass last session’s Patient Bill of Rights. The passage of House Bills 5570–74, introduced by his predecessor as chair, John Jamian, was one of his proudest moments as a legislator. He says "[The initiative] called for a lot of hard work and a lot of input from many different people." Among the package’s many important provisions are requirements for extensive disclosure of health plan provider information to the public; limits, or in some cases, prohibitions on preexisting-condition exclusions; and guarantees of timely action on patient grievances. "I believe we made a real difference when we passed those bills."

Hosptial Conversion

Despite his commitment to bipartisanship, Representative Palamara concedes that there may be some issues on which not all committee members will agree. One is not-for-profit to for-profit hospital conversions.

To date, four bills addressing this topic have been introduced in the Senate. Senate Bills 149–50 (introduced by Senator Schwarz) require the Michigan Department of Consumer and Industry Services and, in certain circumstances, the attorney general (AG) to approve all hospital acquisitions. Another, SB 158 (introduced by Senator Shugars), requires similar approval from the Michigan Department of Community Health (MDCH) and the AG; Senator Shugars also has introduced a fourth bill (SB 156), which requires hospitals to report the community benefits they provide, so that policymakers can determine whether services have been lost as the result of a change in ownership.

Although the House Health Policy Committee will not deal with these bills until they are passed by the Senate, Representative Palamara believes that members must begin to prepare to take them up. "The issue will require a lot of discussion," he says. "Even if we do not prevent hospital conversions, we need to have proper oversight and disclosure in place in order to provide the most protection possible for communities." He adds that such measures properly should protect providers and physicians as well as patients.

Medicaid Managed Care

One of Representative Palamara’s first moves as health policy chair was to appoint a subcommittee that will focus on Medicaid managed-care issues. The nine-member Medicaid Managed-Care Subcommittee, co-chaired by Reps. Sharon Gire (D-Clinton Township) and Raymond Murphy (D-Detroit) already have begun hearings—in Detroit, Flint, and Ann Arbor—to gather public testimony on the transition of Medicaid recipients into the managed- care system. In appointing the group, Representative Palamara said "This is one of the hottest health policy initiatives in the country, and we want to take a closer look at the concept, to ensure that the quality of care is not compromised while we save money."

Public focus has been on Medicaid managed care since last year, when the MDCH announced that it would put out a request for proposals (RFP) to fully capitate Medicaid managed care in five southeastern Michigan counties: Washtenaw, Macomb, Genessee, Wayne, and Oakland . The RFP was released in November, and bids are due March 3. The state expects to award the first contracts in July and begin implementation in October.

Representative Palamara is very confident that the MDCH will work with the subcommittee in exploring the pros and cons of the plan. He also is certain that the subcommittee will have a great deal of input on the governor’s proposed MDCH budget—65 percent of which is allocated to the Medical Services Administration (the state’s Medicaid agency).

Other Issues

The representative believes that prohibiting managed-care organizations from inserting "gag clauses" into their contracts with physicians (such provisions preclude physicians from telling patients about certain treatment options) also will be taken up by the legislature this year.

Representative Palamara thinks that the Youth Tobacco Act likely will come under consideration as well. "Tobacco use by minors is one issue that extends outside of the health care industry; it involves retail shop owners and kids," he notes. He does not expect that legislation prohibiting the sale of tobacco products to minors will eliminate use, but he is optimistic that a revised policy will at least discourage it.

The End is in Sight

Representative Palamara believes that term limits make it even more important for policymakers to deal now with such issues as hospital conversions, Medicaid managed care, and youth tobacco use: "Legislators who take office after term limits [go into effect] may have priorities different from those of us in office now; they also may not have the experience that current members do in dealing with these issues." He points out that twelve of the committee’s seventeen members are serving their last term in the House—he is one of them.

Despite the fact that his career as a Michigan representative is coming to a close, Palamara is excited about this legislative session. Although there are many competing interests in health care, he believes he has kept his focus on the concerns most important to him. "Years ago my dad told me, ‘If you don’t have your health, you don’t have anything.’ This will be the guiding light of the committee while I am chair."