November 1998

Health Care Policy in the Wake of Term Limits

by Lisa Baragar Katz, Consultant for Public Policy

In Michigan, November 3 was not a run-of-the-mill Election Day; rather, it marked the first trial of the state’s constitutional term limits provision—adopted six years earlier by voters.

In the state House of Representatives, 64 of 110 seats were up for grabs because the incumbent was prohibited from running again for that office. The Republicans gained six seats, giving them a 58-52 edge over Democrats in the 1999–2000 session, which begins in January.

Term limits will not hit the Senate until the year 2002, but when it does, 30 of 38 seats will be affected. Meanwhile, the GOP has gained one Senate seat for the next session, increasing its majority to 23 (the Democrats have 15 members) in this chamber.

Certainly, term limits will substantially affect the legislature’s approach to health care policy in coming years.

The Big Picture

Sen. Dale Shugars, chair of the Senate Committee on Health Policy and Senior Citizens, believes that one major effect that term limits will have on the health care debate in Michigan is a loss of institutional memory. While all but one of the five on the upper chamber’s health committee will return to office next session, in the House more than half of the 17-member Health Policy committee, including chairman Rep. Joseph Palamara, will not. With these departing members will go a wealth of knowledge about health policy in Michigan.

Although Representative Palamara agrees that it will take some time before freshmen health committee members are brought up to speed, he is not concerned about the committee’s future: "I think Rep. [Gerald] Law [R-Plymouth, a current committee member] would make an outstanding health policy chair. He works well with both sides of the aisle and has a thorough understanding of [health care] issues." Representative Law has not yet officially been appointed committee chair for the next session, but health policy experts think he will. Another possible contender for the position is Rep. Judith Scranton (R- Brighton), also a current House health committee member.

Greg Aronin, director of government affairs for the Michigan State Medical Society (MSMS) believes that another major effect of term limits on the Michigan legislature, including the health committees, will be to diversify the agenda. "[Term limits] will create a constant influx of new ideas and agendas; this is a positive change," he says.

Sean Gehle, government liaison for the Michigan Health and Hospital Association (MHA), and Nancy McKeague, vice president of human resources for the Michigan Chamber of Commerce agree that the combined loss of institutional memory and diversity of interests may require legislators to invest considerable time and effort in developing the agenda for the new session.

The1999–2000 Agenda

At the end of every two-year legislative session, no matter how hard or long policymakers work, there always is some unfinished business left to be resolved in the new session. Senator Shugars and Representative Palamara agree that among the issues that will carry over to 1999–2000 are continued monitoring and revision of Medicaid managed care.

Senator Shugars also believes that long-term care issues will be critical. He would like to see next session’s legislators address tax credits and deductions for health and long-term care insurance premiums, as well as other health-related tax issues, and also update the Emergency Medical Services law.

Although he will not be returning next year, Representative Palamara says that if pain-management legislation (HBs 4681–6) is not adopted before the end of the current session, he hopes his successor will reintroduce it in the next. The bills create a special pain-management commission and compel pain-management education for physicians.

MSMS, MHA, and Michigan Chamber of Commerce officials say that revisions to certificate of need requirements also will be an important matter. And although MSMS officials suggest that while hospital merger/acquisitions policy remains important, they are uncertain that it will be a priority, but the MHA believes that hospital conversions will be a salient issue during the next session.

The MHA also sees access to health care, including implementation of the MIChoice program for the state’s elderly population, as critical, along with Medicaid funding, managed care, and health care data collection. The Chamber’s McKeague adds mandated benefits to the list.

Finally, MSMS, the Michigan Chamber, and Senator Shugars point out that during the next session, lawmakers must determine how to allocate tobacco settlement funds, which, beginning in spring 2000, will bring Michigan an estimated $104–365 million a year, totaling $8.1 billion over 25 years.

Wealth of Information

Of course, the issues that freshmen House members and other legislators choose to address beginning next year will depend greatly on their own background, beliefs, and knowledge of health care. Lawmakers Shugars and Palamara and the MSMS, MHA, and Michigan Chamber of Commerce are encouraged by the health care experience of incoming legislators.

For example, a possible candidate for the open position on the Senate health committee is current Rep. Bev Hammerstrom (R-Temperance), now a member of the House health committee; she will begin her first term as a senator in January.

On the House side, several freshmen will enter the House with extensive health care knowledge, including a physician, a nurse, and a hospital board member. Kevin Kelly, associate director of the MSMS comments, "We are very pleased that there is a physician in each house of the legislature: Senator Schwarz [R-Battle Creek] in the Senate and Representative DeWeese [R-Williamson] in the House." The Chamber’s McKeague adds that several elected legislators have extensive business experience and understand the costs of mandated benefits and health insurance premiums.

Aronin (MSMS) notes that although legislators will look to each other for information about health care, they also will look to Michigan Department of Community Health officials as well as those from the Michigan Department of Consumer and Industry Services. Gehle (MHA) adds that interest groups also will be important sources of information, and Representative Palamara touts the importance of knowledgeable legislative staff. Senator Shugars notes that "A wise freshman legislator will listen to everybody."

Key to Success

Aronin of the MSMS says that special interest groups that want to succeed in influencing incoming freshman legislators will have to keep in mind that with term limits, House members may serve a maximum of six years (three two-year terms), and Senators a maximum of eight (two four-year terms). This means that legislators will pay especially close attention to their home constituencies, which makes grassroots organization very important. NOTE: Because of Senate turnover in 2002, many House members may serve only two of their possible three terms, opting to seek a Senate seat instead; this also could affect the House’s health-care knowledge base.

Representative Palamara adds that the groups most able to influence his views were those that explained all sides of an issue and gave him the tools he needed to make his own decision. He points out that when lawmakers hear only one side of a story, they find it hard to trust the source, and he adds that new legislators will be particularly skeptical of special interests because the groups will not yet have earned the lawmakers’ confidence.

Conclusion

Senator Shugars believes that Michigan’s legislative turnover presents a great opportunity for new, dynamic leaders to make Michigan the best place for health care. Representative Palamara says he will miss the role he played as a 14-year-member of the House Health Policy Committee but is looking forward to continuing elective life, albeit in a different venue (he was elected to the Wayne County Board of Commissioners).