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December 1998 1997–98 Legislative Session Comes to a Close by Lisa Baragar Katz, Consultant for Health Policy On December 10, legislators closed out the 1997–98 legislative session, which, after a two-year run, adjourned sine die on December 22 (legislators left for the year before sine die but returned for a formal ceremony ending the session). Any bills not passed by both chambers before sine die now are void, and, to be considered again for passage, they must be reintroduced during the new 1999–2000 session. As for bills that did make it through both the House and Senate, those that have yet to be presented to the governor (there are 17) will be presented over the next several weeks, and he has 14 days from the time he receives the bills to sign them. Any legislation the governor fails to sign within that time is considered the subject of a pocket veto and will not take effect. Even though legislators have gone home for the year, many health policy pundits remain in their offices, assessing legislative activity over the last 12 months. The Tally Over the past two years Public Sector Consultants, Inc., tracked and analyzed 398 health policy bills—246 from the House and 152 from the Senate. As of this bulletin’s writing, the governor had signed 44 of the bills into law—13 in 1997 and 31 in 1998. Concerning the number of enactments, the totals differ little from previous sessions. It is common for the legislature to pass and the governor to sign more bills in the second half of a session than the first. 1998 Accomplishments Health care pundits have much to say about the 1998 session. James Haveman, Jr., director of the Michigan Department of Community Health (MDCH), claims that the legislature’s greatest 1998 accomplishment was Public Act (PA) 54, which appropriated funds for and set the parameters of MIChild, a health care coverage program for many of the state’s uninsured children. The act
Haveman adds that between Medicaid, MIChild, and private health insurance, 99 percent of Michigan residents under 18 years have some kind of health insurance coverage. Judy Pendergast, director of government affairs for the Michigan Nurses Association (MNA), asserts that, in addition to MIChild, legislators’ passage of anatomical gift legislation (PAs 118, 120, and 226) was a top 1998 accomplishment. The new laws clarify how to indicate organ and tissue donations on drivers licenses and state-employee identification; they also require the secretary of state to provide related information to licensees. Another 1998 success, says Gene Farnum, executive director of the Michigan Association of Health Plans (MAHP), are statutes (PAs 401–2 and 412) requiring health plans to allow female enrollees to see an obstetrician-gynecologist without prior authorization or referral from their primary care provider. Supporters say the new laws will reduce patients’ out-of-pocket costs, prevent unnecessary treatment delays, and encourage women to receive appropriate preventive care. Farnum also indicates his pleasure with the fate of HB 5221, which would have imposed financial liability on certain health plans for delaying or denying ordinary covered treatment, thereby causing injury to a patient. The MAHP opposed the bill, which passed the House but died in Senate committee. Farnum argues that Michigan already has an effective, state-regulated process to resolve health coverage disagreements, and it is less expensive than the court system. Nancy McKeague, vice president of human resources for the Michigan Chamber of Commerce (MCC), adds that her organization is satisfied that the legislature defeated various pieces of mandated-benefit legislation: "The burden of mandates falls squarely on small business and their employees. It takes away from funds available for wages and discourages businesses from offering health benefits at all." McKeague agrees with Bill Zaagman, manager of external relations for the Michigan Osteopathic Association (MOA), and Greg Aronin, director of government affairs for the Michigan State Medical Society (MSMS), that passage of the pain-management package (HBs 4681–6) was a step in the right direction. The package, also heralded as a success by Haveman (MDCH), Pendergast (MNA), and Farnum (MAHP), creates a special pain-management commission and requires relevant education for physicians. Because he disagrees with certain amendments to the bills, Governor Engler is threatening a veto. Zaagman (MOA) and Pendergast (MNA) argue that SB 479, which passed the legislature but has not yet been presented to the governor, will encourage people’s access to health care. MSMS also supports the bill, which permits qualified, tax-paying health professionals, including physicians and advanced practice nurses (APNs), to claim a tax credit for providing care in underserved areas. Some Disappointments For every group pleased with the above legislative actions, another is not. For example, while there was broad support for the children’s health initiative, many groups would have preferred a simple Medicaid expansion, without the MIChild component. Many consumer groups supported the HMO liability bill and hope to see similar legislation next session. Consumers also tended to support mandated-benefit legislation (e.g., coverage for experimental treatment). Pendergast adds that the MNA was disappointed by lawmakers’ failure to pass SB 104 (passed the Senate but died in House committee), which would have given APNs independent authority to prescribe certain drugs after they had completed certain training/education and met other requirements. Currently, the nurses may not prescribe unless a physician delegates the authority to them. Aronin (MSMS) argues that legislators made the right move when they added language that would have allowed APNs to prescribe without a physician’s delegation, but specifically required a physician’s supervision. The amendment contributed to the bill’s demise. Pendergast, Aronin, and Haveman (MDCH) agree that another 1998 disappointment was the failure of HB 4280 (passed the House but died in Senate committee), which provided for primary enforcement of Michigan’s seatbelt law. Down the Road Haveman (MDCH) reports that 1998 was a year of mainly wins for his department. He predicts that the next legislative session will be as busy as ever, and that among policymakers’ priorities will be resolving some of 1998’s unfinished business. Zaagman (MOA) and Pendergast (MNA) agree that scope of practice issues, such as granting APNs authority to prescribe, will be a top priority next year—for both the legislature and health professionals. Farnum (MAHP) adds that policymakers also will have to address rising health care costs (particularly medical inflation and the expense of pharmaceuticals), which puts pressure on health plans to raise insurance rates: "The [issue] will drive collaborations and consolidations between various healthcare entities." McKeague (MCC) and Farnum both express concern that the mandated-benefits issue may rear its head again, and McKeague joins Aronin (MSMS) in predicting that legislators will likely address pain management further. Haveman (MDCH) predicts that one new issue policymakers will address next year is how to allocate Michigan’s share—$8.1 billion over 25 years—of the recent tobacco settlement money. He points out that beginning in Spring 2000, the state will be paid an estimated $104–365 million a year, as reimbursement for public dollars spent caring for smoking-related illness. Conclusion Haveman (MDCH) concludes that any health care reforms that occurred during 1997–98 were the beginning of a health care industry realignment that will bring many more health policy changes: "If you think 1998 was interesting, just wait for the next two years." NOTE: The November Health Policy Bulletin incorrectly stated that Kevin A. Kelly is an associate director for the Michigan State Medical Society. Mr. Kelly is the managing director. Copyright © 1998 |
