STATE LEGISLATIVE UPDATE

NOVEMBER 2003 STATE LEGISLATIVE UPDATE

The November 2003 elections proved to be a mixed bag for medicine. A physician was elected governor of Kentucky, a state in medical liability insurance crisis. At the same time in New Jersey the physician supported candidates took a beating making an already difficult drive for a cap even harder. However, the house of medicine needs to continue to participate in politics because--until the system is changed--politics is how policy is made.

As of the end of the month, the following state legislatures were in regular session or in recess: MA, MI, NJ, NY, OH, PA, and WI . Through November there have been 176,037 bills introduced in the states and 41,975 have become law.

Some of the bills the Department of Socioeconomic & State Society Affairs is tracking are outlined below. If you have any questions please give Jay Fisher a call at 800-346-2267, x4336.

STATE ELECTIONS

November saw Louisiana, Kentucky and Mississippi elect new Governors. In Mississippi Haley Barbour became only the second Republican governor since reconstruction beating incumbent Governor Ronnie Musgrove. During the campaign Gov-elect Barbour supported additional tort reforms to help address the medical liability insurance crisis in the state.

In Kentucky , Cong. Ernie Fletcher, MD prevailed over Attorney General Ben Chandler to become the first Republican Governor in thirty-two years. In Congress Dr. Fletcher supported medical liability reform and during the campaign indicated he would push for reform in Kentucky in 2004.

In Louisiana Lt. Gov. Kathleen Blanco bested Republican Bobby Jindal to take the Governorship back for the Democrats. With the partisan shift in these three races the new lineup will be 28 Republican governors and 22 Democrats.

Four states held legislative elections as well. The biggest news was in New Jersey where the Senate had been tied 20-20. The Democrats picked up two seats giving themselves a 22-18 edge. In the Assembly the Democrats picked up six seats for a 47-33 majority. The Assembly losses stung the medical community who worked door-to-door to help targeted Republican challengers.

In Virginia the Republicans picked up one Senate seat to extend their control to 24-16 while Democrats picked up four seats in the House of Delegates cutting into the Republicans lead, which stands now at 61-37 with 2 independents. In Mississippi the Republicans gained seven seats in the House, but still trail 76-46. The Senate saw no change with the Democrats maintaining their 29-23 advantage.

On November 15 and 16 the AAOS State Societies Strategy Meeting was held in Rosemont, IL. Representatives from forty-three state orthopaedic societies attended and heard from experts on the following legislative topics: medical liability reform, workers compensation fee schedules, Medicaid reimbursement, patient safety, and self-referral to specialty hospitals. Additionally, speakers addressed unionization of orthopaedists, suing insurers for unfair practices, setting up risk retention groups to provide liability insurance, attracting young orthopaedists to a state society, and how to improve a society's worth to its members.

The PowerPoint presentations from all the presentations are available on the AAOS web site at: http://www.aaos.org/Govern/State/Tools/Orgtools.asp.

TORT REFORM

Republicans in the Minnesota House of Representatives will introduce a comprehensive health care reform bill in 2004 that will contain a $250,000 cap on non-economic damages in medical liability cases.

The Governor of Wyoming and the Wyoming Healthcare Commission have both endorsed a constitutional amendment to allow the legislature to cap non-economic damages in medical liability lawsuits. If the legislature passes the amendment it would go before the state's voters in November 2004 for their ratification.

WORKERS' COMPENSATION

Just a few months after passage of major workers' compensation legislation in California that aimed to save the system $6.2 billion, Governor Schwarzenegger introduced another workers compensation reform bill in the special session. The bill will require use of evidence-based criteria to certify injuries and prohibits chiropractors from certifying injuries. There are many other reforms in the 134-page bill.

PHYSICIAN OWNERSHIP OF HEALTH CARE ENTITIES

The Medicare prescription drug bill that passed Congress in November also contained a provision affecting specialty hospitals. The bill would create an 18-month moratorium on the exception to the Stark regulations that permits physicians to refer Medicare patients to specialty hospitals in which they have a financial interest. The moratorium does not apply to existing specialty hospitals or those under construction.

During the 18-month period the government will conduct studies on the cost of, referral patterns to and quality of care at specialty hospitals. These studies will likely affect the state legislative battles in 2004 over self-referral bans to specialty hospitals.

REIMBURSEMENT

Oklahoma approved increases in Medicaid reimbursement rates. Reimbursement for physician evaluation and management codes will increase from 72% of the Medicare rate to 90% of the Medicare rate.