January 1997 Bulletin

31 states have divided governments
Emphasis will be on bipartisan coalitions

As generally happens during Presidential election years, much of the focus of the November elections was on the presidency and control of Congress. The November elections, however, also had an important impact on state legislative bodies.

Democrats were able to gain control of eight state legislative chambers that were previously under Republican control or tied, while Republicans were able to capture the majority in three state legislative chambers that were previously under Democratic control. The count now stands at 50 state legislative chambers under Democratic control, 45 state legislative chambers under Republican control, two chambers that are tied and a run-off for party control to be held in Texas.

Despite the gains and higher numbers for the Democrats, there are only six states where the party controls both the legislature and the governor compared to the 12 states where the Republicans have control over both the legislature and the governor. Thirty-one states, an all-time high, are operating with separate parties controlling the legislature and the governor's office.

Because so few states are controlled both in the governor's office and state legislative chambers by one party, experts see the start of the familiar trend of a divided government. The results of this election have reinforced this trend and have also shown that the "middle of the road" or moderate politicians are governing our state legislatures. In many states one party may hold the majority in a legislature by only a very slim margin. The days of absolutes in state politics are over and more emphasis will be placed on developing bipartisan coalitions in the coming months.

With the growth of the term-limit movement in the states, more money may be spent by both parties on open seats in state legislative elections. During this election both parties poured large sums of money to the states at the end of the campaigns to win seats. This final push of additional funds was highly uncharacteristic of past campaign practices, and shows that both parties are tending to put an added emphasis on state legislatures.

It is clear that the actions of the state legislatures are being closely watched in Washington, D.C., and may be considered new territory for political parties to attempt to gain control. According to Bill Pound, executive director of the National Conference of State Legislatures, "Politics is more competitive now than at any other point in our lifetime."

This year's elections did not focus solely on state legislative seats, but also on ballot initiatives, including health care reform. The popularity of health care reform in the states was evident in the initiatives that were filed in Oregon and California. Although the measures did not pass, the important indicator is that they were placed on the ballot, and generated an increased interest in health care reform issues.

In Oregon, Measure 39 would have prohibited managed care organizations from discriminating against chiropractors and naturopaths and would have severely affected the use of primary care physicians as gatekeepers in the managed care system. This measure, which failed to win a majority of votes, would have allowed patients to have direct access to alternate providers who are rendering "same or similar services within their scope of practice."

The second initiative, Measure 35, which also failed, would have restricted the compensation methods for health care providers. The referendum indicates acceptable methods of payment including work performed, an hourly wage, prearranged salary and benefits, bonuses paid based on work performed, and reimbursements for expenses. The initiative purposely excluded capitation as a form of payment for health care delivery. The measure was sponsored by Gordon Miller, MD, an ophthalmologist, and would have authorized the suspension of providers' licenses until they were in compliance if they violated the terms of this new law. Oregon has one of the highest managed care penetration rates in the country and is currently at about 42 percent, according to the Association of Oregon Hospitals and Health Systems.

In California, two propositions that would have dramatically changed managed care practices in the state failed to gain passage. Proposition 214 contained a ban on "gag" clauses in managed care contracts, and created state-set requirements for staffing of hospitals, nursing homes and other health care facilities. Proposition 214 also prohibited physicians or nurses to be fired or demoted except for just cause which was defined in the language as "proven malpractice, patient endangerment, substance abuse, sexual abuse of patients or economic necessity."

Proposition 216 contained most of the items in Proposition 214, but also included stronger provisions like new taxes on health care businesses for bed reductions, mergers, acquisitions and restructurings. The proposition also added a tax on individuals who receive stock distributions from health care businesses. Additionally, the initiative would have created a new public health corporation which would have been supported by voluntary contributions and would advocate for health consumers.

Clearly, the results from this election are not revolutionary, but they do point to some trends that we are seeing in state legislative elections. First, states are becoming more moderate. With the margins of victory remaining very slim, the parties in control are not able to rule with an iron fist, but rather an extended hand to the other side for the additional votes needed. Second, state legislatures will become increasingly more partisan based on the increasing amount of money being spent on state legislative elections, especially open seats. Finally, although these ballot initiatives lost, there continues to be a strong interest among legislative bodies to address some of the perceived problems with managed care, and add further protections for patients and physicians.

In the 1995-1996 legislative session, numerous states passed patient and physician protection legislation, ranging from prohibitions on "gag" clauses to mandatory point-of-service options. This trend is expected to continue during the 1997-1998 legislative sessions.

- Reported by Amy Winn, legislative analyst, the Academy's department of state society relations.

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