Hear success of coalition building, grassroots activity
National health care reform died at the federal level, but the field of action has moved to the states, said Michael Graham, MD, in opening the Academy's first State Legislative Strategies meeting June 3-4 in Rosemont, Ill.
To meet that challenge, Dr. Graham said the legislative strategies meeting was designed "to motivate, facilitate, provide the know how, explain what works, and tell what resources the Academy has." The concept of the meeting was developed by the Task Force on Access to Specialty Care, which is chaired by Dr. Graham. It was approved by the Board of Directors and sponsored by the Board of Councilors.
For the representatives from 33 states, COMSS, and the American Orthopaedic Foot and Ankle Society at the meeting, it was a practical lesson in the success of coalition building and grassroots political activity. The need to learn how to be politically active was evident from a review of the incremental health care reforms at the state-level throughout the nation.
LuAnn Corey, senior legislative counsel of the American Medical Association, said 25 states have small business insurance market reforms, 27 states have risk pools to make insurance available to medically uninsurable individuals, and 20 states have purchasing alliances for state-funded coverage such as for Medicaid recipients and state employees.
Corey said Virginia has passed a utilization review fairness bill, Arizona has a new law that imposes fraud disclosure requirements in all health care plans, and 14 states have any willing provider laws, although only Arkansas covers physicians. Eleven states have approved Medical Savings Plans laws and 20 states are considering such bills.
She pointed out that states have turned to managed care to reduce Medicaid costs, and there is a trend to managed care in workers compensation programs.
The two-day meeting included presentations on passage by the Illinois State General Assembly of what was described as the most comprehensive tort reform legislation in the nation. The audience also heard how the Maryland medical community succeeded in passage of the Maryland Patient Access Act which is the first in the nation to abolish "withholds." The law mandates that every employee must be offered a point-of-service plan if the employer offers a closed panel HMO.
State programs that work were described by representatives of the Texas, California, and Pennsylvania orthopaedic societies.
An insightful perspective of how major corporations deal with health care costs was presented by Warren Batts, chairman of the board and chief executive officer of Premark International, which owns a multitude of companies such as Tupperware and West Bend. The corporation's health care costs amounts to $46.3 million or 20 percent of its net income.
To deal with its health care costs, Batts said Premark offers its employees managed care plans, and makes fee-for-service available at an extra cost. Premark formed strategic alliances with third-party providers to focus on health care management and continuous improvement. It implemented broad-based managed medical programs, where available. Batts said Premark developed and uses criteria to select quality provider networks. Premark officials look at the provider's outcomes, efficiency, and patient satisfaction. The firm does not select a provider on the basis of the lowest cost, Batts said.
Edward D. Murnane, president of the Illinois Civil Justice League, told how the organization embarked on a four-step program in 1993 to get comprehensive tort reform enacted. The organization formed a coalition of 35 organizations with diverse interestsfrom business executives and doctors to the Illinois Farm Bureau. Officials educated the public that it wasn't just another business issue, but one that involved everyone. The organization developed legislation, and "made sure the political environment was friendly" by supporting 15 candidates for the state legislature who would vote for tort reform legislation. Fourteen candidates were elected.
The organization held local meetings throughout the state and press conferences, met with editorial board writers, and formed a speakers bureau that would address any group.
It was a bitter campaign, opposed strenuously by trial lawyers, Murnane said.
Passage of the Patient Access law in Maryland also was a hard fought campaign. Again, a coalition effort played a major part in the success.
Joseph A. Schwartz, III, a lobbyist for the Maryland Medical Association, told how a coalition of organizations and their lobbyists worked "inside" the political system for passage of the legislation, while an outside consulting firm whipped-up support of local influential people who would write letters to targeted key legislators who would consider the legislation. Their campaign stressed the need for patient access and exposed the profits of health maintenance organizations.
Rep. Newt Gingrich, (R-Ga.), left , listens to William W. Tipton, Jr., MD, executive vice president of the Academy, center; and William C. Collins, MD, chairman, Board of Councilors. Fellows attending the National Orthopaedic Leadership Conference visited their legislators on Capitol Hill.
Rep. Robert T. Matsui, (D-Calif.), left, discusses health care issues with Peter B. Slabaugh, MD, center, and Dale R. Butler, MD.
Rep. Henry A. Waxman, (D-Calif.) left, meets with John D. Hsu, MD, seated on couch; Stanford M. Noel, MD, center, and Kenneth B. Elconin, MD.