Elec­tion re­sults mixed in state bal­lot ini­tia­tives on health­care re­form law

Modern Healthcare - - Contents - Gregg Blesch

he anger and eco­nomic dis­tress vot­ers expressed in the midterm con­gres­sional re­sults bled through to a va­ri­ety of bal­lot mea­sures af­fect­ing health­care.

In two states, Ari­zona and Ok­la­homa, vot­ers sup­ported con­sti­tu­tional amend­ments re­ferred by their leg­is­la­tures aimed at the knees of Pres­i­dent Barack Obama’s health­care re­form law. The mea­sures pur­port to block the por­tions of the Pa­tient Pro­tec­tion and Af­ford­able Care Act that will re­quire most Amer­i­cans to have ba­sic health in­surance and com­pel em­ploy­ers to pro­vide min­i­mum cov­er­age or pay a penalty.

Hos­pi­tals in those states de­clined to take sides on the amend­ments. In Ari­zona, where 55% of the vot­ers sup­ported an amend­ment, the ac­tual im­pact “re­mains to be seen be­cause it will ul­ti­mately be de­ter­mined in the courts, as its au­thors in­tended,” Lau­rie Liles, pres­i­dent and CEO of the Ari­zona Hos­pi­tal and Health­care As­so­ci­a­tion said in a state­ment.

Ban­ner Health, a Phoenix-based sys­tem that owns 11 hos­pi­tals in the state, will carry on with its ef­forts to pre­pare for changes in the pipe­line un­der the re­form law, ac­cord­ing to a writ­ten re­sponse to a query about the elec­tion’s out­come. “We strongly be­lieve that such prepa­ra­tion is pru­dent and re­spon­si­ble at this time, but un­der­stand that the highly po­lit­i­cal en­vi­ron­ment that sur­rounds health­care re­form will con­tinue,” the sys­tem said.

Vot­ers in Colorado, by a 53% ma­jor­ity, re­jected a sim­i­lar con­sti­tu­tional amend­ment.

The im­pact of such amend­ments—one was ap­proved in Mis­souri in Au­gust—and laws and res­o­lu­tions passed by law­mak­ers in Ge­or­gia, Idaho, Louisiana, Vir­ginia and Utah, may be purely po­lit­i­cal. “Ei­ther the in­di­vid­ual man­date is un­con­sti­tu­tional or it isn’t,” said Ti­mothy Jost, a pro­fes­sor at Washington and Lee Uni­ver­sity Law School who penned an ar­ti­cle on the topic pub­lished in the New Eng­land Jour­nal of Medicine. “If Congress has the power to adopt an in­di­vid­ual man­date, then un­der the Supremacy Clause it is bind­ing on all Amer­i­cans, re­gard­less,” he said. “That is what we fought the Civil War over and was es­tab­lished by a whole se­ries of court de­ci­sions dur­ing the civil rights era.”

Fed­eral courts are al­ready chew­ing on that ques­tion in a num­ber of law­suits brought against the law, in­clud­ing one in Pen­sacola, Fla., joined by 19 state attorneys gen­eral.

TJost said the Colorado vote is ev­i­dence that Amer­i­cans don’t uni­ver­sally op­pose even the most con­tro­ver­sial part of the law. In Ok­la­homa, 65% of the vot­ers last week sup­ported an amend­ment re­ject­ing the law’s man­dates. But Ok­la­homa Hos­pi­tal As­so­ci­a­tion Pres­i­dent Craig Jones said nei­ther hos­pi­tals nor the pub­lic was very fo­cused on that is­sue.

A big­ger con­cern, Jones said, was a ques­tion on the bal­lot that would have amended the state con­sti­tu­tion to guar­an­tee that pub­lic schools were funded at least as well as those in sur­round­ing states. Law­mak­ers would have been forced to redi­rect fund­ing from Med­i­caid and other health pro­grams to fund ed­u­ca­tion, so the hos­pi­tal as­so­ci­a­tion joined a coali­tion cam­paign­ing against the amend­ment. “We had an obli­ga­tion to make peo­ple un­der­stand if this passed there were con­se­quences,” he said. It was soundly de­feated.

It was not a stretch to per­suade vot­ers any­where last week to op­pose mea­sures in­volv­ing spend­ing or taxes. They weren’t in the mood.

In Ge­or­gia, they voted 53% to 47% against con­sti­tu­tional amend­ment rais­ing an es­ti­mated $80 mil­lion for trauma cen­ters with a $10 an­nual fee tacked on to ve­hi­cle reg­is­tra­tion. At 520-bed Me­mo­rial Health in Sa­van­nah, one of two trauma cen­ters in the south­ern half of the state, the fund­ing could have meant an ad­di­tional $5 mil­lion to $7 mil­lion in state sup­port, spokes­woman Becky Keight­ley said, not­ing that the broader goal was to en­cour­age more hos­pi­tals to pro­vide trauma care.

The Washington State Hos­pi­tal As­so­ci­a­tion un­suc­cess­fully threw its weight against two bal­lot ini­tia­tives aimed at rein­ing in taxes. By a mar­gin of nearly 30 per­cent­age points, vot­ers sup­ported an ini­tia­tive that will re­quire the state Leg­is­la­ture to muster two-thirds ma­jori­ties or seek voter ap­proval in or­der to raise taxes for any pur­pose. Washington law­mak­ers sus­pended a sim­i­lar 2007 ini­tia­tive this year as they tried to close a $2.8 bil­lion bud­get deficit.

An­other ini­tia­tive op­posed by the hos­pi­tal as­so­ci­a­tion but ap­proved by Washington vot­ers last week rolls back taxes on candy, soda and bot­tled wa­ter adopted this year in or­der to avert cuts to Med­i­caid and other pro­grams.

Med­i­cal mar­i­juana didn’t fare much bet­ter. Mea­sures in Ore­gon and South Dakota were de­feated and an­other in Ari­zona was too close to call at dead­line.

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