Kaiser Daily Health Policy Report Rounds Up State of the State Addresses

The new year finds governors across the country facing difficult health care choices, as rising costs and increasing Medicaid expenditures combine with the recession to pressure state budgets. Throughout January and February, the governors will give their yearly state-of-the-state addresses, highlighting prior accomplishments and outlining their goals and proposals for the next 12 months. Over the next few weeks, the Kaiser Daily Health Policy Report will summarize the health care issues discussed in these addresses. The following is a look at the speeches given to date:

• Alabama: In his speech on Jan. 8, Gov. Don Siegelman (D) promised to develop a program to help reduce the cost of prescription drugs for seniors. "Too many of our seniors are forced to choose between medicine and food, while the big drug companies continue to raise their prices. It's wrong, and it must be stopped," he said (Office of the Governor release, 1/8).
• California: In his speech on Jan. 8, Gov. Gray Davis (D) pointed to the "10-fold increase" in the number of children in the state who receive health insurance through Healthy Families, the state's CHIP program, which has enrolled 500,000 children in the past three years. He also announced that he will expand the program to cover 100,000 additional children in fiscal year 2003. In the area of managed care reform, Davis said that the state's new Department of Managed Health Care has served about 250,000 state residents. He also pointed out that California's "aggressive crackdown" on Medi-Cal fraud has saved the state $228 million and will save $500 million by next year. In FY 2003, Davis said that he plans to propose a program to recruit and train thousands of new nurses and pledged to reauthorize a program that provides a 20% to 30% discount on prescription drug prices for seniors (Davis speech text, Contra Costa Times, 1/8).
• Colorado: In his speech on Jan. 10, Gov. Bill Owens (R) said that although the state looks ahead to a "challenging budget year," he would "as[k] this Legislature to make improving health care for Colorado's families a priority in this legislative session." Owens proposed designating $18 million to provide prenatal coverage for 3,300 low-income women through the state's CHIP program and "urge[d]" legislators to pass it this session. Owens also called on lawmakers to pass legislation that "allows Coloradans to buy a low-cost, basic health plan." Finally, Owens called for "expand[ing] accessibility and affordability" of health insurance by providing tax credits to small businesses that offer health coverage to their employees after the "budget returns to surplus" (Owens speech text, Associated Press, 1/10).
• Idaho: In his speech on Jan. 7, Gov. Dirk Kempthorne (R) said that he would not reduce funding for the state's Medicaid program despite the state's budget deficit, citing the state's "obligation to help those who need it" and federal requirements. However, he said that Medicaid expenditures in Idaho "have been allowed to grow unchecked." Kempthorne said that in the next year he would propose "significant modifications" to "rein in" Medicaid spending and provide the state Department of Health and Welfare with the "tools to become more efficient Medicaid managers" and "slow the explosive rate of growth." In the area of children's health, Kempthorne touted his record on mental health and immunizations and pointed out that enrollment in the state's CHIP program has increased "three-fold" in the past three years. He also praised Idaho's substance abuse education and treatment programs for children, adults and prison inmates (Office of the Governor release, 1/7).
• Kentucky: In his speech on Jan. 10, Gov. Paul Patton (D) noted that the state has increased Medicaid funding "by almost" 47% since he took office, but said "it's still inadequate to provide our needy neighbors with the basic health care we want for ourselves." To address the issue, Patton called on legislators to "stand up to the big drug companies" by repealing laws that protect them at the "expense of [the state's] most vulnerable citizens." In addition, Patton outlined a proposal to begin training coal miners who have contracted black lung disease for a new career "after they've contracted the disease but before they've become totally disabled" (Office of the Governor release, 1/10).
• Minnesota: In his speech on Jan. 3, Gov. Jesse Ventura (I), noting that the state is facing a $2 billion budget deficit, said that decisions on state funding "should concentrate on what is necessary and not necessarily what's nice." Ventura said he plans to release a budget plan that may raise taxes or cut spending that impacts all part of the budget, including health care, which he said is the "largest area of state spending" after education and is "the fastest growing spending item in the budget" (Office of the Governor release, 1/3).
• New York: In his speech on Jan. 9, Gov. George Pataki (R) asked legislators to help him "make the nation's best health care system even better." Through "prompt, non-partisan action," Pataki predicted the state can increase staffing in all health care facilities statewide, strengthen nursing homes and "protect ... quality of care." Pataki also called on legislators to assist in making Family Health Plus, Child Health Plus and EPIC health care programs for children and seniors "even more accessible." In addition, Pataki asked lawmakers to expand the state's mobile mammography initiative to ensure that women in rural areas receive screenings and make sure that low-income women who are diagnosed with breast or cervical cancer "get the treatment and medication they need" (Pataki speech text, New York Times, 1/9).
• Vermont: In his speech on Jan. 8, Gov. Howard Dean (D) noted that health care "tops the agenda" for many Vermonters. Dean said that although the state "leads the nation in guaranteeing" insurance coverage for children, the state "can do more." He pledged not to cut any child from health care rolls to balance the state budget and to work with the Legislature to enact legislation that "controls costs and moves [Vermont] closer to universal health insurance." Because funds are not available to expand state health programs, Dean said he supports allowing small businesses to buy into the Vermont Health Access Plan. Noting that other states have passed plans to lower prescription drug costs, Dean said he would support drug formularies and would lobby Congress with other governors to "ensure that affordable generic drugs are increasingly available" (Office of the Governor release, 1/8).
• Virginia: In his speech given on Jan. 10, just days before he ceded his office to Gov. Mark Warner (D), Gov. James Gilmore (R) said he has introduced health care proposals totaling $290 million for "the poor, the sick, the elderly and the mentally disabled." To cover the additional spending, Gilmore said he asked state agencies to trim about $200 million from their budgets. His proposals include a plan to "fully fund" Medicaid and $25 million to "compensate" the Medical College of Virginia for its indigent care program. Gilmore also asked the Legislature to "think new" about mental health care, saying that although the population of the state's mental health institutions has decreased 20%, the same number of institutions remains open. "We must stop spending our money on maintaining excess buildings and instead spend our money on improving care for patients" by bolstering community care while "restructuring other institutions," he said. Gilmore stressed that his proposals would not reduce spending for mental health care, but would seek to create a "more efficient, more modern" mental health care system. Gilmore also noted his continued support for legislation requiring informed consent and a 24-hour waiting period for women seeking abortions (Office of the Governor, 1/10).
• West Virginia: In his speech on Jan. 9, Gov. Bob Wise (D) said he will introduce legislation that will "lock in benefits" from the state's share of the tobacco settlement to "assure" funding for future health care needs. Wise also said he will introduce legislation that would give health care coverage parity to West Virginians with mental illness. Wise also praised the state's CHIP and Medicaid programs for enrolling 10,000 children after launching an outreach campaign. In addition, he said the state's prescription drug discount card program has saved seniors $500,000 in the three months since its inception and is "one of the most successful drug discount programs in the nation" with 300 participating pharmacies. Wise also noted that the state's multi-state buying pool is "well on the way to completion" (Office of the Governor release, 1/9).