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 Jan. 14-Jan. 20:

• Arizona: In her speech on Jan. 14, Gov. Jane Hull (R) predicted that spending on some programs for poor residents "may actually exceed our ability to pay, even if the state's economy were hitting on all cylinders." To address the possible shortcoming, Hull said, "It is time to maximize and prioritize our health care dollars. Tough decisions need to be made and they need to be made now. Government cannot be all things to all people." Hull also asked the state's Medicaid program, the Arizona Health Care Cost Containment System, to coordinate a statewide educational program regarding long-term care. Hull concluded the health care portion of her speech by saying, "I want to make it clear that in the upcoming budget I will push strongly to maintain our commitments to responsible mental health funding and the construction of a new state health laboratory" (Hull speech text, 1/14).
• Delaware: In her Jan. 17 speech, Gov. Ruth Minner (D) noted that new health legislation she and the state's General Assembly approved last year has given residents new "right[s]" in their managed health plans. Minner also announced a "package of bills" that would address terrorism, including "emergency health powers legislation" to ensure that Delaware is prepared to handle a chemical or biological attack. In addition, as a result of a study of Delaware's high cancer rates -- results of which will be released "in just a few weeks" -- Minner said she "hope[s]" that the state Legislature will approve a bill banning smoking indoors (Minner speech text, 1/17).
• Indiana: In his speech on Jan. 15, Gov. Frank O'Bannon (D) noted that the state has helped 14,000 seniors purchase prescription drugs through its HoosierRx program. O'Bannon said, "To continue to help our senior citizens get the prescription medicine they need, we cannot slow down. We cannot stop. We cannot wait." O'Bannon also said that his budget plan would include "dramatic changes to Medicaid" (O'Bannon speech text, 1/15).
• Iowa: In his speech on Jan. 15, Gov. Thomas Vilsack (D) said that access to "quality, affordable health care ought to be the right of every Iowa child." Vilsack added that the state is "wholly committed to ensuring that every Iowa senior is secure in the knowledge that he or she can live in good health and dignity." In addition, Vilsack said he wanted 2002 to be the "year we achieve mental health and substance abuse parity in Iowa" (Vilsack speech text, 1/15).
• Kansas: In his speech on Jan. 14, Gov. Bill Graves (R) lamented that the budget he announced last month -- with planned cuts of more than $400 million from the state general fund -- would require reductions in "critical resources to our highest priorities," including programs for children, seniors and people with "mental and physical challenges." Graves said, "It is not a budget I can or will accept." During his speech, Graves announced a new budget, which would restore $3 million in mental health grants; $1.5 million in grants for developmentally disabled people; and $4.4 million in funding for the Senior Care Act, which gives seniors the opportunity to stay at home and "preserves the financial and personal dignity of [elderly] Kansans" (Graves speech text, 1/14).
• Maryland: In his speech on Jan. 16, Gov. Parris Glendening (D) asked that state residents "look beyond Maryland's borders" and "recognize the role racism and bigotry play" in HIV/AIDS in South Africa, where nearly one-quarter of the population is HIV-positive. According to Glendening, "We must unite to end" HIV/AIDS. While Glendening admited that "these issues will not be solved here, in Annapolis," he said that "actions we take this session can be additional important steps on that journey." For example, Glendening said, "Our continued support for higher education may well help produce a scientist whose breakthrough research revolutionizes AIDS treatment" (Glendening speech text, 1/16).
• Massachusetts: In her speech on Jan., 15, Gov. Jane Swift (R) noted that the state has been assisting in "the national effort to combat terrorism." Swift also announced the creation of a Bioterrorism Council, to be led by the state Director of Commonwealth Security (Swift speech text, 1/15). The Boston Herald reports that Swift's speech "was notable for the issues she glossed over," including rising prescription drug costs (Marantz, Boston Herald, 1/16). During her address, Swift did acknowledge that the state has remaining "challenges," including resolving the "health care crisis in our capital city" and statewide. In addition, Swift promised to "provide prescription drug benefits and home care to our elderly and neediest citizens" (Swift speech text, 1/15).
• Nebraska: In his Jan. 15 speech, Gov. Mike Johanns (R) said that the state has "wisely used its proceeds from the national tobacco settlement" for mental health and substance abuse services, minority health, developmental disabilities, respite care, biomedical research and public health grants. Johanns also proposed four initiatives that would increase the number of beds at the Youth Rehabilitation and Treatment Center. Finally, Johanns said that he would "protect priorities including ... Medicaid" when "address[ing] the state's budget shortfall" (Johanns speech text, 1/15).
• New Hampshire: In her Jan. 17 speech, Gov. Jeanne Shaheen (D) said the state's "economy is directly linked to the availability of quality, affordable health care." To that end, Shaheen remains committed to the "simple" goal of "enroll[ing] every child" in the state's CHIP program. In addition, Shaheen is "working hard to address" the problem of increasing prescription drug costs. Shaheen also said New Hampshire will "enhance [its] emergency response systems" in the wake of the Sept. 11 attacks on the World Trade Center and the Pentagon. In particular, New Hampshire is expanding its public health lab and offering biological hazard training to police offers, Shaheen said, adding that the state "must do more" (Shaheen speech text, 1/17).
• New Mexico: In his Jan. 15 speech, Gov. Gary Johnson (R) noted that enrollment in Medicaid has increased by 127,000 beneficiaries and spending by 100% in the last seven years. Johnson said that the state "need[s] to reduce the rate of increase in Medicaid spending, and we need to do that now -- this session." Johnson said his budget includes a $10 million increase for Medicaid, along with a plan that would enroll more people in Medicaid by reducing benefits to some current beneficiaries. Johnson also listed several ideas for improving public health, including legalizing medical marijuana, treatment programs instead of incarceration for drug offenders and assessing civil penalties rather than criminal for those arrested with less than one ounce of marijuana (Johnson speech text, 1/17).
• North Dakota: In his speech on Jan. 16, Gov. John Hoeven (R) noted that a "response to terrorism involves more than our military. ... It involves a concerted response by the ... health care community," among others. To that end, the state has established an e-mail network for "instant communications" with the "health care community to ensure swift response to any public health emergency," Hoeven said. He also announced Healthy North Dakota, a new public initiative intended to "challeng[e]" North Dakotans "to exercise more, to eat a healthy diet [and] to examine their use of tobacco and alcohol." Hoeven promised a "support structure" to help state residents "meet the challenge" (Hoeven speech text, 1/16).
• South Carolina: In his speech on Jan. 16, Gov. Jim Hodges (D) said that while the state "still faces a budget crunch," it "must see this as a challenge." Hodges added that the state needed to "keep ... moving forward. ... Let's use every ounce of creativity to protect our progress ... in ... health care" (Hodges speech text, 1/16).