Kaiser Daily Health Policy Report Features Coverage of 17 Gubernatorial Candidates’ Health Stances

Gubernatorial races will take place in 36 states on Nov. 5. Eleven of the seats are currently Democratic, and 23 are Republican. In the past several months, Kaiser Daily Health Policy Report has identified some races in which health care has played a central role. A brief description of the candidates' health care stances in those races appears below:

Alaska
Sen. Frank Murkowski (R) and Lt. Gov. Fran Ulmer (D) are vying to replace Gov. Tony Knowles (D), who is term-limited.

• As a senator, Murkowski has addressed Medicare reform, cosponsoring a bill in November 2001 that would overhaul the Medicare contracting system and simplify the process providers use to resolve billing disputes (Rovner, CongressDaily, 11/29/01). The Medicare Education and Regulatory Fairness Act would revamp Medicare audit procedures and allow providers to challenge CMS regulations and payment decisions without losing their right to appeal (Kaiser Daily Health Policy Report, 3/8/01).
  
• Ulmer has said she wants to lower prescription drug costs by giving Alaska the authority to negotiate with drug companies for better prices (Ulmer Web site). Ulmer also said she would advocate reforming drug patent laws to make generic drugs more available, adding that if such reforms were enacted, the state's Medicaid program could save $1.5 million per year. While she said that the quality of health care in Alaska has "improved dramatically" over the last two decades, "major weaknesses," such as rising drug costs and the state's nursing shortage, "will be amplified" as the population continues to age. Ulmer also has pushed for expanding telemedicine capabilities (Kaiser Daily Health Policy Report, 8/30).
  

Arkansas
Incumbent Gov. Mike Huckabee (R) is being challenged by state Treasurer Jimmie Lou Fisher (D).

• Huckabee has said he is looking for ways to improve care at the state's nursing homes and has ruled out using money from the national tobacco settlement to fund those programs (Wickline, Arkansas Democrat-Gazette, 2/5). In the previous four years, Huckabee's administration has helped insure as many as 50,000 children through ARKids FIRST, the state's CHIP program (Huckabee Web site). In early October, Huckabee announced that state officials would begin "aggressively promoting" discount cards from drug makers Eli Lilly and Pfizer to state residents who are eligible for Medicare but lack prescription drug coverage (Kaiser Daily Health Policy Report, 10/7). In addition, Huckabee has said he favors treatment rather than incarceration for illicit drug users (Issues 2002 Web site).
  
• Fisher's platform includes a senior prescription drug plan called the Arkansas Prescription Drug Assistance Program. Under the plan, the state would act as a pharmacy benefits manager and negotiate with drug companies to obtain rebates on prescription drugs equal to those set by federal law for the Medicaid program (Kaiser Daily Health Policy Report, 9/18).
  

California
Incumbent Gov. Gray Davis (D) is being challenged by businessman Bill Simon (R).

• Davis has endorsed the state's existing health care system and suggested some improvements but has cautioned against making broad reforms. He has called for a physicians' bill of rights that would require health insurance companies in the state to pay doctors promptly and would protect physicians against "unilateral changes" in their contracts. During his tenure as governor, Davis expanded enrollment in Healthy Families, the state's CHIP program, from 51,000 to 500,000 low-income children. He said recently that he has "reversed course" on a decision earlier this year to eliminate the Child Health and Disability Prevention Program, which provides immunizations and screenings for low-income state children (Kaiser Daily Health Policy Report, 4/4). In addition, Davis noted that during his administration, "one million more children" from working families in the state now have health insurance (AP/Fresno Bee, 10/7). Davis has said he plans to further expand coverage for low-income children (Kaiser Daily Health Policy Report, 4/4).
  
• Simon has "decried" the current managed health care system and has recommended "less government involvement" to address what he has called a "full-fledged crisis" in the state's health care system. In addition, Simon has said that he considered proposals that would increase reimbursements for doctors who treat residents enrolled in Medi-Cal, the state's Medicaid program, and would provide tax breaks for state doctors who treat low-income patients. He also has called for medical savings accounts for state residents with employer-sponsored health plans, tax credits for state residents who purchase individual health plans and health care vouchers for low-income state employees not offered employer-sponsored health insurance (Kaiser Daily Health Policy Report, 4/4).
  

Colorado
Businessman Rollie Heath (D) is challenging incumbent Gov. Bill Owens (R).

• Heath would implement the $2.5 billion "Heath Health Care Initiative," funded by a $1 cigarette tax increase, in which the state would provide $100 million annually for 10 years to help small businesses provide health care coverage. The plan also would provide $100 million annually for 10 years to help seniors pay for prescription drugs and would earmark $30 million annually for 10 years to fund prenatal care and health care services for infants until age two. The proposal also would set aside $27 million per year over 10 years for administrative expenses and future health care projects (Kaiser Daily Health Policy Report, 7/19). In addition, Heath would expand CHIP program coverage to an additional 86,000 children by increasing the eligibility level from 185% of the federal poverty level to 250% (Kaiser Daily Health Policy Report, 8/12).
  
• Earlier this year, Owens proposed designating $18 million to provide prenatal coverage for 3,300 low-income women through the state's CHIP program (Kaiser Daily Health Policy Report, 1/14). During his tenure, he also implemented an annual enrollment fee for the state CHIP program in place of a monthly premium, supported adding a dental benefit to the program and proposed extending Medicaid coverage to women who have been diagnosed with breast or cervical cancer but cannot afford treatment (Owens Web site). Owens has called for "expand[ing] both accessibility and affordability" of health insurance by providing tax credits to small businesses that offer health coverage to their employees (Kaiser Daily Health Policy Report, 1/14).
  

Connecticut
Former state Comptroller Bill Curry (D) is challenging incumbent Gov. John Rowland (R).

• Curry has proposed a health plan that would allow small businesses, self-employed workers and uninsured state residents to join the health plan that covers state employees, a move that he said would help reduce the cost of coverage for thousands of people. In addition, Curry said that the state should band together with 40 other states in purchasing pools to lower the cost of prescription drugs (Kaiser Daily Health Policy Report, 10/15). Under the plan, which is expected to reduce drug prices by about 20%, residents would pay a $25 annual fee to participate. Curry would also establish a state Office of Health Care Consumer Assistance and strengthen the rights for members of managed care plans (Haigh, Associated Press, 10/11).
  
• During his term, Rowland created the HUSKY Plan, the state's CHIP program, to provide health care for about 90,000 children. He worked to increase enrollment in ConnPace, a prescription drug program for seniors, by 12,000 people -- to 47,000 total members -- and has applied for a waiver from the federal government that would increase program enrollment by an additional 11,000. Rowland established a state Managed Care Ombudsman position and signed legislation establishing an appeals process for people wrongfully denied medical treatment or supplies by their health plan. Rowland also supported a law that increased the length of hospital stays for new mothers (Rowland Web site).
  

Florida
Incumbent Gov. Jeb Bush (R) is being challenged by lawyer Bill McBride (D).

• During his term as governor, Bush instituted the Silver Savers program, which covers up to $160 a month in prescription drug costs for about 58,000 seniors who have annual incomes less than $10,000. Participants pay $2 per prescription, the state contributes $29 million annually and the federal government pays about $80 million (Kaiser Daily Health Policy Report, 10/18). Bush this year signed legislation (HB 519) aimed at recruiting nurses to fill the state's 9,000 nursing vacancies. Under the legislation, nurses with three years of experience who are relocating to Florida from other states and territories, including Puerto Rico, that have comparable training standards will be permitted to obtain a Florida nursing license after completing a background check. The legislation also allows the Florida Department of Health to repay nursing students' loans -- up to $4,000 per year for up to four years -- for those who did not receive other financial aid and work in Florida health care facilities. In addition, the law allocates $500,000 in grants for middle and high schools to establish programs to promote students' interest in health care professions. Bush also signed a bill (SB 1808) that provides funding for the Florida Center for Nursing to establish a "state strategy to deal with the nursing shortage" (Kaiser Daily Health Policy Report, 5/29).
  
• McBride has proposed a "three-pronged approach" to provide residents with greater access to prescription drugs. Under the plan, McBride would encourage federal legislators to add a prescription drug benefit to Medicare, expand drug coverage under Medicaid and use the state's bargaining power to obtain lower drug prices from pharmaceutical companies (Mahlburg/Silva, Orlando Sentinel, 10/17). Specifically, McBride said he would create a program that would give residents with annual incomes up to 200% of the federal poverty level, or about $17,000 for an individual, a 30% discount on prescription drugs. About one million people would be eligible for the program, which would cost the state $10 million to $15 million annually and would require about $150 million in federal funding (Kaiser Daily Health Policy Report, 10/18).
  

Idaho
Publisher Jerry Brady (D) is challenging incumbent Gov. Dirk Kempthorne (R).

• Brady would work to "lower the cost of retail prescription drugs" for the state's seniors by advocating a program that would give Medicare beneficiaries without drug coverage discounts of 20% to 40%. Brady also would require any prescription drug manufacturer that sells prescription drugs through Medicaid or another government-funded program to pay the state rebates (Brady Web site).
  
• In his tenure, Kempthorne has voted against increasing tobacco restrictions. He has voted against legislation that would establish medical savings accounts (Issues 2002 Web site). Kempthorne is also working on a proposal by state Sen. Dean Cameron (R) that would expand health insurance to children (Hahn, Idaho Statesman, 9/15). In addition, a Kempthorne spokesperson said that the his administration has implemented reforms this year that are saving $25 million in state and federal funds on prescription drug costs under Medicaid (Russell, Spokane Spokesman-Review, 10/17).
  

Iowa
Doug Gross (R), chief of staff for former Gov. Terry Branstad (R), is challenging incumbent Gov. Tom Vilsack (D).

• Gross has called for evaluating the state's Medicaid waiver programs "on a case-by-case basis to make sure that they are appropriate from a health standpoint and can be supported financially." In addition, Gross has said he will consult "experts in private industry" to help improve administration of the state's Medicaid program (Kaiser Daily Health Policy Report, 9/6). Gross also has said his administration would focus its efforts on providing treatment centers and private assistance programs to illicit drug users (Gross Web site).
  
• Vilsack has said he would establish "report cards" to monitor the quality of care under HMOs (Issues 2002 Web site). Vilsack in August proposed legislation that would require drug companies to offer drugs at reduced prices to seniors, similar to discounts given under the state's Medicaid program. Under the program, pharmaceutical companies would be required to extend the 15.1% discount on brand-name drugs and 11% discount on generic drugs offered to Medicaid beneficiaries in the state (Kaiser Daily Health Policy Report, 8/7). In early October, Vilsack announced he would sue the federal government to force a change in the state's Medicare rates. Medicare spending per-beneficiary in Iowa is the lowest of any state (Kaiser Daily Health Policy Report, 10/2).
  

Maryland
Rep. Robert Ehrlich (R-Md.) and Lt. Gov. Kathleen Kennedy Townsend (D) are vying to replace the term-limited Gov. Parris Glendening (D).

• Ehrlich has said he would restore drug treatment, health care and mental health programs that have been cut under the Glendening administration. Specifically, Ehrlich has said would create "adequate treatment facilities" for illicit drug users and people with mental illness who are now in prisons (Ehrlich Web site). In addition, he has said he would sign an executive order to overturn a state rule that requires parents of mentally ill children to surrender custody to allow their children to receive long-term treatment. He also would use his congressional background to help Maryland attract more federal Medicaid funds for state mental health programs (Kaiser Daily Health Policy Report, 9/30). Ehrlich did not sign a pledge sponsored by the Maryland Citizens' Health Initiative -- which asks candidates to object to CareFirst BlueCross BlueShield's application to convert to for-profit status and to support increased access to prescription drugs for seniors -- because he said it is anti-business and is "nothing more than a step toward universal health care." Ehrlich has proposed a five-point plan to prevent lead poisoning by privatizing a grant program for lead paint abatement and providing tax credits to property owners who remove lead from their homes (Kaiser Daily Health Policy Report, 9/11).
  
• Townsend's platform includes a four-part proposal that would modernize and expand the state's community health centers, expand eligibility for state health programs, subsidize prescription drug costs for low-income residents and seniors and expand the scope of public health programs, including outpatient drug treatment centers (Kaiser Daily Health Policy Report, 9/11). To pay for her initiatives, Townsend would increase the state's cigarette tax from $1 per pack to $1.36 per pack, generating an estimated $105 million in additional revenue annually. She would also sell up to 40% of the state's share of the national tobacco settlement over the next nine years for as much as $400 million, leaving annual state tobacco settlement payments of $55 million, enough to cover "health care and other programs" that receive settlement funds (Kaiser Daily Health Policy Report, 9/30). Townsend signed the Maryland Citizens' Health Initiative pledge (Kaiser Daily Health Policy Report, 9/11).
  

Massachusetts
State Treasurer Shannon O'Brien (D)and businessman Mitt Romney (R) are running to replace acting Gov. Jane Swift (R).

• O'Brien has advocated creating a state office of women's health policy, studying racial health disparities and implementing a tiered drug plan to purchase Medicaid beneficiaries' medications (Kaiser Daily Health Policy Report, 9/18). The tiered plan would save the state about $100 million to $150 million annually, O'Brien says. In addition, O'Brien said she would maintain current Medicaid eligibility levels rather than reverse a decision to deny services to 50,000 long-term unemployed state residents set to be dropped from the program next year (Kaiser Daily Health Policy Report, 8/14). Other proposals from O'Brien's campaign include support for a Massachusetts version of the Healthy Maine program, which offers non-Medicaid beneficiaries up to a 25% discount on prescription medications, and a prescription drug bulk purchasing law that would help reduce pharmaceutical costs (Kaiser Daily Health Policy Report, 8/16).
  
• Romney has said he would institute a Medicaid copayment based on a sliding income scale, give consumers "health guides" to help them compare health costs, create a "health hotline" to eliminate unnecessary trips to the doctor and make the state Health and Human Services Department more "user-friendly." Romney has also proposed excluding punitive damages from awards in medical malpractice lawsuits and asking the federal government to increase the state's Medicaid reimbursement rate (Kaiser Daily Health Policy Report, 9/18). In addition, Romney supports a proposal to charge copayments to Medicaid beneficiaries in higher income tiers of eligibility (Kaiser Daily Health Policy Report, 8/16). He would also try to implement a plan to "reorganiz[e] the alphabet soup" of state human services agencies, creating a group of departments that deals only with public health (Kaiser Daily Health Policy Report, 8/14).
  

Michigan
State Attorney General Jennifer Granholm (D) and Lt. Gov. Dick Posthumus (R) face off in the campaign to replace term-limited Gov. John Engler (R).

• Granholm has said she would "vigorously oppose" a potential for-profit conversion of Blue Cross Blue Shield of Michigan because she believes such a move would "dramatically increase the number of uninsured." She would also propose measures to expand access to Medicaid; MiChild, the state's CHIP program; and MiFamily, a state program for low-income adults who do not qualify for Medicaid and cannot afford private insurance, by making the enrollment process easier and "treat[ing] children in MiChild on the spot." Granholm would appoint a state surgeon general who would "advocate for effective community-based health and wellness promotion and disease prevention programs" and serve as a "watchdog" for the state's public health system (Granholm Web site). She would also use a greater percentage of the state's share of the national tobacco settlement for health services (Kaiser Daily Health Policy Report, 5/14).
  
• Posthumus' "health plan for Michigan" would preserve patients' rights, focus on "preventive care and healthy living" and encourage congressional representatives to pass a Medicare prescription drug benefit. He supports state legislation that would reduce "frivolous" medical malpractice lawsuits and would allow "doctors, nurses and all other health care professionals to do their jobs effectively." He would ask Congress to change Medicaid to a block grant program that would help states "meet the unique needs of [their] residents" (Posthumus Web site). Posthumus also would lobby Congress to provide more Medicaid funding for states (Kaiser Daily Health Policy Report, 5/14).
  

New York
New York state Comptroller H. Carl McCall (D) is challenging incumbent Gov. George Pataki (R).

• McCall has proposed a bulk prescription drug purchasing plan that would use the state's purchasing power to negotiate discounts on behalf of seniors and people with chronic illnesses. In addition, McCall has said he would enact mental health parity legislation that would require insurers to provide mental health coverage at the same level as general health services (McCall Web site). McCall has also said if elected he would propose legislation to prohibit all gifts and cash payments to health care providers by drug manufacturers and require "full disclosure" of drug makers' marketing expenditures (Benjamin, Albany Times-Union, 6/18).
  
• During his tenure, Pataki created Family Health Plus, which provides health insurance to 700,000 low-income uninsured parents and single adults. He also expanded EPIC, or Elderly Pharmaceutical Insurance Coverage Program, which helps about 300,000 low-income seniors purchase prescription drugs (Pataki Web site). He negotiated a multibillion dollar health package, which lawmakers approved earlier this year, that raises salaries for health care workers and cuts some health programs (Kaiser Daily Health Policy Report, 1/16). The plan's financing partly relied on a increase in Medicaid funds the state expected to receive from the federal government, but the Bush administration never approved the increase (Kaiser Daily Health Policy Report, 2/5). Pataki has recently come under fire for his administration's decision to move patients from state psychiatric hospitals to nursing homes where they were housed on isolated floors, not permitted to go outside and had almost no ability to oppose their detention (Kaiser Daily Health Policy Report, 10/11). Pataki said the state commissioners of health and mental health are working to correct the system (Kaiser Daily Health Policy Report, 10/7).
  

Pennsylvania
State Attorney General Mike Fisher (R) and former Philadelphia Mayor Ed Rendell (D) are running to replace Gov. Mark Schweiker (R).

• Fisher said he would increase CHIP enrollment by coordinating outreach efforts between the state Insurance Department and the Welfare Department. Fisher also favors legislation that would help reduce medical malpractice insurance premiums, in part by cutting the amount of coverage physicians are required to carry by $250,000. He supports the Pharmaceutical Assistance Contract for the Elderly, or PACE, which helps 224,000 low-income seniors obtain prescription drugs, and would seek a federal waiver to cover some of the program's costs through Medicaid (Kaiser Daily Health Policy Report, 9/30). Fisher also advocates expanding the PACE program through revenue from slot machines at state racetracks (Fisher Web site).
  
• Rendell would negotiate with drug companies to secure prescription drug prices or would consider purchasing drugs in bulk or joining a multi-state drug purchasing group. Rendell also said he would seek higher reimbursement rates for Medicare and Medicaid and would attempt to increase enrollment in the state's CHIP program by streamlining the application process. In addition, Rendell supports PACE and like Fisher would seek a federal Medicaid waiver to pay for the program's expansion (Kaiser Daily Health Policy Report, 9/30). His plan would expand PACE eligibility by 150,000 seniors. Rendell also would seek a federal Medicaid waiver to provide low-cost health care for uninsured adults (O'Toole, Pittsburgh Post-Gazette, 5/14).
  

Rhode Island
Businessman Don Carcieri (R) and former state Sen. Myrth York (D) are vying to fill the seat of term-limited Gov. Lincoln Almond (R).

• Carcieri has proposed a plan that would allow small business owners and recently unemployed workers to purchase health insurance through the state's RIte Care program, which provides health coverage for low-income children and women (Kaiser Daily Health Policy Report, 10/11). Carcieri also has expressed concern that seven health insurance companies have left the state in the past three years. Carcieri has said that if elected he would "act to keep ... small insurers [in the state], while we review the situation that has brought them to this decision." He also said, "We need to review the impact that government regulation has on the marketplace to be sure that state policies and regulations are not preventing insurers from doing business here" (Carcieri Web site).
  
• York has announced a proposal similar to Carcieri's that would allow small business owners and the unemployed to buy health insurance through RIte Care. Under York's plan, participants would pay the full cost of insurance, and unemployed workers could receive up to 18 months of coverage. York added that the proposal would save the state money because it could leverage a larger pool of customers to obtain lower premiums in negotiations with health plans (Kaiser Daily Health Policy Report, 10/11). As part of a four-part prescription drug plan, York said she would propose legislation that would prohibit drug makers from "counting advertising as part of their operating expenses," a figure used to determine whether the companies qualify for state tax incentives (Kaiser Daily Health Policy Report, 7/3).
  

Tennessee
Former health care executive and Nashville Mayor Phil Bredesen (D) and Rep. Van Hilleary (R) are facing off in the race to replace Gov. Don Sundquist (R), who is term-limited.

• Breseden has said he believes TennCare, the state's Medicaid managed care program, is a "fundamentally sound program that is off track and must be fixed." To improve TennCare, Bredesen would "tighten up eligibility" by improving the eligibility reverification process and ensure that people "on TennCare deserve to be on TennCare." Bredesen also would alter benefits based on state funding levels and ensure that the benefit package does not serve as encouragement for privately insured people to end their coverage. Breseden also said he wants to create a "Children's Cabinet" that would include commissioners and directors from several state agencies. The cabinet would focus on expanding child advocacy centers, ensuring that all children have access to health care and creating school health initiatives. Bredesen also said he supports enhanced enforcement of Tennessee's regulatory and statutory systems to assure the safety and quality of nursing homes. Bredesen wants to extend more opportunities for home- and community- based services (Bredesen Web site).
  
• Hilleary has said TennCare is to blame for the state's budget problems. He said, "TennCare is so structurally flawed, so managerially flawed ... that it has destroyed our finances." According to Hilleary, TennCare has to restructured and the program's benefits should be overhauled to match those offered in other states. Because of TennCare's "very good" benefits, individuals from other states "take advantage of the program," Hilleary has said (Jordan, Memphis Commercial Appeal, 4/17). Hilleary has said he would ensure that all TennCare beneficiaries actually are eligible for coverage. He also would ensure that beneficiaries considered "uninsurable" have been unable to procure private insurance because of a pre-existing medical condition and thus are eligible for TennCare coverage (Hilleary Web site). Hilleary said TennCare should rely more on generic drugs, adding, "We should not use precious TennCare dollars to finance advertising campaigns" for brand-name pharmaceutical firms (Nashville Tennessean, 8/15).
  

Texas
Incumbent Gov. Rick Perry (R) is being challenged by businessman Tony Sanchez (D).

• Perry in May proposed a measure that would allow businesses with fewer than 10 employees to purchase health insurance through the Texas Health Insurance Risk Pool, with monthly premiums ranging between $180 and $750. Perry also proposed using $20 million from the state's share of the national tobacco settlement to double the number of federally qualified health centers in underserved and rural areas between 2004 and 2005; enacting a law that would require state insurers to offer prescription drug coverage in their Medicare+Choice plans; and requesting a federal waiver to allow families enrolled in the state's CHIP program to purchase employer-sponsored health coverage (Kaiser Daily Health Policy Report, 5/30). Perry has also proposed publishing a small business "rate guide" and helping small employers find information about health plan options for their employees (Perry Web site, 5/02). Perry in April proposed limiting noneconomic damage awards in medical malpractice cases to $250,000, as well as designating "special trial courts" for such cases and limiting personal injury trial lawyers' contingency fees (Perry Web site, 4/02). Perry last year vetoed a bill (SB 1156) that would have saved the state more than $416 million over five years and would have expanded Medicaid coverage. According to Perry administration officials, the governor believed the state could save money without the legislation and he "generally opposes" expanding health care "to which some people might then assume they are entitled" (Kaiser Daily Health Policy Report, 6/20/01).
  
• Sanchez said he has made health insurance reform a focus of his campaign. "The state of Texas faces real problems with skyrocketing health ... insurance rates. ... I will do all that I can for the people of Texas to make sure they get fair and affordable insurance coverage," Sanchez has said. Sanchez has said he would designate prompt pay and medical liability reform as his legislative priorities. In addition, he advocates managed care reform to decrease insurance premiums. Sanchez has asked medical providers in the state to develop a "comprehensive bill" to address these issues "that can be defended in the courts" (Sanchez Web site).
  

Wisconsin
State Attorney General Jim Doyle (D) is challenging incumbent Gov. Scott McCallum (R).

• Doyle has proposed several health reforms during his campaign, including a plan that would allow more elderly residents to receive care at home, rather than in nursing homes. In addition, Doyle has said he supports legislation that would establish large purchasing pools of private sector and government employees to help negotiate discounts on health insurance premiums and prescription drugs. Doyle also has proposed increasing income eligibility under BadgerCare, the state's health program for low-income families, from 185% to 200% of the federal poverty level (Kaiser Daily Health Policy Report, 9/11). Doyle has not provided an estimate of how many additional people would qualify for the program or what the expansion would cost (Kaiser Daily Health Policy Report, 8/14).
  
• McCallum signed a law in July that provides an additional $38.2 million for the state's health insurance programs, including BadgerCare (Kaiser Daily Health Policy Report, 9/11). In addition, McCallum recently launched SeniorCare, which will provide prescription drug coverage for more than 250,000 low-income seniors who are not eligible for Medicaid (McCallum Web site).