And By Report

March 13, 2003

* Louisiana Governor is not required to deliver a state of the state address.

Report

2003 State of the State Addresses:Governors’ Discussions of Budget and Health Care IssuesBy

Sara Wilensky, JD

And

Betsy Schipani

March 13, 2003

2003 State of the State Addresses:Governors’ Discussions of Budget and Health Care Issues

State Date ofSOS

New Initiatives Medicaid SCHIP TheUninsured

FY 2004 EstimatedState Budget

Deficit(in millions of

dollars)_Alabama No data

availableN/A N/A N/A N/A $500

Alaska 1/23/03 N/A The delivery of adequate healthcare is a real challenge, mademore difficult by the escalatingcosts of Medicaid.… ensure we have a sufficientnumber of qualified health careprofessionals throughoutAlaska… identify strategies tomaximize federal and stateresources so we can improve thedelivery of health care servicesalong with preventative healthcare strategies.

N/A N/A $896

Arizona 1/13/03 N/A N/A N/A N/A $967Arkansas 1/14/03 …reduce health care costs

with reform of medicalmalpractice…Legislation isbeing introduced to bringsome control and boundariesto the risks faced bybusinesses, doctors, hospitalsand employers, as well as justprivate citizens. The purposeis not to protect bigcorporations or insurancecompanies, but it is to protectall of us from a system ofhealth care that we'll simplynot be able to afford or accesswithout some reform

…without you joining me andfinding new revenue, we simplywill not meet the court-orderedmandates in education orMedicaid

$223

California 1/8/03 N/A N/A My budget will protect,to the extent possible,our progress in public

N/A $18,000 – 26,000

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State Date ofSOS




dollars)_education, public safetyand children's healthinsurance

Colorado 1/16/03No dataavailable

N/A N/A N/A N/A $900

Connecticut 1/8/03 1. We are askingstate employees totake a smallerraise this year, anda wage freeze nextyear.

2. We are asking fora reasonableincrease in theirhealth carepremiumpayments.

3. We are asking foran increase in theirprescription drugco-payments.

N/A N/A N/A $1,500

Delaware 1/23/03 My budget proposal willinclude a plan to spend $5million from the tobaccosettlement fund on the first-year recommendations of thecancer council. These fundswill be used to begin earlyscreening for colorectalcancer, to pay for cancertreatment for the uninsured, tobegin to investigateenvironmental causes ofcancer and to reduce tobaccouse in Delaware.

One such cut has already been

When I began work on thebudget proposal, the gapbetween projected revenues andexpenditures for FY04 stood at$300 million - more than 10percent of our budget…The gapexisted because the currentprojection of revenues next yearis that they will be less than stategovernment's level of spendingthis year. Add to that the largelyunavoidable increases to thebudget from the mandated costswe see every year: increases inMedicaid, increases in healthcare and prescription costs

N/A N/A $300

March 13, 2003

State Date ofSOS




dollars)_announced -- the closing ofthe Gov. Bacon Health Centerin Delaware City. The statehas been operating threenursing homes when it onlyneeds two, creating theopportunity to save $2.5million without diminishingservices to citizens or puttingstate employees out of work.The level of care thesepatients receive will notchange as they and theemployees who have servedthem so well are moved toone of our two other healthcare facilities.

care and prescription costs…

Florida 1/22/03 Health and human servicesspending has increased by arecord $4 billion.

For example, under our KidCareand Medicaid budgetrecommendations, 1.3 millionchildren will be receiving healthcare coverage, up 69 percentfrom four years ago. The numberof developmentally disabledbeing served has increased by330 percent.

N/A N/A $2,000

Georgia 1/27/03 …we have identified anadditional $285 million thatwill allow us to fully fund thehomestead exemptionproperty tax cut withouttaking away from education,health care or other criticalneeds.

N/A N/A N/A $900

Hawaii 1/21/03 I am proposing to level theplaying field for privatehealth insurance companiesby eliminating the 4% generalexcise tax on their policies,thereby increasingdramatically the chances ofnew providers entering the

N/A N/A N/A N/A

March 13, 2003

State Date ofSOS




dollars)_market.

I am also proposing thatHMSA and KaiserPermanente be prohibited inthe future from sitting on theboard that recommends whichinsurance companies canenter the market in Hawai`i.

I am proposing legislationthat only affects lawsuits thatare found by a panel ofindependent doctors andlawyers to be without merit. Itwill reduce the cost ofmalpractice insurance andhelp to hold down the cost ofhealthcare.

In order to bring immediaterelief, I have put together apublic-private partnership thatwill provide free prescriptiondrugs to our most vulnerablecitizens. This unique programis possible because theHawaii Medical Associationhas offered to mobilize thesupport of Hawai`i'sphysician community, andfund a hotline so that help isreadily available.

Long-term care insurance isreadily available and oftenaffordable, but relatively fewpeople have availedthemselves of this self-helpremedy. To encourage thepurchase of such insurance, Iam proposing a 30% taxcredit to be phased in over a

March 13, 2003

State Date ofSOS




dollars)_three-year period.

Idaho 1/7/03 …cutting all state funding toour seven health districts andeliminating the CatastrophicHealth Care fund…

We improved the quality of ourhealthcare to Medicaidrecipients and reduced costlytrips to the emergency room byinvesting in a program calledHealthy Connections.

We reduced the growth ofMedicaid from 16% down to just6%.

…there would still be a $100million shortfall and the realityof slashing ALL remainingagencies, including seniorprograms, Veterans Services,and Medicaid

N/A N/A $200

Illinois No dataavailable

N/A N/A N/A N/A $3,600

Indiana 1/14/03 N/A N/A We have found childrenwithout insurance inBluffton and Newburghand Terre Haute andCrawfordsville andacross the state. Andwe've done somethingabout it. We haveenrolled nearly half amillion children inHoosier Healthwise -which is both Medicaidand CHIP, theChildren's HealthInsurance Program.

We have askedWashington to restorethe money that it

N/A $850

March 13, 2003

State Date ofSOS




dollars)_provided - and thenjerked away - moneythat would allow us tohelp many morechildren get the healthcare they need.

Iowa 1/15/03 Iowa should lead the nationwith the highest percentage ofresidents with mental healthand substance abusecoverage. Let us make theenactment of mental healthparity a landmark for whichthis legislature will beremembered and celebratedfor years to come.

And we will seek legislationto give the Department ofInspections & Appeals theauthority to regulate adult daycare facilities for dependentadults and seniors, so thatfamilies can feel secure aboutthe quality of care theirfamily member receives.

We will look whenever,wherever, and for as long as ittakes for strategies to controlMedicaid costs without limitingaccess to quality healthcare.

Today, we protectalmost ninety-fivepercent of our childrenby providing access tohealthcare throughMedicaid; Hawk-I, ourchildren's healthinsurance program; orother private insurance.

N/A $414

Kansas 1/15/03 The '04 budget does notinclude any revenue transferfrom the state to cities andcounties, because thosedollars are essential toeducate our Kansas children,protect our most vulnerablecitizens, and ensure access toquality health care.

More than 450,000 Kansansreceive their health insuranceand health services from thestate. As the largest purchaserof health care in Kansas, we

N/A N/A N/A $700

March 13, 2003

State Date ofSOS




dollars)_must look for ways to utilizeour purchasing power andhelp contain costs…I havebegun to work with mycolleagues in the Midwest toleverage the prescription drugcosts of Kansans throughmulti-state purchasing.

Kentucky 1/9/03 N/A We've increased Medicaidspending 64 percent; and theMedicaid budget is still $450million short.

Proposed 2% Medicaid cut

We've been among themost successful states toimplement the children'shealth insuranceprogram. Over 51,000children in Kentuckyhave health insurancecoverage today becauseof our work!!!

N/A $360

Louisiana N/A*No dataavailable

N/A N/A N/A N/A N/A

Maine N/A N/A N/A N/A N/A $375 – 475Maryland 1/15/03 N/A For Seniors: $7.3 million for

1,000 additional placements forthe Medicaid Older AdultsWaiver to move people out ofnursing homes and back intotheir homes.

N/A N/A $1,200

Massachusetts 1/29/03 I will also call on all stateemployees to pay a largershare of their healthinsurance, from the 15percent we now pay to 25percent. And some stateworkers will face layoffs aspositions they have filled willno longer be needed.

N/A N/A In some cases, I'll askcitizens who receivefree medical care tocontribute a share ofits cost. Some healthservices will be paredback. Providers, likehospitals and nursinghomes, will also beasked to share in ouremergencyreductions. Of everydollar now spent for

$1,400 – 2,000

March 13, 2003

State Date ofSOS




dollars)_health and humanservices, there will beabout a 1 _ centreduction.

Michigan 2/5/03 On behalf of our seniors, wehave submitted - just thisafternoon - a waiver requestto the federal governmentasking for additional federalfunds to expand EPIC, ourElder Prescription InsuranceCoverage program. Thewaiver will allow us to morethan double the number oflow-income Michigan seniorswho can rely on EPIC forcomprehensive prescriptioncoverage.

Citizens are providing inputthrough a Medicaid summit onhow to repair our brokenMedicaid system.

I have also instructed the State'sDirector of Community Health,Janet Olszewski, to beginnegotiations with other states toform a multi-state compact forprescription drugs. Byleveraging the compact'simmense buying power, weexpect to cut tens of millions ofdollars from our Medicaid drugcosts this year.

N/A N/A $1,603

Minnesota 2/6/03 Former U.S. Senator DaveDurenberger has agreed tolead a Blue Ribbon TaskForce of Minnesotans to helpus chart a course for thefuture of health and healthcare in Minnesota. This taskforce will provideMinnesotans with a longrange cost control strategy tomake health care moreaffordable. I expect this taskforce to finish its work withinthe next eight months.

N/A N/A N/A $2,442

Mississippi 1/9/03 During the special session onmedical malpractice, I calledfor the creation of acompensation fund to providerelief for rural Mississippi.Today, I again urge itsadoption as part of the overall

N/A N/A N/A N/A

March 13, 2003

State Date ofSOS




dollars)_plan to ensure quality healthcare for our people.

Missouri 1/15/03 I will also seek a cigarette taxdedicated to health care. Butin this proposal, the moneywill be needed to protectexisting health care needs,including health care for ourlow-income elderly.

N/A N/A N/A $1,000

Montana 1/21/03 We can also retain ourtalented teachers byaddressing the rising costs ofhealthcare.

On behalf of educators inMontana, I urge you to sendme HB 302, sponsored byRepresentative Dave Lewisand developed in partnershipwith the educationcommunity. This legislationcreates a statewide teachers'insurance pool to keep costsdown for our schools.

As we work to address healthcare needs, I ask for yourconsideration of legislation toimplement a senior discountprescription plan in Montana.

Our budget addresses theneed for more community-based programs for thementally ill by limiting thepopulation at the MontanaState Hospital in WarmSprings, and creating threeregional programs.

In addition to these healthcareissues, our hospitals and

We must also address the wiseuse of our Medicaid dollars.That is why I am creating aMedicaid Reform Commission,to be headed by Dr. PeterBlouke to address growingneeds and escalating health carecosts.

N/A N/A $66

March 13, 2003

State Date ofSOS




dollars)_clinics are faced with othertough challenges, not the leastof which is the shortage ofqualified healthcare workers.

I established a task force toaddress those shortages, andin response to theirrecommendations, I havecommitted $120,000 offederal money to partner withSuperintendent McCulloch toprovide a healthcare careerspecialist in her office. OPIwill also provide $30,000 offederal money over the nextthree years, and we are askingprivate industry to supportthis effort as well.

Nebraska 1/15/03 My budget recommendationsrequire reductions acrossnearly all programs, services,and aid provided by Stategovernment…I have alsospared from deep cuts publicand private nursing homes,the state's 24-hour carefacilities including ourveterans' homes, and ourhome for the developmentallydisabled. And finally,children's health care, thefamily childcare subsidy, andearly childhood education aidare spared deep cuts underthis budget recommendation.

Aid to individuals includesMedicaid, childcare subsidy, andother individual assistanceprograms. The total price tag thisyear is $535 million or 20percent of the total budget.Medicaid, the state and federalhealth care program for low-income seniors, the disabled, andchildren, is the largestcomponent of this category atthree-quarters of the total. Thecomplete elimination of aid toindividuals for one year - ofcourse, not a possibility - wouldnot balance the budget.

N/A N/A $337 – 449

Nevada 1/20/03 I am proposing a 15 centincrease in property taxes,and the creation of anadmissions and amusement

N/A Ladies and Gentlemenof the Legislature, Irefuse to balance thisbudget on the backs of

N/A $359

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State Date ofSOS




dollars)_tax… the vast majority ofthese taxes will only provideenough revenue to meet thebasic needs of our state'sgrowth. Growth means the…the enormous increase inmandated caseloads forMedicaid and welfare, and therising cost of health carebenefits for public employees.

our children, seniorcitizens, and the poor.Moreover, I will not cutprograms such asNevada Check-Up.Cutting a programwhose sole purpose is togive health care to25,000 needy children iswrong. No, it is notwrong, it is heartless. Ifit is your choice to doso, you will do it overmy veto.

NewHampshire

2/13/03Text

not yetavailable


New Jersey 1/17/03 We've developed a specialtumor registry so that everyNew Jersey patient diagnosedwith cancer will have greateraccess to state-of-the-artclinical trials through anetwork of hospitals andoncologists. We've createdSWAT teams to respond tosuspected cancer clusters.

In the next budget, we willbuild on these investmentsbut we can start now bypassing legislation to promotestem cell research to be donehere in New Jersey.

N/A N/A N/A $4,000

New Mexico 1/21/03 Additionally, the grossreceipts tax on payments tophysicians from commercialHMOs should go away. The

The last administration took thisdevelopment a giant step fartherby giving the HMOsmanagement of Medicaid the

N/A N/A N/A

March 13, 2003

State Date ofSOS




dollars)_gross receipts tax is forcingdoctors to leave our state,threatening the health andwelfare of our communitiesparticularly in rural NewMexico.

I propose $4 million forscholarships and otherfinancial incentives to thesehealth care professionalswhile they are in training.We'll require them to practicehere in New Mexico.

management of Medicaid - thefederal program that is a majorfinancial component of almosteverything that happens in healthcare. The result - intended or not- is that Medicaid andcommercial health insurance arejoined at the hip. Hard times inMedicaid will be made up byraising the premiums chargedcommercial customers. Higherpremiums will reduce thenumber of people covered -which in turn increases thefinancial pinch on the big HMOsstarting the whole cycle overagain.

We must reshape or reform ourhealth care industry in ways thatextend health insurancecoverage to more people. I don'tbelieve a single-payer system isthe answer to universalcoverage, but we must - and will- find ways to make health carecoverage more universal for ourstate's citizens. The broader thereach of coverage the greater thestability in the industry.

We need to provide prescriptiondrug relief to our senior citizens.This should be accomplishedthrough Medicaid for low-income and disabled seniors.

For all seniors, I will enter intoforceful negotiations with drugcompanies to obtain the largestpossible price discounts. I agreewith those who say prescription

March 13, 2003

State Date ofSOS




dollars)_drug coverage for senior citizensis a federal responsibility, but wecan't simply ignore the problemat the state level.

The legislative Medicaid ReformCommittee just reported on ninemonths of study on the almost$2 billion a year program. Thisadministration will make thatstudy the starting point fromwhich to decide what must bedone in the short term.

New York 1/8/03 N/A N/A N/A N/A $10,000 – 12,000North

Carolina3/3/03 We tackled the skyrocketing

costs of prescription drugs forour seniors. Our new SeniorCare program helps them gettheir medication while theykeep their health. People saidwe could not afford to goforward in this economy, butNorth Carolina will protectthe greatest generation in anyeconomy.

And while Washington stilldebates this issue, NorthCarolina passed the strongestPatients Bill of Rights inAmerica…

And finally, we must gethealth care costs undercontrol. We cannot allowfederal mandates to destroyeducation and public safetyinvestments.

Let me be clear - our healthcare programs help our mostvulnerable citizens. We know

We will help those on Medicaidas well. Under our newACCESS initiative, healthproviders will emphasizeprevention, and begin enrollmentthis year. It will cost us less andprovide patients more.

N/A N/A $2,000

March 13, 2003

State Date ofSOS




dollars)_that we will all be judged byhow we treat the least of ourpeople.

But if we fail to control costs,and try to be all things to allpeople, we will soon beunable to provide anythingfor anybody. The only viablelong-term solution isprevention. It works in theprivate sector and it can workin government.

Diet, exercise, and checkupsprevent health problems.

An ounce of prevention isworth a pound of cure - and apound of cure is getting tooexpensive to waste.

It is wrong to ask others totake care of us if we are notwilling to take care ofourselves.

Tonight I am proposing thatthe state increase its wellnessbenefit by one-third next year.It is the right investment toprovide incentives to staywell.

North Dakota 1/7/03 We can empower our seniorsto live at home longer, and wecan help those with limitedincome to afford theprescriptions drugs they need.To do that, I have proposed --and I ask you to support --funding for HealthySeniorsRx, our new

N/A N/A N/A N/A

March 13, 2003

State Date ofSOS




dollars)_prescription drug program, aswell as increased funding formore home-based services forour seniors and disabled.

Ohio 1/22/03 Mental Retardation andDevelopmental Disabilitieswill gradually move peoplefrom institutions tocommunity-based settings,enabling us to close one ortwo developmental centers inthe next two years.

[Medicaid is] also about tobankrupt Ohio, and nearly everyother state in the union. TheMedicaid growth rate is simplyunsustainable. The year I tookoffice, Ohio spent under $6billion on Medicaid. By the endof the coming budget, costs willhave risen to $10 billion a year -an increase of over 75 percent injust six years.

We'll continue to protect ourmost vulnerable populations,including children and pregnantwomen. We'll also make itpossible for more seniors andpersons with disabilities to livein settings they prefer. But wemust enact tough measures toslow the growth rate ofMedicaid or else decimate everyother category of state spending.

I will propose to freezereimbursement rates for allproviders, require a new formulato pay for long-term institutionalcare, eliminate many optionalservices, and change eligibilitycriteria that will significantlyaffect the number of adultOhioans receiving Medicaidservices.

Due to federal mandates,Medicaid costs are hard tocontrol. Even with the steps I'm

N/A N/A $2,000

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State Date ofSOS




dollars)_proposing, Medicaid willincrease by nine percent nextyear, far more rapidly than staterevenues, requiring an additionalexpenditure of $300 million instate share alone in our nextfiscal year.

Oklahoma 1/13/03 Already, I have begunworking with other Governorsin our region to form a multi-state bulk purchasing pool tohelp drive down the cost ofprescription drugs. We needto explore other options formaking health care moreaffordable, such as thatproposed by Senator Jay PaulGumm in Senate Bill 710 andSenator Bernest Cain inSenate Bill 830. No one -especially our seniors -should have to choosebetween buying groceries orlife-saving medicines.

We should continue to build onthe health care and HMOreforms already enacted by theOklahoma Legislature. Forexample, we should maximizeour Medicaid program, and, atthe same time, increase accessby allowing limited liability fordoctors who donate care to thepoor.

N/A N/A $593

Oregon No dataavailable

N/A N/A N/A N/A $960 – 1,267

Pennsylvania 5/4/03No dataavailable

N/A N/A N/A N/A $500 – 2,000

Rhode Island 2/4/03 We're going to throw ourenergies into tackling therising cost of health care. Ourlow-income neighbors, ourelderly and our workingfamilies need RELIEF.

N/A N/A N/A $175 – 250

SouthC li

1/22/03 N/A Medicaid spends over 3 billiondollars each year - and it is

N/A N/A $700

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State Date ofSOS




dollars)_Carolina currently in crisis. It will require

about a $150 million increase infunds just to keep the existingprograms going. One solution isto simply raise taxes. I think thisaction alone would be a mistakebecause simply raising taxes isno more than a band-aid for apatient in critical need ofsurgery. We have a duty to worktogether to find a solution notjust for this year - but also forsubsequent years.I have specific thoughts ondecreasing the income tax withany proposal to increase thecigarette tax to fund Medicaid.This may well be an acceptabletax substitution as the federalgovernment pays 70% ofMedicaid while SouthCarolinians pay 100% of theincome tax.

Let's also look at Medicaidreforms - eligibility, betterlinkage with non-profit andfaith-based institutions, and adifferent approach to the waythat Medicaid provides service.

Medicaid doesn't look at healthin any sort of long-term context,but rather seems to serve as aninsurance agency that simplypays to treat symptoms. I thinkit's very important that weimplement a system whereinMedicaid patients have medicalhomes and primary carephysicians that look at theirhealth needs and the causes of

March 13, 2003

State Date ofSOS




dollars)_those health needs.

There's something wrong with aMedicaid system that paid for$26 million in visits toemergency rooms last year,though in many cases care couldhave been provided in a settingless expensive for the taxpayerand less institutional for thepatient.

There is something wrong with aMedicaid system that will payfor a series of differentspecialists' opinions or specialtyprocedures, but doesn't pay forsignificant preventive services.

There is something wrong with aMedicaid system that will payfor a $1500 a year drug plan toreduce cholesterol for twentyyears - but it won't pay for anongoing, $200 a year nutritionalplan that would reducecholesterol by an even greateramount.

We know that a diet high insaturated fat can lead tocoronary heart disease. Well, wehave plaque in the Medicaidblood stream. Before we ask formore blood to go through thoseconstricted arteries we owe it totaxpayer, patient, and provideralike to reform the system.Concurrent with any proposalfor more money, there must bereform. If we need waivers formore flexibility, I will go to the

March 13, 2003

State Date ofSOS




dollars)_mat in Washington to get them.

South Dakota 1/14/03 We will implement aprescription drug program forour seniors until such time asCongress acts to responsiblyimplement a nationwide plan.

I think, in addition to that,we'll have to revisit somewhatthe Physician TuitionReimbursement Plan. Wehave physicians in our statethat are taking advantage of itnow. But there's room togrow and expand it. We havea shortage in dentists withinour state. I would proposethat part of the slots that wecurrently have available - weallow up to ten positions rightnow to take advantage of thetuition reimbursement plan. Ibelieve that we should takethree of those and allow thosefor dentists to come back toour state. The dental industrywithin our state through afoundation that theirorganizations have puttogether to cooperate with usto expand it and to helppromote the education ofdentists allowing for them tocome back into the state. Butthere's another, there's anotherbenefit here.

I would like to offer a statesolution for those individualswho have no other place togo, I would like to offer to

…we have a tough time gettingdentists to all participate in ourMedicaid program because wedon't pay a real good rate forreimbursement for charges fordental care. We have fewer andfewer dentists that are actuallyworking on our Medicaidpatients. And, so as part of thisrequirement (for the tuitionreimbursement plan), is that ifthese young people come backto our state, they would berequired to take Medicaidpatients as well for a period oftime.

N/A N/A $54

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State Date ofSOS




dollars)_them a solution similar towhat we have offered to ourstate employees. It's twoprong - first of all, for ourstate employees we haveoffered them the opportunityin working with a selectgroup of pharmacists whohave chosen to work with us aplan in which when theybring in a prescription, thatpharmacist will look at it andsee if he can replace a namebrand drug with a genericdrug. In doing so, we havesaved over $500,000 on ourstate employees plan. That'safter we pay that pharmacist$10 for his work. In somecases, it means going to alarger pill and cutting them inhalf in some cases. But thepharmacist is working withus. I'd like to expand that planand allow those samepharmacists and otherpharmacists who care to do soto work with their seniorcitizens on the sameapproach. Then I'd like to goone step farther because partof the savings between thegeneric drugs and the namebrand drugs, I'd like to take asmall part of it and bymembership, by membershipfor those seniors in the sametype of a plan as what wehave for our state employees.Now the seniors will stillhave to pay for their drugs,but they're going to get it at adiscounted rate that we

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State Date ofSOS




dollars)_receive for our stateemployees. I believe thesavings will be significantand it will give them the sameopportunity for a savings ontheir drugs as a person who isunder the age of 65 and is onan insurance company'sdiscounted plan.

Tennessee No dataavailable


Texas 1/24/03 N/A N/A N/A N/A $4,000 – 7,800Utah 1/21/03 N/A N/A N/A N/A N/A

Vermont 1/9/03 N/A Vermont has chosen to extendMedicaid coverage to those whodo not qualify for traditionalMedicaid, either because theirincomes are too high, or becausethey do not meet other eligibilityrequirements. Currently,Vermont offers benefits that areamong the most generous in thenation, and under my budget, wewill continue to do so. In fact, Ipropose Medicaid spendingincreases totaling $16 million.Not only does the Medicaidreform package I amrecommending preservetraditional Medicaid, but itreduces the cost of health carefor the poorest and sickestVermonters who benefit fromour expanded Medicaidprograms.My plan maintains traditionalMedicaid, reduces health carecosts for the most vulnerable,and preserves Vermont's health

My budget outlines acompassionate course ofaction that improves theMedicaid program andbegins to extend itssolvency, whileensuring the neediestVermonters areprotected. Theoverwhelming majority-- nearly 70 percent -- ofbeneficiaries coveredunder traditionalMedicaid and the StateChild Health InsuranceProgram, including Dr.Dynasaur - that is thepoor who are disabled,blind, or elderly,expectant mothers, andchildren who have noinsurance or who areunderinsured - will seevirtually no changes.

$28

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State Date ofSOS




dollars)_care safety net for the future byreplacing the complicated andregressive co-payment systemwe currently operate under witha simple, progressive deductiblesystem.Under this system, the healthiestbeneficiaries and those withhigher incomes are being asked,on average, to pay more for theirhealth care coverage than theyhave in the past in order toinsure that the neediest areprotected from catastrophichealth care bills.

In order to prevent abuse oftaxpayer dollars, I also apply thesame resource test to VHAPbeneficiaries that applies totraditional Medicaid patients.

Virginia 1/8/03 To keep patients safe, I amproposing to give the Boardof Medicine new tools tocrack down on those doctorswho fail to meet the higheststandards. Our goal is not toburden the great majority ofphysicians who deliverquality care, but to help weedout the few bad doctors whoshould not be practicing.

The federal government'sdecision not to fully fund itsshare of Medicaid costs Virginia$65 million a year.In fact, about half of alladditional spending in ourbudget is in health and humanresources. Without some action,additional funding for Medicaidalone would have totaled about$200 million. That is clearly notsustainable.In preparing our budget, I madethe choice to protect eligibilityand services to people. I havesent you a budget that preservesbasic services, while freezingprovider reimbursements forhospitals, nursing homes, andHMO's. It also includes steps tocontrol the soaring cost of

We have made FAMIS -- Virginia's children'shealth insuranceprogram -- more familyfriendly, by removingred tape andadministrative barriers.Since Labor Day alone,we have provided healthcare coverage to anadditional 18,000children. This is goodfor children, good forworking families, andsince the federalgovernment pays two-thirds of the cost - it'sgood for taxpayers aswell.

N/A $1,116

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State Date ofSOS




dollars)_prescription drugs.To soften the impact, I haveincluded $60 million to preserveaccess to health care. Thisfunding would support specialreimbursements to providerswho are the sole source of healthcare in their communities, orwho serve disproportionatenumbers of low-incomeVirginians.

Washington 1/14/03 But let's recognize that thecost of prescription drugs is akey driver of our escalatinghealth care costs. As apurchaser of prescriptiondrugs, the state mustimplement a preferred druglist of safe, effective andaffordable drugs to reduce thecosts to state government.And let's work together toextend the state's buyingpower to benefit seniors andothers without prescriptiondrug coverage.

I'm also proposing that weestablish a new SeniorPrescription DrugInformation Clearinghouse.This program will help low-income seniors obtain drugsthat are available free, or atlow cost, frompharmaceutical companies. Itwill also provide informationon generic drugs and discountpurchasing clubs.

N/A …my budget proposalcontinues to fund allexisting health careprograms for children.We will still be amongthe top three or five inthe nation in providinghealth care for our kids.

N/A $1,000 – 1,334

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State Date ofSOS




dollars)_West Virginia 1/8/03 $20 million proposal to

address high medicalmalpractice rates. Plan wouldoffer tax reductions andcredits toward the purchase ofinsurance. Also would limitjury awards for pain andsuffering at $250,000 to$350,000 inmost cases, andlimit damages for injuriessuffered in trauma oremergency care rendered ingood faith to $500,000.

N/A N/A N/A $250

Wisconsin 1/30/03 Wisconsin sold off its nearly$6 billion tobacco settlementfor pennies on the dollar toplug a one year budget hole.As a result, we must now findan additional $600 millionthis year alone -- just to stayeven.

That's a tragedy for ourpeople -- and it's especiallyheart-breaking for me. Wetook the tobacco companieson when everyone said theywere invincible. Thesettlement we won wasWisconsin's opportunity toinvest in smoking preventionfor kids -- health care for ourpeople -- and so many otherneeds.

I am directing stategovernment to develop aHealth Insurance PurchasingPool to allow smallbusinesses and farmers totake advantage of the buying

N/A N/A N/A $2,000

March 13, 2003

State Date ofSOS




dollars)_power of state government topurchase more affordablehealth care coverage for theiremployees and their families.

I have also directed ourgovernment to find new waysto pool our prescription drugpurchases, with those of localgovernments and even otherMidwestern states, so that wecan increase our bargainingpower and obtain lower costsfor prescription drugs.

The Potowatomi Tribe built a$10 million health care centerin Crandon that's open toevery member of thecommunity. In fact, 60percent of its patients are non-Native American. More than70 percent of kids are nowimmunized. Pregnant womenare getting exceptionalprenatal care. And the clinicis serving 4,000 patients.

Wyoming 1/15/03 Historically, you have paid100% of the cost of healthinsurance for employees, andthey are then required to payall additional costs for theirdependents. My predecessorhas recommended that wemove in a new direction, byrecommending to you that we- the employer - begin paying75% of the cost of insurancecoverage for all employeesand their eligible dependents.I am recommending that wego a step further and provide

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March 13, 2003

State Date ofSOS




dollars)_85% of the premium cost,leaving 15% to be covered bythe employee.

I am requesting sufficientfunding to make this changeeffective March 31 of thisyear. This raises the stateinsurance contribution fromthe prior recommendation of$16.6 million to $23 million.

I encourage your support of aHealth Care Commission forthe next several years andperhaps longer. A properlyconstituted and fundedcommission can build policybased on data, not anecdote. Itcan make sure we arestretching our dollars andbuilding policy for decadesnot election cycles. I believewe can make common senseprogress on complex issuesfrom liability insurance toMedicaid, if we developaccurate information andengage our citizens on acontinuing basis

1. State Budget Deficits for Fiscal Year 2004 are Huge and Growing. Lav, I. and N. Johnson. Center on Budget and PolicyPriorities. Washington, DC. January 2003. Available online: www.cbpp.org.

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