Post-Election, Insurance Exchanges, Other Health Care Issues Loom Large In States
Six public radio reporters - Martha Bebinger (Mass.), Elizabeth Stawicki (Minn.), Sarah Varney (Calif.), Erika Beras (Penn.), Lynn Hatter (Fla.) and Elana Gordon (Missouri) - talk about how ballot initiatives and state legislative elections could affect the future of the health law implementation and public health in their states.
Listen to the audio or read the transcript:
MARTHA BEBINGER: I’m Martha Bebinger at WBUR in Boston. Yesterday in Massachusetts, voters overwhelmingly approved a ballot question that would legalize marijuana here, making us the 18th state in the country that will now allow patients with a debilitating medical condition to seek a certificate for the use of marijuana to give them some relief.
A second ballot question that would have allowed physicians to prescribe life-ending drugs, physician-assisted suicide - it was called Death With Dignity here - was defeated 51 to 49 percent. About six months ago in the polls, that same question had overwhelming voter support in the high 60s (percent). But in the intervening time, the Catholic Church and a number of well-financed groups launched a major ad campaign - on TV, radio and in newspapers - to try to defeat that question and they did, in the end, succeed.
SARAH VARNEY: This is Sarah Varney with Kaiser Health News in San Francisco. The big news here is that Proposition 30, which is a state ballot measure that was going to raise the sales tax by a penny for the next few years and increase the income tax on some of the highest earners here in California, passed. This was a big concern for people in California, because if it had not passed there was going to be a question about whether or not the state could move ahead with this promised Medicaid expansion. California obviously has been far ahead of the other states in the United States in terms of its enthusiasm over the health law. Now, the people that I’ve talked to today have essentially said that all of this uncertainty is gone.
So the big news here is that with this state ballot measure passing, with Obama maintaining the presidency, and with the Senate in Democratic control, people here are saying it’s really full steam ahead for the implementation of the exchange and for the Medicaid expansion. A lot of people who work on the exchange now are saying, "We’ve got nine or 10 months to do this. We’ve got to erect this online portal. We’ve got to make a lot of very crucial decisions about which kinds of plans are going to be offered on the exchange. We’ve got to figure out how to communicate that to people."
It’s a theme I heard a lot today from people who are working on the exchange and working on the Medicaid expansion: "Quite frankly, we now are going to be trying to convince people to get insurance. Many of these people have never had insurance. They’re used to going to the emergency room or going to the community clinic or just not having health care in general. So now how do we really communicate to an incredibly diverse audience why they should take up one of these plans, either go onto the exchange or sign up for the Medicaid expansion."
So that’s a real concern now, it’s really on the ground, nuts and bolts, how are we going to get this up and running in the next nine or 10 months?
ELIZABETH STAWICKI: I’m Elizabeth Stawicki with Minnesota Public Radio in St. Paul. Before the election, Minnesota had been locked in a battle of political wills over carrying out the federal health care law here. Gov. Mark Dayton, a Democrat and a staunch supporter of the president’s health care overhaul on one side. And on the other side a Republican-controlled legislature. Nowhere did that division play out more than in designing a state health insurance exchange. Republicans refused to pass legislation to set one up here in the past two legislative sessions, even though some Republican constituencies - such as the Chamber of Commerce and those that oppose legalized abortion - pleaded with Republicans to get involved. But that Republican roadblock is now gone. Not only did the State Senate flip Democrat, the State House of Representatives surprisingly is now Democrat-controlled as well. That means Minnesota is completely Democrat-controlled and led by a governor who solidly supports the president’s health care law.
ERIKA BERAS: I’m Erika Beras with WESA Public Radio station in Pittsburgh. We cover the entire southwestern Pennsylvania region of the state. With President Obama’s win last night, it was a pretty big endorsement for health care reform, but it also I think is going to provide a number of troubles and problems for this state. Number one, the state has gotten $33 million to set up its health exchange and they haven’t done a single thing with the money.
I just spoke with the insurance office today and they said they were pretty much waiting to see what would happen with the presidential election. Governor Corbett has said, when the Supreme Court decision came down, that he was very disappointed with the decision, and I think they thought that maybe if they waited a little while, they would maybe not have to set the exchange up at all.
They have sent out several releases, and they have published several letters that they’ve sent out the Department of Health and Human Services saying that there are too many unanswered questions right now. They don’t know how much autonomy the state of Pennsylvania will have over the exchange. They’re not sure how much it will cost. And they’re not exactly sure it’s really the best thing for the state.
So, I think from this point on they’re still moving forward, and they’re not exactly sure what’s going to happen.
LYNN HATTER: I’m Lynn Hatter with Florida Public Radio in Tallahassee. There were a lot of surprises last night in Florida. Voters faced long lines at the ballot box and a closer than expected presidential race here that still has not quite been decided.
But when it comes to health care-related issues, Florida voters delivered their opinions very loudly and very clearly. There were two health care amendments before Florida voters this year. One was Amendment 1, which was called Health Care Freedom. This proposal was placed on the ballot by the Florida Legislature. It was essentially the state’s response to the federal health care overhaul law. The proposal blocked the state from instituting what’s widely known as a universal health care system here in Florida, but voters rejected that proposal.
There was also Amendment 6, which would have blocked public funding for abortions. A lot of people considered Amendment 6 a moot point, because state and federal law already do that. Planned Parenthood put about $2 million into a campaign to defeat that proposal.
Both of them failed: both Amendments 1 and 6. Amendment 1 only got about 48 percent of Florida voters’ support, and Amendment 6 only got about 45 percent of the vote. Both of them here in our state needed 60 percent of voters to approve them in order to be placed into the state’s constitution.
ELANA GORDON: I'm Elana Gordon, with KCUR, the public radio station in Kansas City, Missouri. With last night's election, there's a lot more certainty with the federal health law and where it stands. But here in Missouri, there's still a lot of ambiguity on how that's going to be implemented. That's especially the case after voters overwhelmingly approved Proposition E here. Basically, what that message sends is: The governor, or the state, doesn't have the power to implement any health [insurance] exchange activity, or an exchange, without the approval of the legislature or the people.
The sponsor of the measure has said this is about dealing with the abuse in power of the governor, now Missouri Gov. Jay Nixon, who won the election, a Democrat. But he said he has no plans to set up an exchange. Others interpret this type of measure as a statement on the health law itself - opposing the federal health law and sending that message to the legislature. So that was one of the main things that passed in Missouri.
Looking out, with the legislature coming back in January, it really looks like the state's on track for a federal exchange. The other component of that measure is that it allows taxpayers to sue state employees or anyone involved in the state with health exchange activity. So there's that element to it as well.
The other measure that's health-related in Missouri, which failed, was a cigarette tax. There was an effort to raise Missouri's cigarette tax - the lowest in the country - that failed by a very small margin.