March 8, 2004

MHA's Monday Executive Briefing
March 8, 2004

  In this week's edition...
- State News -
1. Barbour, Tuck confirmed for Health Issues Forum
2. Chief Justice Pittman announces retirement
3. Kerry makes weekend campaign appearance in Jackson
4. Six complete in races for 2nd, 4th districts
5. House upholds insurance bill
6. House adopts rule changing majority for withdrawing bill from committee
7. Bill passes Senate to give Barbour control over 10 agencies
8. Hundreds rally in support of cigarette tax
9. Detailed summary of Medicaid Reform Bill
10. Barbour’s Medicaid plan includes higher fees on nursing beds
11. Pickering to vice-chair Energy and Commerce Committee
12. Lott running for re-election?
- National News -
13. Bush, Kerry even, AP poll indicates
14. Committee could begin reconciling pension relief bills this week
15. Senate panel passes FY05 budget; includes Medicaid reductions
16. Premier lobbyist Kuhn to head CMS Medicare office
17. Database Designed to Reduce Malpractice Lawsuits
18. Kerry locks up the nomination
19. Role of Health Care in Elections
20. Senators urge HHS to enforce specialty hospital moratorium as intended

- State News -

  1. Barbour, Tuck confirmed for Health Issues Forum
   MHA's annual Health Issues Forum will be held on Wednesday, March 10, at the Hilton Hotel in Jackson. During this legislative forum, we will share with our members the results of our commissioned study, “The Business of Caring: The Economic Impact of Mississippi’s Hospitals on the State’s Economy.” 
 There will be a press conference on the results of the study at 11 a.m. at the Hilton. During lunch, we will have a legislative update on important health care bills we are tracking in 2004 on the state and national level. At 1 p.m., Gerald A. Doeksen, Regents Professor at Oklahoma State University, will discuss details of his economic impact study. Afterwards, Gov. Haley Barbour, Lt. Gov. Amy Tuck and Sen. Alan Nunnellee will comment briefly about what they see as important health care issues during this legislative session.
   There is no charge for this meeting and lunch will be provided. Seating is limited so please RSVP representatives from your hospital if you have not done so yet. For more information about the Health Issues Forum or to register, contact Diane Clift at (601) 368-3217, (800) 289-8884 ext. 3217 or dclift@mhanet.org. You may also visit www.mhanet.org and click on the Health Issues Forum banner to register.

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  2. Chief Justice Pittman announces retirement
   Mississippi Supreme Court Chief Justice Edwin L. Pittman announced today that he will retire, effective March 31, 2004. He made the announcement this morning to news media in Hattiesburg, where he grew up. He is retiring nine months before the expiration of his elected term, which would end in January 2005. The Governor will appoint someone to serve the unexpired term. A justice will be elected to the next full eight-year term during the Nov. 2 general election.
   Chief Justice Pittman has served on the Mississippi Supreme Court since January 1989. He became chief justice in January 2001.  He served in the Mississippi State Senate from 1964 to 1972; as State Treasurer from 1976 to 1980; as Secretary of State from 1980 to 1984; and as Attorney General from 1984 to 1988. He retired from the Mississippi National Guard as Brigadier General with 30 years of service.
   Presiding Justice James W. Smith Jr. of Brandonwill become the new Chief Justice of the Mississippi Supreme Court. The position of Chief Justice is held by the justice with the longest service on the court. Justice Smith began his service on the Supreme Court in January 1994. The Supreme Court chief justice is the chief administrative officer of the state court system.
   Justice Kay B. Cobb of Oxfordwill become the newest presiding justice of the Supreme Court. Justice Cobb has served on the court since 1999. The court's other presiding justice is William L. Waller Jr. of Jackson, who assumed the rank of presiding justice on Jan. 5. The nine-member court usually works in panels of three justices. The Chief Justice presides over one panel. The two justices next in seniority are known as presiding justices, and preside over the two other panels.

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  3. Kerry makes weekend campaign appearance in Jackson
   Democratic front-runner John Kerry brought his campaign to Jacksonthis weekend, two days before election day in Mississippi. Kerry arrived on Saturday night and attended church services on Sunday at Greater Bethlehem Temple Apostolic Faith Church on Robinson Street. He briefly addressed the 2,500-member congregation before going to a 2:30 p.m.rally and town meeting at TougalooCollege's Owens Health and WellnessCenter. Invitations had gone out to supporters in the state asking for $2,000 donations for an event at Schimmel's restaurant Kerry attended before he was scheduled to fly out Sunday evening.
   Kerry, who won primaries and caucuses in nine of 10 states last week, will be on the ballot Tuesday in Mississippiwith several other Democratic presidential candidates, such as Wesley Clark, who have dropped out of the race. Mississippihas six electoral votes up for grabs.Second DistrictU.S.Rep. Bennie Thompson, D-Miss., will accompany Kerry during his visit in Mississippi. Thompson earlier endorsed former Vermont Gov. Howard Dean, who dropped out of the race.

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  4. Six complete in races for 2nd, 4th districts
   In the Republican primary, Stephanie Summers-O'Neal, Clinton LeSueur and James Broadwater are the choices in the 2nd district to challenge U.S. Rep. Bennie Thompson, a Democrat. LeSueur tried two years ago to defeat Thompson and failed, but he did receive 44 percent of the vote. Summers-O'Neal, a Jackson businesswoman, describes herself as a third generation Republican who can give a new voice to the district. James Broadwater is a former pastor and teacher who wants to improve conditions in the Delta, especially education.
   In the 4th District, three Republicans will compete for the chance to defeat U.S. Rep. Gene Taylor, a Democrat who has served since 1989.   State Rep. Mike Lott, a small business owner in Petal, criticizes Taylor for not voting along party lines.  Karl Cleveland Mertz, a Long Beach resident who owns a bed and breakfast, is pushing a platform of "family, faith and freedom." The third candidate is Steven McCaleb of Long Beach.
   Mississippi's other two congressional members--Republicans 1st District U.S. Rep. Roger Wicker and 3rd District U.S. Rep. Chip Pickering--are unopposed in the primary. Polls are open from 7 a.m. till 7 p.m.

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5. House upholds insurance bill
   The House has passed a bill supporters say should help lower medical malpractice insurance premium costs for hundreds of Mississippidoctors. The bill expands the Medical Malpractice Insurance Availability Plan, a state-run insurance pool created last year for doctors and hospitals unable to find medical malpractice insurance.
   Rep. Ed Blackmon, chairman of the House Judiciary A Committee, said the bill would require the state to appropriate $12 million for the pool to help cover doctors' premium costs. The $12 million would offset the tail coverage for doctors in the pool. Doctors need tail coverage so that they'll be insured for procedures performed before joining the pool. Thursday's House vote was 118-2.
   Several insurers have stopped writing policies in the state, which some attribute to Mississippi's legal climate. The bill would provide liability insurance for 125 doctors whose patient caseload is made up of at least 35 percent Medicaid recipients. It would also pay medical malpractice insurance for retired physicians who provide volunteer, unpaid health care services. Blackmon said the bill addresses tort reform because doctors who participate in the pool would receive the same protection as a state employee, which means the most a doctor could lose in a lawsuit is $500,000.
    On the Senate side, a tort reform bill would cap pain and suffering damage awards at $250,000. The Senate bill also requires that all medical malpractice claims be evaluated by a medical review panel. The bill has been sent to the House. A similar tort reform proposal by Rep. Jeff Smith, D-Columbus, won't make it out of Judiciary A, Blackmon said. "We're going to wait and look at the Senate bill rather than look at that one," Blackmon said. The bill is House Bill 1569.

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  6. House adopts rule changing majority for withdrawing bill from committee
   House members voted Wednesday to amend their rules to make it more difficult to withdraw bills from committees, a move some say is to thwart tort reform legislation. The House rules were amended to require a two-thirds majority of votes to withdraw a bill from a committee. Previously, a simple majority of the 122-member chamber was required. The 72-50 vote was cast largely along party lines.
   Rep. Ed Blackmon, D-Canton, whose Judiciary A subcommittee is reviewing tort reform bills this session, said it would take a lot of convincing "to get a positive vote'' on the proposals in his committee. If major tort reform legislation doesn't emerge from the Judiciary A subcommittee by Tuesday's bill deadline, it is dead for this session. Some lawmakers had hinted there would be efforts to bypass Blackmon's committee to bring tort reform to the House floor. Lawmakers withdraw a bill from a committee to either give it a floor vote or to send it to another committee that is likely to pass it. The change would make a bill have strong support before it was pulled from a committee. The resolution is House Resolution 39.

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  7. Bill passes Senate to give Barbour control over 10 agencies
   The Mississippisenate voted Wednesday to give Governor Haley Barbour the authority to fire employees at will in ten state agencies. The bill passed 33-to-16. Opponents say the legislation eliminates job protection at the agencies, as well as an employee's due process to a hearing or appeal if fired. Supporters say the bill is needed to allow Barbour to shave $25 million off state spending as part of a cost-savings plan. The bill now moves to the House.
   The proposal would give Barbour oversight over the agencies for one year. The bill impacts the Division of Medicaid, the Department of Public Safety, the Department of Human Services, Mississippi Bureau of Narcotics, and the Mississippi Development Authority. Other agencies impacted by the bill would be the Department of Environmental Quality, Mississippi Employment Security Commission, the Department of Corrections, the Department of Finance and Administration and the Mississippi Emergency Management Agency.

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  8. Hundreds rally in support of cigarette tax
   Hundreds of American Cancer Society volunteers used hospital wristbands to encircle the state Capitol on Tuesday to support a 50 cents-per-pack hike in cigarette taxes. The bracelets represent the deaths of 4,900 Mississippiadults each year from smoke-related illnesses. One of the state House proposals by Rep. May Whittington, D-Schlater, would produce $117 million annually, with all of the funds to be pumped into Medicaid. 
   The cigarette tax hike would give Mississippiits first increase since 1985. Mississippi's cigarette excise tax stands at 18 cents, far below the national average of 73 cents. Some lawmakers who joined cancer society volunteers for lunch said they will back the tax plan. But getting it passed will be an uphill fight since many lawmakers campaigned last year on no new tax pledges.
   As they lobbied at the Capitol, cancer society volunteers made the point that higher taxes would discourage teens from smoking. While the youth smoking rate has decreased from 30.3 percent in 1998 to 23.1 percent in 2002, bill supporters say that's still too high. More than one-fourth of Mississippiadults — 27.3 percent — smoke cigarettes, according to the American Cancer Society. Cancer society reports show nearly 90 percent of smokers start before age 18. The bills before the Legislature seek to prevent 20,000 teens from picking up the habit.

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9. Detailed summary of Medicaid Reform Bill

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  10. Barbour’s Medicaid plan includes higher fees on nursing beds
   Gov. Haley Barbour said Tuesday his plan to raise nursing home bed fees to produce more Medicaid money is different from raising taxes, which he has said he adamantly opposes. Barbour, a Republican, is pushing legislation he says will garner $130 million in savings for the cash-strapped Medicaid program. One component of that legislation, Senate Bill 2436, calls for hiking the fees on all nursing home beds from $4 to $6.
   The hike would mean an additional $14.1 million in state funds and another $47.4 million in matching federal funds. Providers are responsible for the bed fees, and while new costs couldn't be passed on to Medicaid recipients, providers could choose to pass them on to other patients.
   Barbour, who has repeatedly said he is against tax hikes — and that fee hikes are just a different form of tax hikes — elaborated Tuesday on exactly what constitutes a tax. "When does a tax, or when does a fee, or when does a charge amount to a tax?" he said during a Clarion-Ledger Editorial Board meeting. "If the government gives you the same service or values your property at the same value and you have to pay more, that's a tax increase, no matter what you call it." But, he explained, that if taxpayers want to pay a higher tax to improve the condition of a program, then it's not actually a tax.
   "The nursing home people think paying the maximum bed fee will mean there's more money available for Medicaid patients in nursing homes, then that's not a tax. That is them asking: Let us do our part to generate more money for us and the people we serve," he said. "When they ask for that because they think it produces a better program from them, then they're getting an additional benefit."
   "The health of the people of this state is important to all of us," Warren Jones, Barbour's new Medicaid director, told subcommittee members. "I think we're all tired of being at the top of the bad lists and at the bottom of the good lists. This is an opportunity to make a difference."
   Barbour’s Medicaid plan would also shift some of the state's 700,000 Medicaid recipients with "dual eligibility" to the federal Medicare program. The plan would improve Medicaid screening, checking eligibility more thoroughly. Instead of the questionnaire sent to recipients now, the state would perform physical examinations. This would not only reduce the number of noneligible recipients, supporters said, but would create a database to help with disease management and prevention.
   The plan would also create a "medical home," or primary provider list for patients. This, supporters say, would be voluntary, but would reduce the number of people going to emergency rooms for nonemergency treatment by providing patients with a list of physicians they could see. "The legislation... focuses on health care problems and solutions," Barbour said. "It's good for Medicaid and it's good for Mississippi."
   In a news release, his office said the higher fee would not be a tax increase because providers recoup the money in matching federal funds. The money, however, goes to all Medicaid providers, not just nursing homes. The bill was passed out of a Medicaid subcommittee Tuesday.

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  11. Pickering to vice-chair Energy and Commerce Committee
   Third District Mississippi Congressman Chip Pickering will soon be the new Vice-Chairman of the Energy and Commerce Committee in the House. In addition to being the oldest of House Committees (first established in 1795), it is also one of the most powerful with jurisdiction over issues relating to telecommunications, consumer protection, food and drug safety, public health and Medicare, air quality and environmental health, the supply and delivery of energy and interstate and foreign commerce in general, Pickering will serve under new Chairman Joe Barton (Texas-6) who replaces outgoing Chairman Billy Tauzin (Louisiana-3).

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  12. Lott running for re-election?
   Senator Trent Lott’s recent fundraiser fueled rumors that Lott is leaning toward a run for re-election in 2006. Lott has said publicly that he’s not sure whether or not he’ll seek a 4th term in the Senate. When asked at the fundraiser if he is running again, Lott said he’d talk about it later. The fact the checks for the event were made out to “Trent Lott for Mississippi,” Lott’s campaign committee, raised eyebrows.

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- National News -

13. Bush, Kerry even, AP poll indicates
   In the first poll since John Kerry locked up the Democratic nomination, Kerry and President Bush are tied while independent Ralph Nader has captured enough support to affect the outcome. The Republican incumbent has the backing of 46 percent, Kerry 45 percent and Nader, the 2000 Green Party candidate who entered the race last month, was at six percent in the survey conducted for the Associated Press by Ipsos-Public Affairs. Four years ago, Nader appeared on the ballot in 43 states and Washington, DC, garnering only 2.7 percent of the vote.

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14. Committee could begin reconciling pension relief bills this week
   A conference committee set to reconcile House and Senate bills that would relieve hospitals and other employers from soaring pension fund contributions could begin meeting as early as this week and aims to have a final bill ready for enactment by April, when many employers will have to make contributions to their pension funds, a spokesman for the panel told AHA News Now. House Speaker Dennis Hastert yesterday named nine representatives to the committee, which also includes five senators. Both the House and Senate bills would lower required deficit-reduction contributions by replacing the 30-year Treasury bond interest rate used to calculate contributions with a composite corporate bond rate for two years; however, the Senate bill provides additional relief for the steel and commercial airline industries. The new House conferees are Education and the Workforce Committee Chairman John Boehner, OH, ranking Democrat George Miller, CA, and members Sam Johnson, R-TX, Howard McKeon, R-CA, Patrick Tiberi, R-OH, and Robert Andrews, D-NJ; as well as Ways and Means Committee Chairman Bill Thomas, CA, and ranking Democrat Charles Rangel, NY.

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  15. Senate panel passes FY05 budget; includes Medicaid reductions
   The Senate Budget Committee on Thursday passed a budget resolution for fiscal year 2005 that assumes $9.6 billion in Medicaid spending reductions over five years, as proposed by the president, and caps discretionary spending at $814 billion, assuming a freeze for most programs at last year's spending levels. The full Senate is expected to take up the budget resolution this week. The proposal fully funds the president's homeland security request, including $476 million for hospital preparedness, and offers no hospital Medicare cuts, but includes user fees for processing some claims. It also instructs the Senate Finance Committee to come up with $3 billion in savings to offset several proposed tax cuts, without saying how that should be accomplished. In letters last week, AHA and five other organizations representing the nation's hospitals and health systems said they strongly opposed any budget provisions that would reduce or cap funding to the Medicaid program. The House Budget Committee is scheduled to markup its budget resolution March 10.

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  16. Premier lobbyist Kuhn to head CMS Medicare office
     Lobbyist Herb Kuhn is leaving the hospital advocacy business to help the CMS administer the new Medicare reform law, the agency said. Kuhn joined the CMS today as director of the Center for Medicare Management, replacing Thomas Grissom, who left the position in December 2003 for medical devicemaker Boston Scientific Corp. Kuhn, 47, has been vice president for advocacy at Premier since 2000. Before that, he spent 13 years as vice president for federal relations at the American Hospital Association. "We look forward to Herb bringing more than two decades of Washingtonhealthcare policy and management experience to his new charge," Acting CMS Administrator Dennis Smith said in an e-mail broadcast to CMS staff. The Center for Medicare Management serves as the focal point of the agency's interactions with healthcare providers, fiscal intermediaries and carriers, according to the CMS' Web site.

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17. Database Designed to Reduce Malpractice Lawsuits
   An   online database for doctors that tracks patients, their attorneys and expert witnesses involved in malpractice lawsuits aims to reduce “frivolous” cases, the Wall Street Journal reports. Access to the database, which so far has about 50 members and fewer than 100,000 patient names, costs $4.95 a month. Dr. John Jones, a Dallas-area radiologist and creator of the database, said in most cases it doesn’t provide the outcome of a suit or whether or not it had merit. The database, launched in November, is a response to the increasingly hostile malpractice environment.
   Doctors are required by their ethical codes to provide medical care to patients in emergency situations. However, in nonemergency situations, doctors aren't required to see all patients. A doctor and patient must trust each other, and if a doctor doesn't trust a patient or vice versa, there isn't an obligation to see that patient, said William G. Plested, chairman of the board of trustees of the American Medical Association.
   Patient advocates argue that a doctors' malpractice history is hard for the public to obtain. The National Practitioner Data Bank, which tracks malpractice payments, isn't available to the public, but hospitals, managed-care groups, professional societies and state licensing boards can access the information. However, several states, including Massachusetts, California and Arizonahave made doctors' malpractice histories available to the public.

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18. Kerry locks up the nomination
   Sen. John F. Kerry locked up the Democratic presidential nomination on March 2 with a coast-to-coast string of Super Tuesday victories that included landslides in California, New York, Ohioand Maryland, eliminating Sen. John Edwards from the race and setting up what promises to be a divisive confrontation with President Bush in the general election. Kerry praised his departing rival, seen within the party as a strong candidate to become Kerry's running mate, as "a compelling voice" within the party and a "valiant champion" for Democratic values.
   Edwards's quick decision to end his candidacy allows Kerry to pivot instantly to a general election contest against Bush that has already begun. It intensified last Thursday when Bush's reelection committee began airing its first ads of the campaign. Edwards’ performance in the primaries has prompted many Democrats to express support for a Kerry-Edwards ticket, and supporters had warned him that he would damage his chances of joining the ticket if he continued in a futile effort against Kerry.
   Kerry enjoyed across-the-board support throughout the primaries, with no major faction of the party dissatisfied with him as the nominee, and Democratic strategists said that, as a result, he will have little trouble unifying the party quickly and turning his attention to the general election contest.
   But he nonetheless faces a series of challenges making the shift to challenging Bush, from needing to raise millions of dollars to sustain his candidacy between now and the Democratic National Convention in July to figuring out a way to keep the energy and attention of the voters on him without the weekly primary competitions. Beyond that, said Democratic strategists, Kerry will need to retool his message for a general election audience and flesh out his policy differences with Bush in greater detail.
   Although Bush's first round of ads will be positive, emphasizing the president's record and accomplishments, the attacks from both sides have already begun. Kerry has pounded on Bush for months, and in the past few weeks the Republicans have begun to fire back, portraying the presumptive Democratic nominee as soft on defense, wrong in his opposition to the 1991 Persian Gulf War, a flip-flopper who straddles tough issues and a Washingtoninsider.

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  19. Role of Health Care in Elections
   With campaigning underway around the country, the January/February 2004 Kaiser Health Poll Report examines health care as an issue in past elections and provides insight into its potential role this year. The new "Health Care and Elections" Featured Topic explores where health policy has ranked as a voting issue in past elections for the White House and Congress, the role it is likely to play this year, and the possible effect of voting behaviors of groups such as the elderly and uninsured.
   A broad and informative bimonthly report, the Kaiser Health Poll Report provides key tracking information, including historical trends and in-depth analysis of public opinion about hot health care topics. The report also includes the Health Security Watch, Health Care Priorities, and Health News Index, all of which are part of the most recent survey conducted February 5-8, 2004. You can find the January/February 2004 Kaiser Health Poll Report here.

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  20. Senators urge HHS to enforce specialty hospital moratorium as intended
   In a letter sent Friday to HHS Secretary Tommy Thompson, a bipartisan group of senators urged HHS to enforce the 18-month moratorium on specialty hospitals imposed by the Medicare Prescription Drug, Improvement and Modernization Act as Congress intended. Sens. Charles Grassley, R-IA, Max Baucus, D-MT, Don Nickles, R-OK, and John Breaux, D-LA, said HHS should exclude from the moratorium only those specialty hospitals under development that have completed architectural plans, received funding and met zoning and state approval. "While the Secretary has some discretion in determining whether these factors have been met, we are extremely troubled by recent efforts to weaken the exception language and to possibly create a significant loophole...Requiring entities to fulfill only one of the four factors would create a significant loophole," they said. They also said operating an emergency room would not exclude a specialty hospital from the moratorium, and that the legislation clearly defines a specialty hospital as a hospital primarily or exclusively treating cardiac or orthopedic conditions, or providing surgical or other specialized services.

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