Potpourri of Health Policy Issues in June.

My cup runneth over with potential issues to explore.

June has been a busy month both locally and nationally insofar as things I like to write about. The shame-on-me is that I have not carved out enough time to do so!  In part I am still picking up the pieces after my early spring travels. Exploring how to unpack and deal with the new Medicare prescription drug data base also took a lot of time.  The truth is that I am a slow writer handicapped by a default and probably over-wordy professorial style.  I haven’t even been able to update the Institute’s Facebook and Twitter pages!  What follows is a list of things that occured during the month that I wanted to write about and hope to do so in more detail later.  These are not necessarily in chronological order or of importance.

The Supremes Rock & Rule!
We were presented with two back-to-back major decisions by the U.S. Supreme Court. The first, King v. Burwell, allows federal subsidies of health insurance premiums for low income individuals and their families to continue even if their insurance was purchased in states that chose to allow the federal government to operate their health insurance exchanges.  The lawsuit brought by Obama/Obamacare-haters to limit premium support to insured individuals in states like Kentucky that chose to operate their own exchanges would have essentially gutted the Affordable Care Act (ACA) and tossed millions back into the uninsured category. For the time being, Obamacare stands intact for at least the next year and a half, despite promises by opponents to throw up additional challenges. All our legislators should be working together to deal with a major remaining deficiency of the ACA.  The Act has been very successful in decreasing the number of uninsured people, but it makes little headway against the exploding costs of unnecessary, marginally effective, or for that matter even necessary medical care.  Continuing to forbid the federal government to negotiate over the prices of drugs is a case in point. Subsidies were deemed necessary for a reason! Continue reading “Potpourri of Health Policy Issues in June.”

Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.

Gov. Beshear used his line-item veto on the state budget passed by the General Assembly to alter two higher-education education items. They relate to the Kentucky Community and Technical College System, and to the University of Louisville.

With regard to the former, the Governor altered language with the intent of giving more leeway to the governance of KCTC to use agency bonds and fees to fund capital projects on their campuses. With regard to the latter, the Governor reduced the University’s role in evaluating its own need for QCCT funding for indigent care or the effect of the reduction in the amounts appropriated. Continue reading “Governor Steve Beshear Exercises Line-Item Vetoes on State Budget.”

Kentucky’s Universities Fare Poorly in 2014 Legislative Session.

Funding of Higher-Education in Kentucky– Death By a Thousand Cuts.

chestnut-st-2014The 2014 Kentucky legislative session is not over yet, but some would say it never really got started. The Governor has time to veto bills that have already passed, including line-item vetoes in the Budget. The House and Senate still have a final day or two to try to pass additional legislation or override any vetoes. Unless there is a miracle on the Ides of April, the budgets of the state Universities are now graven in stone.

What Makes a Good Legislative Session?
Complaints have been voiced that this session was not a fruitful one because so few bills of any significance were passed. That would be a valid observation if the most important function of the General Assembly was to pass good laws. Another school of thought, to which I have some affinity, is that the highest function of legislative bodies is to prevent bad laws from being born– legislative contraception as it were. From that perspective, our Kentucky House and Senate committees with their competitively-adversarial political party structures serve to prevent attachment of many nascent bills to the walls of their respective full chambers. Many bills deserve to be thus aborted.

I spent a good bit of my free time these past few weeks trying to understand what was happening to funding for the Quality Community Care Trust fund (QCCT) that has for some 30 years provided supplemental funding to the University of Louisville Hospital to care for uninsured inpatients. The amounts of funding provided by the city of Louisville and the Commonwealth have been decreasing, the contractual parties have changed several times, and the permitted uses of the money had slowly changed over time in an evolving medical ecosystem. In my opinion, that program is nearing the end of its useful lifetime. I have written about these matters often over the past two years and will continue to do so as I go through the Louisville archive of contracts and correspondence now available to me.

Not a Great Legislative Session for the State Universities.
Our public institutions of higher education are probably more unhappy than most with the outcomes of the session. At a time when they are being urged to enroll and graduate more students, their budget allotments from the general fund continue to shrink. Just as our state retirement systems were systematically underfunded to the point of impending insolvency, so too has funding to renovate or replace our university inventories of aging or inadequate buildings been ignored. What might have been accomplished in small pieces has now become an unmanageable disaster. Money for new educational facilities is largely a gleam in the eyes of university Boards of Trustee members. As I combed through legislative documents this spring, I had occasion to examine the blunt-knife approach to carving up academic budgets, but also to gain insight into the priorities of these institutions and the hoops they must jump through to advance their interests. The initial budgets from the General Assembly called for an across the board cut to the university budgets of 2.5%, and according to some, the 14th year in a row of such cuts. Continue reading “Kentucky’s Universities Fare Poorly in 2014 Legislative Session.”

Analysis of Hospital Acquisition Sponsorship Agreement: Catholic Health Directives.

There are a number of reasons why many individuals and organizations have opposed or had serious concerns about the proposed acquisition of University of Louisville Hospital by Catholic Health Initiatives. The transfer of a state and public asset to a private one, the separation of church and state, the alignment of the entire medical training and clinical operations of a public medical school with a religious organization, transferring a substantial portion of Kentucky’s healthcare system to an out-of-state caretaker, or agreeing to onerous anticompetitive restrictions with other Kentucky health care providers and educational institutions are among them.  Any one of these issues provides sufficient grounds for rejecting the proposed business arrangement.

Perhaps the most emotionally controversial of these problems is the agreement by the University of Louisville to subjugate itself to some of the religious teachings and policy of the Roman Catholic Church as the basis for the provision of medical care in its teaching and clinical facilities. The University of Louisville has placed its operations at ground zero of an abortion controversy that has torn asunder the civil fabric of our community.  Because it is defined even in the Sponsorship Agreement as an instrumentality of the Commonwealth of Kentucky; the University of Louisville has put Governor Beshear, Attorney General Conway, State Auditor Luallen, Mayor Fischer, and other governmental offices and officials into the most difficult position possible.  I do not know what these officials have been told in their private briefings by the business partners, but I heard the hospital system representatives say publicly that medical treatment of women would hardly be affected at all; with the exception of certain procedures the University has contractually agreed not to do. To my and many ears, their protestations and promises changed from day to day and place to place. Requests for the specific contractual language and other relevant agreements were refused in an off-hand manner. To hear the advocates speak, the implications of their business decision on our community and on women’s health care, and the magnitude of the compromise of our institutional academic and medical ethics and independence were a “small thing.”  I cannot agree. Continue reading “Analysis of Hospital Acquisition Sponsorship Agreement: Catholic Health Directives.”