Health Advocates Face Bleak Prospects in 2002

by Col Owens

Health advocates have faced an uphill struggle in their pursuit of a universal health care system since the failure of the Clinton initiative in 1994. Following that debacle, which caused many advocates to beat a hasty and prolonged retreat, advances have been largely incremental, affecting one age group/health status group/income group/disease group at a time.

Notwithstanding, there has been notable success. Coverage for healthy, non-disabled families has grown dramatically in recent years. Children have benefited the most, through federal enactment of the Children's Health Insurance Program (CHIP) and Ohio's increase in children's coverage to 200 percent federal poverty level (FPL). Ohio now covers pregnant women to 150 percent FPL and working parents to 100 percent FPL. It is not insignificant that with the exception of pregnant women, these persons are relatively inexpensive to cover, with per capita costs of about $100 per month for children and $140 per month for adults.

In its budget session this past spring, the legislature adopted a measure proposed by the Ohio Family Coverage Coalition (in which UHCAN Ohio participates), authorizing the seeking of a waiver to use unspent State CHIP funds to pay for part of Ohio's earlier parent expansion. In this period of economic recession and budget retraction, the Ohio Department of Job and Family Services (ODJFS) is pursuing this waiver to save money and (not incidentally) to defuse any effort to repeal the expansion.

Ohio's current budget woes make prospects for further expansions in the next year bleak. For example, ODJFS officials report that even if Congress adopts a more favorable Medicaid match rate for expansion initiatives as part of an economic stimulus bill, Ohio has no state funds to use as match. The legislature is currently completing work on HB 405, a budget correction bill, which includes significant cuts in many services. To date Medicaid services have been spared, but both the House and Senate are utilizing tobacco settlement funds previously allocated to public health, prescription drugs and primary care, to balance the budget. ODJFS officials fear that if the tax measures in the House version are not adopted and if further cuts are ordered, other areas including Medicaid could be targeted. Further problems could evolve if Medicaid expenditures keep growing, especially those for nursing homes and prescription drugs.

This is a frustrating time for advocates. Significant support exists across the state for increasing parent eligibility and for adopting the federal "Ticket to Work" Medicaid Buy-In option to allow persons with disabilities to work and not lose health care. However, nobody predicts progress in these areas. The only area where action is expected is prescription drug coverage. Several bills, including HB 290, supported by UHCAN Ohio, are under consideration and, while controversy exists, some progress appears possible. The long march toward universal coverage includes periods of progress and periods of inaction. We are in such a period of inaction, most concede. Yet, as in sports, a strong offense is often the best defense. Our best course is to press on with an affirmative agenda; perhaps to argue for a great leap forward funded by a cigarette tax increase. We must keep hope alive!

Col Owens is Senior Attorney at the Legal Aid Society of Greater Cincinnati. He has served as team leader of the Welfare Team for fifteen years and teaches Poverty Law at the University of Cincinnati, College of Law.

From the Director, Larry Bresler

Anthrax Drug Maker Keeps Lower Cost Drugs from Consumers

At the same time that UHCAN Ohio is working for passage of the Prescription Drug Fair Pricing Act passed here in Ohio, we are joining with groups nationally to make prescription drugs more affordable to consumers. We are doing this by confronting and taking legal action against pharmaceutical companies that maintain excessively high drug prices through unfair and illegal practices.

A good example of this involves the drug Cipro. Cipro has received a lot of publicity in recent weeks because it is the primary antibiotic drug to treat anthrax. However, even before the anthrax scare, Cipro was the best selling antibiotic drug in the world.

Bayer Corporation, the maker of Cipro, has been selling Cipro in the United States for about $4.67 a pill. After the Anthrax outbreak, Bayer agreed to drop the price to the U.S. government to $.95 a pill, suggesting a real sacrifice for the country. However, the estimated cost to make Cipro by Bayer is only $.20 a pill.

Three generic companies had intended to make a generic version of Cipro available to the public in 1995. The cost for this generic Cipro was expected to be about $.40 a pill to consumers. Bayer was able to get the generic companies to abandon its plans to bring cheaper generic brands to the market by paying the companies $200 million not to manufacture the generic Cipro.

Through the Prescription Access Litigation (PAL) project, UHCAN Ohio and 13 other groups have filed a lawsuit to stop the agreement between Bayer and the three generic drug companies to allow the cheaper generic versions of Cipro to be produced and marketed in the United States.

The Cipro case illustrates the greed of the pharmaceutical companies at the expense of the consumers who are in need of drugs that they frequently can not afford. It shows the necessity of passing the Prescription Drug Fair Pricing Act in Ohio and of confronting the unfair and illegal practices of the drug companies nationally.

Columbus Hospital Pledges to Care for Uninsured
Doctors North Agrees to Coalition Recommendations

Doctors North Hospital President Denny Freudeman agreed to recommendations made by the Community Coalition on Health Care in the Short North at an action meeting held in Columbus on November 29. He explained to a packed audience that Doctors North would continue to serve the community when it converts its emergency room to an urgent care center in early 2002.

The coalition of community groups was organized last winter by UHCAN Ohio when cutbacks threatened services at the hospital, the only source of basic care for many area residents. Few in the area, which includes a large percentage of uninsured working families, were aware of the changes planned.

The coalition took its recommendations for financial assistance, extended evening and weekend hours, and materials to inform the community to Doctors North and parent company Ohio Health. At the meeting, Mr. Freudeman agreed to all three recommendations and committed to ongoing meetings between Doctors administrators and the coalition.

Mr. Freudeman stated that urgent care services will be covered by hospital free care programs, and physicians' services not covered will be subsidized for indigent patients by Doctors Hospital. In addition, the urgent care center would be open 12 hours during weekdays - either 9:00 a.m. to 9:00 p.m. or 10:00 a.m. to 10:00 p.m. - and 8 hours on weekend days. Doctors representatives distributed informational materials about hospital changes and services offered.

Coalition members thanked Doctors North and Ohio Health administrators for their ongoing attention to the concerns that were raised and their strong commitment to the community - especially its most vulnerable residents.

The coalition will continue working to ensure that community needs are met at the new urgent care center. Please call the Columbus office of UHCAN Ohio at 614-253-4340, or email Kim Dill at kimdill@uhcanohio.org , if you want more information or are interested in joining the coalition.

Do-It-Yourself Trip to Canada for Affordable Rx

The following outline for a do-it-yourself trip to Canada for prescription drugs comes from Congressman Sherrod Brown's office. The congressman also arranges regular bus trips to Windsor, Canada. (The pharmacy and physician are noted because they work with Congressman Brown's office and are close to the Windsor border. There are others in Canada with similar arrangements.)

-> 1. Have your American physician write a prescription for a 90-day supply of medication with three 90-day refills.
This will enable you to get your prescriptions refilled by mail for one year. Make sure your name, street address, city, state, zip, and date of birth are printed on the prescriptions clearly.

-> 2. Phone Dr. Hammer at 1-519-945-4503 to make an appointment. There is a $40 office visit fee for co-signing your U.S. written prescription - a necessary condition of getting your prescriptions from a Canadian pharmacy. This must be paid in cash at the time of your visit.
-> 3. Phone Hunter Pharmacy at 1-519-945-4333 with a list of your prescriptions and let them know when your appointment with Dr. Hammer is. That way the pharmacist can make sure your prescriptions are ready for pick-up the day of your trip.

-> 4. Now you're ready to make the trip to Canada.

Paying with MasterCard or Visa allows for the best exchange rate. Discover Card is not accepted. Personal checks from a bank in the U.S. will incur an additional charge.

Data of Note

Costs go up

Nationally, per capita health care expenditures in 1998 came to $3,800 (State Health Expenditures Account from the Health Care Financing Administration - now Centers for Medicare and Medicaid - website).

In 2000, total retail prescription sales in Ohio totaled $5, 258,441,000. That amount does not include over-the-counter drug sales. Ohioans averaged 11 prescriptions per person. The average price per prescription was $42.18 (Scott Levin's Source Prescription Audit).

The public sector does better

"Historically, the public sector in health insurance in the United States has significantly outperformed the private sector." - Bruce Vladeck, who served as HCFA administrator from 1993 to 1997, on studies suggesting that Medicare + Choice has cost taxpayers billions of dollars more for traditional benefits than fee-for-service Medicare (American Health Line, April 24, 2001).

State Coalition Forms Around Rx Legislation

On December 4, labor and community met in Columbus around a common problem, prescription drug costs, and a legislative remedy, the Prescription Drug Fair Pricing Act.

Representatives from statewide organizations: AARP Ohio, Ohio AFL-CIO, Ohio Public Interest Research Group, Ohio Nurses Association, Ohio United Way, SEIU, UHCAN Ohio, and the UAW formed the steering committee of the newly formed Coalition for Affordable Prescription Drugs. State Representative Dale Miller, the sponsor of HB 290, attended the organizing meeting. William Burga, president of the Ohio AFL-CIO, and Athena Godet-Calogeras, associate director of UHCAN Ohio, agreed to act as co-chairs of the coalition.

The broad-based Coalition for Affordable Prescription Drugs will be announced next month during a press conference in the Atrium of the Ohio Statehouse.

Great Quote

"The insurance industry has decided that if you are sick, you ought to eat the costs. It's a very dubious social policy."
- Princeton University health economist Uwe Reinhardt, on a new type of health plan that could lower costs for those with lower medical expenses but raise costs for those with higher medical expenses (American Health Line, December 5, 2001).

Ohio Legislation Highlights

UHCAN Ohio keeps an eye on Ohio health legislation.
For more information on pending bills, either check our website or call the policy director, Cathy Levine, in our Columbus office, (614)253-4340. Full texts of bills are available on the state's website: www. legislature.state.oh.us.

Budget Balancing Bill: 3 different plans to balance the budget now exist and a Conference Committee is beginning to iron out the differences. The Senate version eliminates "revenue enhancements" in the House and Governor's version and makes up the difference by increasing cuts in human services from 6 percent (house version) to 8 percent. The Senate version also uses $309 of tobacco settlement funds for the budget. These funds were previously earmarked for public health, primary care, and other vital health services.

Senate Bill 128, Local Tobacco Regulation, would limit the authority of city or local boards of health to pass rules restricting the sale or use of cigarettes or other tobacco products. Under current law, boards of health may pass rules necessary for the public health, or prevention or restriction of disease. Under this bill, no order or rule from a board of health regarding sale or use of tobacco would take effect in any municipality, town or village, unless adopted by the legislative authority of that municipality, village and other local government after a public hearing. If enacted, the bill would make it nearly impossible for health districts to enact tobacco restrictions. The tobacco industry brought this bill to Ohio and received a warm welcome from the majority of legislators. Local health departments and anti-smoking groups have worked hard to stop the bill. Status: passed by the House and Senate; is in Conference Committee. If passed, the Governor may veto it.

Are you a UHCAN Ohio member?

Not yet, you say? Please hesitate no longer. Join UHCAN Ohio now and help us work for comprehensive, affordable, and publicly accountable health care for all. We look forward to welcoming you into the UHCAN Ohio family -- and the movement for health care justice!