The State of NC Healthcare

On Stanly Regional Medical Center and Scotland Memorial Hospital

Posted in Grassroots, NC Healthpress, Reform-in-progress by writemyline on 12 February 2009

John Lowder’s recent article In the Stanly News and Press (1 Feb. 2009) discusses Stanly Regional Medical Center’s (SRMC) management service agreement with Carolinas HealthCare System (CHS). It is a well-written statement with significant points of discussion that speaks directly to Stanly County citizens. It identifies the issues and circumstances leading to the SRMC Board of Directors’ decision to deepen the hospital’s relationship with CHS. Articles similar to Lowder’s Making change work for the community appeared about the same time in The Exchange and The Fayetteville Observer; however, these articles announce a management contract between CHS and Scotland Memorial Hospital in Laurinburg.

It is not surprising that CHS is the largest healthcare organization in the Carolinas. It is a very aggressive one in terms of acquisitions, mergers, leases, and management contracts. The Charlotte-based business has ties to 25 facilities from North Wilkesboro NC to Charleston SC; two additional hospitals in western NC are currently considering affiliate proposals. Russ Guerin, CHS executive vice president of business development and planning comments in the Charlotte Business Journal that Carolinas HealthCare management relationships, such as those with Stanly Regional and Scotland Memorial, can lead to mergers and leases.  

Integrating CHS’s large academic healthcare model into Stanly and Scotland’s smaller healthcare culture will be challenging. Technically speaking, the contract provides that the autonomy of the small hospitals remain; however, the management association with Carolinas HealthCare will be very visible in the public eye as well as the professional one. This could tax the confidence of some folks. Stanly and Scotland have histories that are entirely built on their local communities. Shifting their identity towards a corporate giant is unsettling; and, to some people, equates to a departure from certain long-held values of the community.

Indeed, management is a necessary component of any healthcare delivery system; but the public and professional perception of management weighs heavily on patients and their families. Perhaps the decision of Scotland and Stanly boards to deepen their relationships with Carolinas HealthCare System will prove financially fruitful and beneficial to the health of the community; but if and how much community citizens and local healthcare professionals will benefit financially is questionable, especially given the current chaotic state of the US economy. And the greater community, including physicians and healthcare professionals, could wait months, or perhaps even years, before the trickle-down effects of change deliver a substantial and beneficial outcome.

Smaller geographic areas, particularly rural ones and those with increased over-65 and disabled populations, are bound to the services closest to home. For some, there is no element of choice when it comes to health services; and when this is the case, public trust is absolutely critical. The role of organizational healthcare leadership in small boroughs and rural areas has a primary obligation to its service area population because there is no local competition providing other options.  Regardless of the business, service, or industry, public trust is critical for security and progress. And fostering and maintaining trust requires forthrightness, especially when it comes to healthcare issues.

In regards to SRMC, there are statements in need of clarification for the benefit of Stanly County citizens:

John Lowder writes: “Control over Stanly Regional will remain within the community. The Board of Directors will continue to govern the medical center and will retain ownership of all assets. The Board will make decisions in the best interests of the community and our same management team, led by Al Taylor, will run the medical center.”

Scott White, spokesperson for Carolinas HealthCare, says something different about the contract with SRMC in the Hickory Record: “We’ll hire the executive officers and manage the hospital on behalf of the board.”  (Hickory Record, 28 January 2009)

White’s and Lowder’s conflicting statements are very troublesome for the public. Merging the two statements suggests that CHS will hire the existing SRMC executive staff, including CEO Al Taylor. If that is, indeed, the case, then “control over Stanly Regional” will not actually remain in the community because its executive staff will not be appropriately vested by SRMC and its board of directors. Clarification and a more detailed disclosure of CHS’s management contract would be a positive step towards preserving public trust.

Another thing lacking is substantion of SRMC’s claim of a long-standing relationship with Carolinas HealthCare by physicians and healthcare professionals close to home. Public confidence is better built on relationships with the first line of care–primary care physicians, family doctors, specialists, and other healthcare providers, not management.  Moreover, how involved were Stanly physicians in the board’s decision? 

 Healthcare reform is an undeniable paradigm shift occurring at all levels of American society, from grassroots to corporate giants. It is a phenomenon that will ultimately redesign systems of healthcare delivery, finance, and management. It is a phenomenon in which organizations like Stanly Regional Medical Center and Scotland Memorial Hospital along with hundreds of other independent non-profit hospitals in the US will lead and represent the healthcare culture of small communities. On the other hand, Carolinas HealthCare System and other corporate giants will aggressively protect their own interests and profitability; small community-led healthcare will not be a top priority in reformation from their perspective.

 Indeed, change can be positive and work for small communities when citizens are directly involved in the process. Patients and families in Stanly and Scotland counties have that opportunity now by expecting their leaders to listen and respond with diligence and honesty.


Carolinas HealthCare System to “manage” Stanly and Scotland

Posted in Grassroots, NC Healthpress, Reform-in-progress by writemyline on 30 January 2009

The Charlotte Business Journal featured an article by Jennifer Thomas this week that announces a management service agreement (MSA) between Carolinas HealthCare (CHS) and two independent NC hospitals: Scotland Memorial Hospital (SMH) and Stanly Regional Medical Center (SRMC). The article, CHS to manage two more hospitals, appeared on January 28.

Thomas writes that CHS’s 10-yr. contract with Stanly begins March 1 and with Scotland on April 1. The article does not disclose the financial terms of the two contracts; however, the article suggests that the 10-yr. contract could mean a merger later on down the road. Russ Guerin, executive vice president of business development and planning at CHS,  is quoted: “managing independent local hospitals is a business line of (CHS).”  He also comments that such agreements have the potential for mergers.

Interestingly, CHS and Stanly’s recent request for a certificate of need for a 40-bed rehab facility was denied by N.C. Division of Health Service Regulation (NCDHSR) because the two organizations failed to demonstrate need and cost-effectiveness. The facility would have been built in Cabarrus County. CHS and Stanly are appealing the State’s decision. 

Both Stanly and Scotland serve local communities and are significant providers of care “close to home.”  People age 65 and over constitute 14.6% of Stanly County’s population. In addition, 20% of the county’s total population consists of disabled citizens over the age of 5. In Scotland County, 11.6% are 65 and up and 22% disabled.  Stanly’s older population exceeds the state/county average of 12.2%; and both, Stanly and Scotland, exceed the state/county average of 17% disabled. (Census Bureau)

“Close to home” care is a big concern for many of the folks affected by big hospitals swallowing up smaller ones. CHS is the 3rd largest public system in the country and the largest in NC. It owns, leases, or manages 25 hospitals from North Wilkesboro NC to Charleston SC, including SRMC and SMH.

See press releases on the Carolinas Medical Center website:

Stanly Regional Medical Center Partners With CHS

Scotland Regional Health Care System Partners with CHS

Jim Buie’s comments on healthcare reform

Posted in Reform-in-progress by writemyline on 12 January 2009

Jim Buie (The Buie Knife) posted the following comment on writemyline in response to an earlier post that first appeared on this blog and entitled “Bits and pieces” of healthcare reform . I think Jim is right on target and that his thoughts deserve consideration, especially his idea of healthcare being similar to a public utility.

Jim Buie: 
It will be very important for those of us concerned about health care reform to put the heat on the new administration. Sens. Kennedy and Baucus will take a leading role in proposals, I’m reading. What passes will largely be determined by COST, given the huge bailout package. The argument that will be most persuasive is that health care reform, in the long run, SAVES money. We in the U.S. need to face the fact that other countries manage to INSURE EVERYONE and provide, overall, better care for far less cost than we do. We need to learn from studies of comparative health care internationally and implement recommendations.

– by insuring the uninsured, we move them away from the most expensive care, in emergency rooms, and eliminate cost-shifting.

– by allowing the gov’t to purchase generic phamaceuticals in bulk, we reduce price gouging by pharmaceutical companies.

– we should reduce the “for profit” nature of private health care, with exorbitant salaries for executives. Cap their salaries and eliminate bonuses. Start thinking of health care as a public utility.

– reduce the number and wasteful purchase of expensive machines, such as CT scans (utilization in the u.s. is far greater than in other countries).

– merge small insurance groups into much larger pools to reduce adverse selection, ban cherry-picking of healthy (and most profitable) patients, and reduce the overall risk of health care plans — that should reduce monthly premiums because risk is shared more widely.

– maybe open up Medicare to younger people, and the federal health insurance programs to people who aren’t federal employees. If people could get into these plans, they’d pay far less than they do for private health care plans.

(I currently pay $300+ a month as a self-employed person for health care for myself, my wife, and son, but there’s a $10,000 a year deductible. This is not really health insurance, it’s simply insurance against the loss of our home in the event of major illness.)

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“Bits and pieces” of healthcare reform?

Posted in Reform-in-progress by writemyline on 16 November 2008

From Can Obama Truly Deliver?   “On October 31, Obama told CNN that he would set five immediate priorities: “stabilize” the financial system, move toward energy independence, enact some form of healthcare reform, grant middle-class tax cuts, and strengthen the education system. But he made clear that the nation has entered an era of limits because the economy is in such bad shape.”

But will Election Day exit polls further influence President-elect Obama’s “todo” list? 

According to Kenneth T. Walsh of US News and World Report(USN&WR), “about 62 percent of voters said the economy was their biggest concern–far and away the most important issue. About 19 percent listed Iraq or terrorism, and 9 percent said healthcare.”  USN&WR did not report the numbers for voters mostly concerned with energy independence, education, and other issues. If exit polls determine Obama’s response to American voters and the order in which he addresses the country’s most significant concerns, then healthcare reform is not so high on the list. With the overwhelming majority of voters depending on deliverance from the current global financial crisis, Obama’s promise of healthcare reform is likely to fade in the background.

USN&WR says that Obama’s aides “expect him to compromise in his own particular way.” They say that the President-elect will likely “scale back each of his priorities.” An unidentified, but “prominent Democrat who knows him well” says Obama will do “bits and pieces” rather than abandoning or down-sizing the issues he promised to work on. 

As far as Obama’s healthcare reform plan, it is probably safe to assume that it won’t be as aggressive as promised throughout his campaign and could settle on “insuring everyone under 18 years old so no child would be without health insurance”–not exactly the universal care that appealed to voters most concerned about healthcare. While insuring those 18 and under is, indeed, a worthy accomplishment, whether it can boost the movement toward overall reform is questionable. 

One wonders if some or a little change is better than no change at all, particularly when the larger issues continue to burden the whole system of healthcare providers and institutions as well as the entire profile of the population they must serve. Can a government-initiated healthcare reform project set out on the path of least resistance and get anywhere, especially when politically motivated? Is it likely to make a lasting impact?

It will be necessary for President-elect Obama to continuously re-evaluate his priorities; still, the American people depend on progress or at least the hope of it. In regards to healthcare reform, it is critical that leadership fuel the momentum with the knowledge that lasting and positive change is a long-term goal, that results are often slow to come into focus, and that the final page will most likely be written by future leaders and subsequent administrations. With that said, perhaps President-elect Obama will be the one who truly initiates change–not necessarily the one who signs final legislation.

President-elect Obama has a difficult task ahead because not all voters are going to be satisfied with just “bits and pieces” of the expectations they cast along in the ballot box. As one of those voters, I am more hopeful that our President will initiate and engage in an effective healthcare reform process in which there is no turning back–one that, perhaps, may not come to an end under his tenure, but surely would not have started without vision and leadership.

A talk in the park

Posted in Reform-in-progress, The Vote 2008 by writemyline on 30 October 2008

I had an interesting conversation with a young friend the other morning. She’s a pharmaceutical sales rep with one of the bigger drug companies. I was very impressed with her friendliness and willingness to talk about the healthcare situation in NC and the US.

We met on a park bench while our little ones (her two small children and my one grandson) played nearby. As our conversation broadened, the topic of healthcare surfaced. We talked about the cost of important life-saving drugs and health insurance, the effect of generics on the profits that support further research and development of new treatments and drugs, and the difficulties of high-risk individuals in affording health insurance coverage.

She asked me which presidential candidate I believed had the better healthcare reform plan. While I certainly appreciated her inquisitiveness and interest, I was more impressed with her willingness to ditch partisan politics and get down to the nitty-gritty of reality: Neither McCain or Obama’s health plans are a miracle cure for America’s ailing healthcare culture. Our individual experiences, when gently juxtaposed in the park, exposed the false security in political-driven reform (regardless of which critter–a donkey or elephant–pulls the cart).

That conversation was a breath of fresh air. 

The increasing number of negative political campaign ads had put me in a funk. With Election Day less than a week away, those negative ads become downright insulting–desperate in their appeal to those voters guided by emotions rather than information when marking their ballots. And with the current economic crisis, the healthcare crisis, and the war in Iraq, emotions are quite vulnerable to the toxicity of negative campaign ads.

The talk in the park accomplished a lot. It’s that kind of exchange that, perhaps, influences the potential for change most significantly. Simple sharing and talking about the state of healthcare and the need for reform is more encouraging to the American people than a public brawl between political parties. I am reminded that not one single advancement in the American healthcare culture has come about by bashing political opponents.

I get it.
My young friend gets it.
So why can’t candidates for public office get it?

Maybe they need to have a talk in the park.

NC high-risk health insurance pool enrollment opens

Posted in NC health insurance, Reform-in-progress by writemyline on 18 October 2008

The News & Observer reports that open enrollment for NC’s high-risk health insurance pool begins Monday, October 20. [See New state health plan opens Monday] Additionally, folks who are interested about the guaranteed coverage program can find detailed information at the INCLUSIVE HEALTH website.

Inclusive Health, also known as the North Carolina Health Insurance Risk Pool (NCHIRP), provides affordable, individual health insurance coverage for North Carolinians who do not have access to an employer health plan and face higher premiums due to a pre-existing medical condition.

Inclusive Health is scheduled to begin offering coverage on January 1, 2009. Established by the State Legislature, Inclusive Health is a non-profit entity. It is not part of the state government but operates under the supervision and control of its Board.  Its Executive Director is Michael Keough.  

Inclusive Health plans are available in three options with varying deductibles and benefits that include prescription drug coverage. These plans are outlined in a downloadable PDF at the Inclusive Health website along with enrollment applications and other information. There is also a rate calculator that determines the cost of premiums according to age and whether the applicant is a smoker or non-smoker.

Who can fix this?

Posted in Reform-in-progress, The Vote 2008 by writemyline on 11 October 2008

The headline reads: Health insurance coverage dwindling.Those in Carolinas are losing employer-based insurance at faster rate than in most other states. (By Karen Garloch); and it’s a headline that is likely to make a significant impact on the upcoming elections.

Karen Garloch’s article in the Charlotte Observer is one that needs to be plastered on billboards all across NC. It states a truth that a little less than half of NCers already knows first-hand. NC’s insured population has fallen from 69% in 2000 to 59% in 2007. In case those percentages appear benign, consider this:

In 2000: (8,049,313)   =  5,554,025 insured/2,495,288 uninsured

In 2007: (9,061,032)   =  5,346,008 insured/ 3,715,024 uninsured

NC Population growth from 2000 to 2007: 1,011,719

Increase in NC’s uninsured from 2000 to 2007: 1,219, 736

Essentially, every citizen born in NC over the last seven years, and then some, is uninsured.

But who can fix this?

Watching the Presidential Debate this past week did not bring immediate relief to concerns. Going back to Jonathan Oberlander’s assessment of Obama and McCain’s healthcare plans, both candidates acknowledge the critical need for immediate reform, but via juxtaposing properties that “reflect fundamentally different assumptions about the virtues and vices of markets and government.”

As far as NC is concerned, the jury is still out about which candidate has the plan that can turn around the trend of dwindling healthcare insurance. Obama’s plan seems to largely depend on employer-paid coverage while McCain’s plan shifts the bill to consumers but with a bonus tax credit. Both candidates also acknowledge the problem of high-risk coverage and pre-existing conditions which, in NC, have a significant impact on affordability. Obama’s plan appears more complicated all around and would take quite a bit of time to accomplish. His plan heavily relies on employer-mandated insurance benefits which causes one to speculate how that would work under the current economic crisis and high unemployment rates. Also, how likely would employer-mandated health benefits boost the job market for North Carolinians  who are able to work but currently unemployed? 

McCain could probably achieve his plan in less time, but there are some down sides to his proposal, like deregulation of the insurance markets in relation to NC’s current unemployment stats–if you don’t have a job, you probably can’t afford any kind of premium and getting a job might be a very long-term process. Obama’s national health plan (similar to Medicare) would be of more benefit to these folks. And if you already get health insurance through an employer, you’ll start paying tax on that benefit.

NC’s new health insurance risk-pool is scheduled to begin enrollment on January 1, 2009. Just under 200,000 Carolinians ( 178,000 (under 65)) will get a break in BCBSNC’s very expensive high-risk rates, but will it be a break big enough to make a significant difference in the number of NC’s uninsured? Individual high-risk rates could still be over $800/month; and for many, that just isn’t enough to make it affordable. For an unemployed high-risk person, there is no affordable coverage even with the risk pool.

What percentage of NC’s uninsured miss out on health coverage because of unemployment or lack of employee benefits? Probably close to all those under age 65 in one way or another. So what’s to fix first–healthcare or the economy? Obama says he’ll prioritize those issues and work sequentially; McCain believes it is possible to work on both healthcare and the economy simultaneously.

Which candidate has the plan best for NC–a plan that brings immediate (or as immediate as possible) relief to both the unemployed and high-risk or uninsurable populations?  Who–McCain or Obama–is more likely to take positive and aggressive action that, at a minimum, slows the decline in NC’s insured?

Ideally, Karen Garloch’s next article about NC and health insurance will boast a different headline: Health insurance coverage increasing.Those in Carolinas are gaining employer-based insurance at faster rate than in most other states.

North Carolina Health Insurance Risk Pool Feasibility Study

NC Health Access Coalition releases plan for affordable health coverage

Posted in Reform-in-progress by writemyline on 15 September 2008

Affordable Coverage for All is Possible

The NC Justice Center‘s Health Access Coalition (NCHAC) has released a plan to expand affordable health coverage to all North Carolinians, make North Carolina a national leader in controlling health costs, and fairly finance health reform.

Here’s a brief outline of the plan:

1. Cover every child and make prevention a priority. Expand successful existing public programs like NC Health Choice and allow higher-income families to buy health insurance through these public programs by paying a sliding-scale premium based on income. Families who can afford child coverage but fail to purchase it will pay a penalty.

2. Expand public coverage for lower-income parents and pregnant women. Expand Medicaid to cover lower-income parents of children currently covered by public programs.

3. Make health insurance less expensive for small businesses and their employees. Ban insurance companies from charging more to small businesses because owners, workers, or family members have pre-existing health conditions. Consolidate the small business and individual markets and enact a state-subsidized quality health plan that is truly affordable for small businesses.

4. Guarantee an affordable choice of health plans for everyone. Ban insurance companies from charging higher rates or denying coverage because of pre-existing health conditions. Invite private insurance companies to offer health plans through a newly created North Carolina Private Health Insurance Clearinghouse. Subsidize these plans to guarantee affordability. Require employers not offering standard health coverage to contribute a percentage of wages and salaries to the Insurance Clearinghouse. Enforce penalties on individuals for not purchasing health coverage when affordable options are available.

5. Control health care costs. Move the NC health care system towards preventing disease first rather than treating it last. Responsibility for prevention and healthy lifestyles should be first priority for individuals themselves, parents for their children, and our entire community. Join efforts to hold down drug costs and improve quality of care. Establish a NC Institute for Health Care Quality, Cost, and Research to evaluate expensive new treatments and technologies and make cost-saving recommendations and related public health information widely available.

6. Fairly finance reform. Guaranteeing affordable health plans for everyone will cost money. North Carolina faces special challenges in this regard, especially in its rural regions. First, the state should obtain substantial federal assistance to pay for costs associated with public child and parent health programs. Second, a cigarette tax increase of 65 cents a pack should be enacted. Finally, hospitals, health insurers, and government should all be required to contribute to health plan subsidies in proportion to expected savings anticipated when more people are covered.


Read NCHAC’s Guaranteed Affordable Choice – The Full Plan

Speaking of experience…How do the candidates measure up to healthcare reform?

Posted in Reform-in-progress by writemyline on 30 August 2008

John McCain

Barack Obama

On healthcare:

On healthcare:

Harness market competition for comprehensive reform. (Feb 2008): Preserve quality of health care by individual responsibility. (Dec 2007): Give individuals $2500 refundable tax credits for healthcare. (Oct 2007): Control health costs so manufacturers stay competitive. (Oct 2007); No mandated universal system; no mandated insurance coverage. (Jun 2006);We should be able to re-import drugs from Canada. (Jan 2006); Include a health savings account in healthcare reform. (Jan 2006);The problem with health care in America is inflation. (Jan 2006); Supports tax-free medical savings accounts & tax credits. (Nov 2004); 1989: No mandatory catastrophic Medicare coverage. (Jan 2004); 1993:To socialize healthcare would be to ruin it. (Jan 2004); Greater consumer access to generic drugs. (May 2002); Higher taxes on cigarettes. (Jan 2000); Matching funds for seniors citizens’ prescription drugs. (Dec 1999); Expand health insurance to 11 million uninsured children. (Dec 1999); Keep health care promises to aging veterans. (Nov 1999); Address powerlessness when faced with health care crises. (Jul 1999); “Patient rights” means value human life over dollars. (Jul 1999); Expand medical savings; community health; & tax deductions. (Jul 1999); Patient Rights: access; MDs over HMOs; grievance process. (Jul 1999); Allow paying extra for choice of doctors & care. (Jul 1999) Full doctor-patient discussion even when it costs HMO. (Jul 1999); Supports patient rights; regulate nicotine as a drug. (Jul 1998); More tax-deductible health costs; limits on malpractice. (Jul 1998)

End-of-life self-medication ok; euthanasia by others not ok. (Apr 2008); Hillary’s plan must either be enforced, or leave out people. (Feb 2008); The problem with health care is about affordability. (Jan 2008); Subsidies to people who can’t afford care–not single payer. (Jan 2008); Bring GOP & Dems together to make healthcare affordable. (Jan 2008); FactCheck: Reducing obesity would save $18B, not $1T. (Dec 2007); Reforms in prevention and drug price negotiation save money. (Dec 2007); Tackle insurance companies on reimbursement system. (Oct 2007); Help young people deal with the cost of medical education. (Oct 2007); Morally wrong that terminally ill must consider money. (Sep 2007); FactCheck: Correct that insurance lobbying cost $1B. (Sep 2007); National smoking bans only after trying local bans. (Sep 2007); Reform failed in ’90s because of drug company lobbying. (Jul 2007); Take on insurance companies; drive down health care costs. (Jun 2007); Address minority health needs by more coverage & targeting. (Mar 2007); Health care tied to balancing costs and taxes nation wide. (Jun 2006); Allowing seniors to bulk purchase will save taxpayers’ money. (Oct 2004); Allow prescription drug re-importation. (May 2004)



Voting Record

Voting Record

-Allow appealing HMO decisions externally & in court. (Jul 1999)

-Voted NO on expanding enrollment period for Medicare Part D. (Feb 2006)

-Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)

-Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)

-Voted NO on $40 billion per year for limited Medicare prescription drug benefit. (Jun 2003)

-Voted YES on allowing reimportation of Rx drugs from Canada. (Jul 2002)

-Voted YES on allowing patients to sue HMOs & collect punitive damages. (Jun 2001)

-Voted YES on funding GOP version of Medicare prescription drug benefit. (Apr 2001)

-Voted NO on including prescription drugs under Medicare. (Jun 2000)

-Voted YES on limiting self-employment health deduction. (Jul 1999)

-Voted YES on increasing tobacco restrictions. (Jun 1998)

-Voted NO on Medicare means-testing. (Jun 1997)

-Voted NO on blocking medical savings accounts. (Apr 1996)

-Tax credits for those without employee health insurance. (May 2002)

-Tax deduction for long-term care insurance. (May 2002)

-Support telemedicine for underserved areas. (May 2002)

-$350 billion for prescriptions for poor seniors. (May 2002)

-Rated 25% by APHA, indicating a anti-public health voting record. (Dec 2003)


-No need to mandate coverage; just let people afford it. (Jul 2007)

-Voted NO on means-testing to determine Medicare Part D premium. (Mar 2008)

Voted YES on requiring negotiated Rx prices for Medicare part D. (Apr 2007)

-Voted YES on expanding enrollment period for Medicare Part D. (Feb 2006)

-Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)

-Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)

-Increase funding for AIDS treatment & prevention. (Jan 2001)

-More funding for Rx benefits, community health, CHIPs. (Jan 2001)

-Improve services for people with autism & their families. (Apr 2007)

-Preserve access to Medicaid & SCHIP during economic downturn. (Apr 2008)

















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