With healthcare on the front of everyone’s minds as Congress continues to formulate a replacement to ObamaCare, here is an idea that could revolutionize the industry and drive costs down tremendously.
One of the largest factors driving up health care costs today is the lack of transparency of the true costs of health care services and the lack of incentives for consumers to pursue high quality, low-cost options. In short, a person doesn’t know how much a certain procedure or test costs and even if they did, they would have zero financial incentive to investigate where to find the best price for that health care service.
This is where having the “Right to Shop” comes into the picture.
Price shopping for medical services can be very difficult and time consuming, as prices aren’t generally accurate, and they vary depending on who’s paying the bill. If you have to price shop through an insurance company, it gets even more difficult.
Health care providers rarely disclose their prices. For those that do, consumers are often not informed as to whether the posted price is for cash, with insurance, a co-pay, Medicare, etc. At times these disclosed prices do not incorporate all necessary costs—for example, an anesthesiologist’s fees.
Insurance companies often post general price ranges for their customers and contract with care providers to change pricing, which is often hidden from consumers as well.
Last night, Governor Gary Herbert addressed government officials and members of the public to deliver his annual “State of the State” address. He touched on job creation, education, air quality, self-reliance, and health care, among other issues. Below, we present the real state of the state—one that does not rely, in whole or in part, upon politically popular issues that poll well with key constituencies.
What is the state of the state?
Governor Herbert posed this question to the assembled audience, answering it in the affirmative—that the state is strong, and even “outstanding.” Nevertheless, the state faces significant challenges that were not addressed in the speech, and need serious scrutiny in order to protect the rights of each Utahn. We would disagree with the Governor’s assessment; while it’s easy to point to the growth of the market as a leading indicator of the government’s performance, this data point is peripheral to the underlying issues where the state is not performing very well.
This bill passed the Senate on a 17-12 vote but failed in a House committee on a 4-8 vote.
Libertas Institute supports this bill.
Senator Mark Madsen has sponsored legislation that would allow patients suffering from a few conditions to possess and use cannabis, with a doctor’s approval and recommendation. Senate Bill 73 would prohibit smoking, but allow the individual to ingest cannabis for relief or treatment through an oil, topical, vapor, or edible.
Last year, Senator Madsen attempted to legalize medical cannabis; the bill failed by a single vote in the Senate. This year’s bill is significantly different, and much more highly regulated—crafted with input from state agencies and regulators, patients, industry representatives, and advocates. It crafts the right approach in opening up a tightly regulated marketplace for this medicine, while providing a safe harbor to sick and suffering Utahns who should not be subjected to the criminal justice system.
Below is a detailed summary of the bill, broken down by category, with line numbers in the bill provided for reference.
- Physicians may not be employed by cannabis growing, processing, or testing facilities, or dispensaries, and may not have any ownership interest in a dispensary. (420, 1219-1222)
- Physicians who recommend cannabis to a patient fill out and submit an application online during an office visit with the patient. The information is saved into the electronic verification system, to which state agencies and law enforcement have access. (788-791)
- Physicians who voluntarily choose to recommend cannabis to patients under the law are shielded from civil and criminal liability, and licensure sanctions. (860-869)
- A Compassionate Use Board of physicians may hear applications for a one-off compassionate use approval for conditions not listed in the bill; physicians and satisfactory evidence would be required, and the Department of Health would over final say in issuing a card. (930-996)
- Physicians must be licensed and certified by their appropriate American medical board, in a limited few specialities pertaining to the list of conditions allowed for medical cannabis use. (999-1021)
- Physicians who voluntarily choose to recommend cannabis must complete training administered by the Department of Health. (1008-1010)
- Physicians may only recommend cannabis to 20% or less of their patients, unless they receive approval from the Compassionate Use Board upon demonstrating that the physician’s practice has unique characteristics that warrant an increase. (1011-1012, 1023-1027)
- Physicians may only advertise online that they recommend cannabis; no other advertising is allowed. (1221-1222)
Law Enforcement and Oversight
- An inventory control system is required, which tracks every single cannabis plant from its infancy, harvest, processing, and sale to the end user. (227-248)
- A video recording system is required minoring all cannabis businesses at all times. 45 days worth of video must be stored, it must be tamper proof, and cameras must monitor “all handling and processing of cannabis.” (232-239)
- An electronic verification system is required that allows patients and physicians to apply, connects to the inventory control system to track who purchased cannabis, where, and when, and will be accessible by law enforcement. (818-856)
- The Departments of Agriculture and Health may revoke licenses and impose penalties for violation of the law—up to $5,000 per violation. (604-647, 1327-1350)
- Medical cannabis patients, and industry owners and employees, are not subject to marijuana law penalties provided they are in full compliance with the Medical Cannabis Act. (1547-1639)
- Smoking cannabis is prohibited. (1632-1637)
- Applicants who qualify must submit to the Department of Health a signed recommendation by a physician, pay a fee, and provide personal information. (754-769)
- A parent or legal guardian may obtain a permit for a minor who qualifies and receives a recommendation from a doctor. (770-787)
- Frail patients may indicate up to two caregivers who may, upon application and approval, receive a card allowing them to obtain and transport cannabis to the patient. Caregivers must pass a background check and may be excluded for certain felonies. (792-804, 904-928)
- Medical cannabis cards are valid for the lesser of: an amount of time specified by the physician; or two years. They are renewable provided that physician approval is given. (805-815)
- Those who obtain a card must carry it with them at all times outside their residence, and cannabis must be in packaging that contains the bar code to allow it to be tracked. Such persons have a rebuttal presumption of legal use if questioned by law enforcement. (873-901)
- Patients who do not qualify under the included list of conditions may seek approval from the Compassionate Use Board for their condition. (931-996)
- Qualifying patients must have one of the following conditions: AIDS, Alzheimer’s, ALS, cancer, Crohn’s disease, Epilepsy, MS, PTSD related to military service, or chronic pain. To qualify for chronic pain, the physician must first determine that the individual is at risk of becoming chemically dependent on, or overdosing on, opiate-based pain medication. (1030-1046)
- Government employees may not be terminated for using medical cannabis. (1050-1068)
- In a custody dispute or proceedings to terminate parental rights, a court may not discriminate against a parent because of the parent’s possession or consumption of medical cannabis. (1418-1421, 1832-1834)
- Medical cannabis patients have an affirmative defense against the state’s metabolite law that prohibits driving with any amount of metabolite, whether it is pharmacologically active and impairing or not. (1437-1441)
- Police officers and Division of Child and Family Services employees may not take a child into custody on the sole basis of the possession or use of medical cannabis in the home, if done in compliance with the Medical Cannabis Act. (1717-1719)
- Tax revenue from the sale of cannabis is deposited into the Medical Cannabis Restricted Account. This revenue may only be used to fund the state regulation of medical cannabis. (735-750, 1683-1684)
- Medical cannabis is exempt from sales tax. (1642-1651)
- A retail purchase of medical cannabis is assessed a 4.7% tax. (1669-1671)
Cannabis Production Establishments (Grows, Processing facilities, Independent Testing Laboratories)
- Applicants for a license must have $250,000 in liquid assets, submit a detailed application, pay a large application fee, and pass a background check. (256-338)
- All employees must submit an application, pay a fee, pass a criminal background check. Convicted felons may not be employed by these facilities. (341-356)
- Employees transporting cannabis must carry their registration card at all times; there is a rebuttable presumption that such individuals are carrying cannabis legally. Cannabis being transported must be labeled, bar coded, and monitored. (390-404, 449-464)
- A security system is required that can provide notice of unauthorized entry to law enforcement. (408-415)
- A physician may not be employed by these facilities. (420)
- Local governments may not enact zoning ordinances that prohibit these facilities on the sole basis that they are cannabis production establishments; they are a permitted use in agricultural, industrial, or manufacturing zones. (423-429)
- The Department of Agriculture may inspect a facility’s records up to three scheduled times per year, and one unscheduled time per year—or at any time the department has reason to believe a law has been violated. (432-440)
- These facilities may not advertise to the general public in any way. (443-444)
- Home grows are prohibited.
- Cannabis grown may not be visible from the street level outside the facility. (473-475)
- The Department of Agriculture will establish administrative rules regarding pesticide and fertilizer use to ensure cannabis grown is safe for human use. (486-492)
- All harvested cannabis is tracked with a unique identifier. (476-479)
- Products must have a label that contains detailed information about the cannabis, along with bar code and unique ID tracking to tie it to the processed and harvested cannabis from which it originated. (512-520)
- Cannabis products must be in a tamper resistant package that is not appealing to children and is opaque. (521-526)
- Cannabis products may not be in a physical form that is appealing to children. (525-526)
- The Department of Health may create administrative rules regarding the physical criteria for cannabis products. (531-533)
- No products are allowed that apply cannabis agents to the surface of an existing food product not produced by that facility (e.g. candy, cookies, and other pre-made foods). (534-536)
- The Department of Agriculture may establish product quality standards for cannabis products to ensure safety for human consumption. (539-546)
- A person may not obtain a testing facility license, or work for a testing facility, if they have an ownership interest in, or are employed by, a dispensary, processing facility, or cultivation facility. (325-333, 557-558)
- All cannabis or cannabis products must be tested to determine the cannabinoid profile, and if it contains any mold, fungus, pesticides, other microbial contaminants, or residual solvents. (566-576)
- Tested cannabis that is found to be unsafe for human consumption must be reported to the Department of Agriculture. The cannabis may be seized, embargoed, or destroyed. (588-600)
- Applicants must have $500,000 in liquid assets, submit a detailed application, pass a background check, and pay a large fee. (1072-1101)
- Dispensary licenses are valid for two years, and renewable. (1104-1108)
- Dispensaries are limited to one per county, except counties of more than 200,000 residents, in which one dispensary for 200,000 residents may be issued. (1135-1138)
- The Department of Health will evaluate applicants to determine which has best demonstrated experience with a related business, operating a secure inventory control system, complying with a regulatory environment, training and monitoring employees, and which applicant has connections to the local community and can best reduce the cost of cannabis to the patient. (1139-1149)
- All employees must submit an application, pay a fee, pass a criminal background check. Convicted felons may not be employed by a dispensary. (1152-1188)
- Employees transporting cannabis must carry their registration card at all times; there is a rebuttable presumption that such individuals are carrying cannabis legally. Cannabis being transported must be labeled, bar coded, and monitored. (1192-1205)
- Only those with a medical cannabis card may enter. (1210-1211)
- Dispensaries must have a single, secure public entrance, a security system, and track everything in the inventory control system. (1210-1218)
- No cannabis may be consumed at the dispensary. (1225-1226)
- Dispensaries may only sell cannabis, cannabis products, cannabis devices (such as vaporizers), or educational materials related to the medical use of cannabis. (1232-1236)
- Dispensaries may only sell, in any one 30-day period, 2oz. or less of unprocessed cannabis, or cannabis products that contain 10 grams or less of cannabinoids. All purchases are tracked to ensure dispensary shopping, to exceed this limit, does not occur. (1239-1255)
- Devices (vaporizers) that resemble a cigarette are prohibited. (1256-1257)
- Cannabis products sold must be clearly labeled in tamper resistant containers that are bar coded and tracked. (1264-1272)
- Dispensaries may not advertise, except for signage on the building that contains the dispensary’s name, hours of operation, a green cross, and a website address. (1275-1283)
- The Department of Health may inspect a dispensary’s records up to three scheduled times per year, and one unscheduled time per year—or at any time the department has reason to believe a law has been violated. (1286-1293)
- Local governments may not enact zoning ordinances that prohibit dispensaries on the sole basis that they sell cannabis; they are a permitted use in agricultural, industrial, or commercial zones. (1296-1304)
This bill was modified from its original version, and then passed both chambers of the legislature unanimously.
Government mandates often unreasonably drive up the cost of health care, as regulations place direct burdens on health care providers or function to reduce their number operating in the marketplace. These regulations violate the principles of a free market that is otherwise (in theory) guaranteed by the Utah Constitution.
Under current Utah law, advanced practice registered nurses (APRN), or “nurse practitioners,” are required to pay a doctor under a “consultation and referral plan” (C&R) before being able to prescribe certain medications—despite receiving advanced training in order to be able to prescribe medications. These nurse practitioners are already licensed by the state, registered by the Drug Enforcement Agency (DEA), and permitted to make such prescriptions under their professional scope of practice, but are still subject to this arbitrary arrangement.
Moreover, the requirement does not specify what “consultation and referral” must include and does not specify the type of doctor. Thus, a legally compliant C&R plan could be for a mental health nurse in St. George to pay a podiatrist in Logan to sign their form. In some cases, these C&R’s have become little more than an extra revenue source for doctors—while creating financial barriers for nurse practitioners. This requirement is particularly onerous in rural areas where there are already shortages of doctors; nurse practitioners can help meet the need, but are discouraged from doing so due to this mandate.
Registered nurses who undergo advanced training to become APRN’s and who already have DEA registrations permitting them to prescribe medication should not be subjected to additional arbitrary state regulations. Senate Bill 58, sponsored by Senator David Hinkins, removes the mandate for advanced practice registered nurses to enter into consultation and referral plans with doctors prior to being permitted to prescribe schedule II and III prescription medications.
Free market reforms aimed at removing arbitrary barriers to entry ensure that the supply of goods and services in a market can meet demand. This system is what will produce the most competitive prices for consumers, the best quality, and employment opportunities for producers. This is particularly true in health care. Government should seek to reduce regulations that unnecessarily drive up the cost of delivering health care. With so many locations in Utah suffering from health care provider shortages, it is important that we ensure all health care providers are permitted to practice their profession to the full extent of their training and professional scope of practice.
This bill was tabled in committee.
Libertas Institute supports this bill.
The (not so) Affordable Care Act is a federal law that, among many other things, mandates the purchase of insurance. Not many are aware that members of recognized health care sharing ministries are exempt from the mandate. These ministries are faith-based organizations where members voluntarily share costs one with another, to defray expenses much like a traditional insurance system would.
While this exemption from federal law is in place, providing cost sharing program members with the exemption needed from the insurance mandate, Representative Mike Kennedy has sponsored House Bill 113 to provide a similar exemption in state law.
Title 31A of Utah code contains all of the insurance laws for the state. HB113 would make clear that the entire title does not apply to members of a health care sharing ministry. Effectively, this means that state law would reflect reality, namely, that cost sharing programs are not insurance, and should not be regulated as such.
To qualify for the exemption, these ministries would be required to provide notice to members that the ministry is not an insurance plan, and despite a good record of cost sharing to cover each person’s medical costs, the individual him or herself is ultimately liable for all personal medical costs.
“[Medicaid expansion] you came into my heart
With a burning love
That stings like a bee”
-“Where Did Our Love Go,” The Supremes, 1964
The following is in response to a recent post that appeared on Utah Poverty News, entitled: “On the issue of Medicaid expansion, like so many things, we can’t go back to 1964.”
We appreciate the opportunity to respond to recent points and to clarify why Medicaid expansion is so worrisome a path for Utah to follow. In a humorous critique of our recent letter opposing Medicaid expansion, proponents of Medicaid expansion imply that our opposition is misplaced and that we would have to go back in time to 1964 when Medicaid was first started to fix our frustrations. This is not so. Medicaid expansion on its face represents significant federal micromanagement in state health care policy and has proved disastrous for many states. The line from The Supremes’ 1964 hit “Where did our love go,” referenced above, describes the problems already being felt by Medicaid expansion in some states. The promises from Washington were rosy and “tender” as they penetrated the “burning” hearts of state lawmakers around the country, but the result of implementation has, “like a bee,” stung state budgets and the truly needy.
At least 7 of the 29 expansion states have experienced cost overruns as enrollment projections were vastly under-predicted. More troubling is the way in which expansion has left state programs strapped for cash and unable to provide critical care to those most medically needy. Moreover, as more enrollees seek care from a limited pool of doctors that accept Medicaid, needy patients will find themselves further and further down the waiting list for actual care. While the temptations of rosy feelings of love for a program that promised so much for so little led states to expand, the fiscal and economic realities for these states have ruled supreme and couldn’t “get us” or “make us love” it in the end.
Recently we wrote about some of the problems with Medicaid expansion and reasons why the Governor and legislature should not proceed with the Healthy Utah proposal. Simply put, the discussion over Utah Medicaid expansion under “Obamacare” ignores the fundamental policy question about whether Utah should be providing taxpayer-funded health insurance or health care for able-bodied, childless, working-age adults at all.
Historically, the state has never done so, and policy makers have made little effort to do so until now. Many agree that such a program falls well outside the traditional limits of government policy. Nothing has changed about the fundamentals of this debate.
The incentives, however, have changed; under Obamacare, the federal government has promised to the states that it will pick up all or part of the fiscal tab for such a policy—at least for a period of time. We warn that this is a false and empty promise—one that is predicated on burdening future generations with debt by expanding unsustainable deficit spending. It is a promise that leaves our children and grandchildren exposed to serious future fiscal problems. It is a promise that leaves existing needy patients exposed to doctor shortages. For these reasons, we join with others to call on the legislature to protect Utahns from the problems associated with Obamacare’s Medicaid expansion.
This bill failed in the Senate on a 14-15 vote.
Libertas Institute supports this bill.
In 1915, 100 years ago, the Utah legislature banned a wide range of drugs, including cannabis. At the same time, the law specifically legalized possession, use, or sales of these substances “upon the written order or prescription of a physician.”
With respect to cannabis that medical option was rescinded—but one conservative lawmaker wants to go back to the way things were. Senator Mark Madsen has introduced Senate Bill 259 to legalize medical cannabis in the state, along with an industry that can provide products to patients looking for relief, treatment, or potentially even cures to their medical conditions. An example of two people who can benefit from this new law was published in an exclusive interview by Libertas Institute last week.
This bill would enact a number of provisions relating to the production, use, and sale of cannabis, including the following:
- Licenses would be issued to medical cannabis growing facilities, production facilities, and dispensaries to legally conduct business in selling cannabis to individuals with permits to purchase it.
- Individuals who suffer from a qualifying illness, and whose licensed physician provides a signed statement indicating that the individual suffers from the illness and may benefit from treatment with cannabis, will be able to legally obtain and use cannabis.
- The cannabis can be orally ingested, vaporized, or topically applied; it may not be combusted/smoked.
- Individuals will be limited in how much cannabis they can purchase within any given time period.
- No more than one dispensary will be allowed in each county, except for counties with more than 200,000 residents, in which case one dispensary per 200,000 residents will be allowed.
- Child-resistant packaging and clear labeling will be required of all products sold.
- Detailed tracking will be required to monitor seed-to-sale so as to minimize abuse or wrongful access.
- Signage, marketing, and access in any way appealing to or accessible by minors will be prohibited.
- A security plan will be required for licensed cannabis-related facilities, access will be limited, inspections will be allowed to ensure compliance, and other provisions are included to minimize any other problems.
Cannabis is clearly safer than alternative legal substances—even more so than previously thought. A legislature that is almost unanimously supporting “Right to Try” legislation, which would allow terminal patients to access potentially life-saving medication not yet approved by the FDA, should likewise pass this law—do we really want to wait until people are at death’s door before the government steps back ever so slightly?
This bill is about the freedom to choose—allowing a patient and their doctor to determine if the medicinal properties of cannabis might help alleviate, treat, or cure their condition. Speculative concerns about potential misuse of this product does not justify its outright prohibition. We encourage full support of this important legislation.
The most well known case in this regard is the ongoing lawsuit by Hobby Lobby against the contraception mandates in the (so-called) Patient Protection and Affordable Care Act. This company is owned by the Green family, who are devout Evangelical Christians who believe that life begins at fertilization. As such, they object to being compelled to offer health insurance plans that offer all forms of contraception—including abortifacients that prevent a fertilized egg from implanting in the uterus.
Three options are available to the Green family: comply with the law and violate their religious beliefs, break the law and face severe fines, or sell or close the business. Thus, the lawsuit.