Subject: States Turn Out a Flood of AIDS-Related Bills Date: Published: 8/20/87 159 lines Source: WALL STREET JOURNAL. Copyright Dow Jones & Co. Inc. States Turn Out a Flood of AIDS-Related Bills As Issue Remains in Talking Stages in Washington --- By Joe Davidson Staff Reporter of The Wall Street Journal While Washington wrestles with the question of what to do about AIDS, most of the action on the issue has been taking place elsewhere -- in 50 state capitals, where officials are dealing concretely with a problem the federal government is still only talking about. AIDS-related bills are flooding state legislatures. During the height of the state legislative season, five to 10 AIDS-related measures were being introduced every day, according to Richard Merritt, director of the Intergovernmental Health Policy Project. All told, some 550 such measures have been introduced in legislatures this year. The largest proportion of those bills, about 20%, have to do with mandatory testing, principally of marriage-license applicants, for AIDS, or acquired immune deficiency syndrome. "Every state legislature -- if they haven't already -- is going to be faced with a mandatory testing bill or a bill to prohibit mandatory testing or both," says Woodrow Myers, Indiana's health commissioner and president of the Association of State and Territorial Health Officials. In addition, however, legislators are grappling with questions about health-care costs, confidentiality and discrimination, among many others. The question of whose rights to emphasize has been central to the AIDS debate in state capitals just as it has been in Washington. It focuses on the age-old political problem of "the rights of society versus the rights of individuals," says Philip Lee, director of the Institute for Health Policy Studies at the University of California, San Francisco. Dr. Lee says the "ideological debate" has contributed to the flood of state AIDS bills, with the political right wing a main source of legislation. In some ways, the AIDS debate has turned conventional political debate on its head. On most issues, the political right historically has tended to emphasize individual rights; in this one, though, many conservatives are pushing measures that they argue will protect the great number of people who aren't infected. So far, complains State Rep. Penny Pullen, a conservative Republican Illinois legislator, public health officials have placed "the right of individual protection above rights of the public to be protected and remain uninfected." Rep. Pullen, who was recently appointed to President Reagan's national commission on AIDS, was a key figure in the Illinois legislature's approval of a controversial "public protection package" of AIDS-related measures. Gov. James Thompson is expected to act on the bills next month. Among other things, the measures require AIDS testing of prison inmates, convicted prostitutes, other sex offenders and intravenous drug users, and certain hospital patients. Public-health authorities must notify school officials when students test positive for AIDS, and corpses of AIDS victims must be so labeled. One particularly controversial bill mandates contact tracing -- the tracking of intimate partners of those who test positive for AIDS. Bernard Turnock, the state director of public health, initially opposed the measure. But while the issue was being deliberated, Republican members of the state Senate served notice that if he "did not change his stance (against) contact tracing, he would not be reconfirmed," says Tom Schafer, a spokesman for the Illinois Department of Public Health. After reaching a compromise with the GOP leaders, the director was reconfirmed. "The kind of bills that have been passed in Illinois really runs counter to the general consensus so far in the states, that voluntary cooperation is really the way to go," says Mr. Merritt, whose health project at George Washington University studies trends in state health policies. Few state mandatory-testing proposals have become law because most public health officials don't believe broad testing is cost-effective. A positive AIDS test doesn't mean the patient has the disease. It does indicate he or she has been infected by the virus and can pass it to others. Mr. Merritt says that 79 premarital-testing bills were introduced in 35 legislatures this year. So far, however, only Louisiana, Illinois and Texas have passed bills requiring testing of marriage-license applicants, and only Louisiana's has been signed into law. The Texas legislation wouldn't take effect until indications of the disease in the state have jumped substantially, but the Illinois and Louisiana statutes take effect regardless of the incidence of AIDS. While testing and contact-tracing have been big issues this year, future legislative sessions are expected to come to grips with financing the AIDS fight and even the question of quarantine. M. Roy Schwarz, an assistant executive vice president of the American Medical Association, believes that "sanctions against those who (test positive) but refuse to behave themselves" are a real possibility. Still unanswered as states grapple with these issues is who will pay the AIDS bill. With budget austerity the watchword in Washington, "clearly this is something that has to be done in partnership by the federal government, states, localities, the private sector," William Roper, head of the federal Health Care Financing Administration, said on ABC's "Nightline" recently. "Everybody has to deal with this monumental problem." But dividing up the burden also is a difficult issue. For example, some state officials want to prohibit insurance companies from requiring clients to take an AIDS test -- a prohibition already in effect in the District of Columbia. Insurers, however, have responded with threats to stop writing policies. Medicaid, the federal-state health program for poor people, hasn't yet been severely hit by AIDS costs. Nonetheless, the states, which pay half the Medicaid bill, are preparing for an increased financial burden. All but nine states have decided to allow Medicaid coverage of the estimated $10,000 yearly per-patient cost of a recently approved drug that may prolong the life of AIDS patients. And "all the states are going to be hit hard eventually on the question of who is going to pay when the private sector and Medicaid doesn't," predicts Dr. Myers, also a member of the president's AIDS commission. Already, funding on AIDS has jumped as awareness -- and fear -- have increased. During the last three years, total state expenditures for AIDS-related activites rose more than threefold, to $92.7 million from $27 million, according to an Intergovernmental Health Policy Project report. State spending hasn't been directly related to the number of AIDS cases. New Jersey spends more than the combined expenditures of Florida and Texas, yet has fewer cases than either. And California spends almost twice what New York does, despite having fewer total cases. Despite the differing levels of spending in the states and the variety of approaches to the problem, politicians and public-health officials agree with Illinois's Rep. Pullen, who says: "The states have a heavy responsibility, because it is generally in the states where the public-health power resides." --- AIDS Spending by States With Most Cases CUMULATIVE CASE TOTAL PERCENT OF SPENDING SPENDING SINCE JUNE '81 U. S. TOTAL FOR 1986* FOR 1988* New York 11,083 28.6% $ 4,500,000 $16,372,000 California 8,896 22.9 15,590,000 32,065,000 Florida 2,667 6.9 576,000 2,000,000 Texas 2,513 6.5 72,800 2,249,400 New Jersey 2,245 5.8 1,969,000 7,377,000 Fiscal years Sources: Centers for Disease Control, Department of Health and Human Services; Intergovermental Health Policy Project, George Washington University [This article is made available here by Dow Jones Co. for the personal and non-commercial use of callers to this bbs, in the hope that it will be of some help to those who are suffering from the disease and others who are seeking to help them.]