South Dakota voters’ decision on an “any willing provider” ballot initiative is among a number of health care–related ballot initiatives that will be voted on in the upcoming midterm elections.
Others include a measure in Illinois that would require insurance providers that have prescription drug coverage to provide prescription contraceptives, and an Arizona ballot question regarding terminally ill patients’ access to experimental drugs.
If approved, South Dakota’s Initiative Measure 17 would allow providers who are willing to meet a health insurer’s coverage terms to provide health care services to insured patients without those patients incurring any out-of-network fees.
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South Dakota, Illinois and Arizona will have key health care ballot initiatives during the midterm elections next month.
In recent years, the state has seen a significant increase in the number of closed and narrow provider networks, noted Dr. Mary J. Milroy, president of the South Dakota State Medical Association. That has disrupted the patient-physician relationship as patients find their long-time physicians are no longer in their health plan’s networks, said Dr. Milroy, a general surgeon from Yankton, S.D.
“Most patients don’t automatically choose their insurance company,” Dr. Milroy said in an interview. Employers can change employees’ insurance coverage, or coverage could shift with an employment change.
“If your personal physician, who maybe has been taking care of you for years, is not included in the panel for the new plan, then you have to switch or you have to incur out-of-pocket costs,” she explained. “We do not think that is good for continued and comprehensive medical care.”
Under the ballot question, physicians not in a patient’s insurance network but who want to continue a relationship with that patient would simply have to agree to the terms that the insurance provider has for physicians in its network. There would be no special treatment and physicians would have to uphold any terms imposed on in-network providers, including agreeing to reimbursement rates, quality standards, and other terms. If they agree, the patient’s visit would be treated like an in-network visit.
“We don’t see that such a change would negatively affect cost of health care,” Dr. Milroy said. “In fact, we think it would actually increase competition.”
If voters agree and vote positively on the initiative, it will have the force of law, according to Dr. Milroy.
Illinois voters will be asked to vote yes or no on whether any insurance plan in the state that offers prescription drug coverage “be required to include prescription birth control as part of that coverage.”
How that is to be implemented and what exactly would be covered as part of prescription birth control would be determined when the state legislature crafted a bill following voters’ approval of the question, which would leave the question of whether emergency contraception would be covered.
Dr. Maura P. Quinlan, chair of the Illinois Section of the American Congress of Obstetricians and Gynecologists, said in an interview that the ballot initiative is a way for voters to weigh in on the debate, noting cases like the recent Hobby Lobby Supreme Court decision had “no role for voters in Illinois to say how they feel about this.”
In general, the Illinois section supports the ballot initiative, commenting that while there might be costs associated with coverage, “it is so much cheaper to cover the cost to prevent an unplanned pregnancy than to pay for the pregnancy, the care of the child, etc. Always, preventive measures are much cheaper when insurance is trying to decide what they cover,” said Dr. Quinlan, who is in private practice in La Grange, Ill.
In Illinois, the ballot question does not have the force of law but would require the state legislature to enact a law to implement the initiative.
In another ballot initiative, Arizona voters will be asked to decide whether terminal patients in the state should have access to experimental drugs that have not yet received FDA approval.
According to the text of the “Terminal Patients’ Right to Try” act, an eligible patient must have a terminal illness as determined by the person’s physician, and the physician has determined there is “no comparable or satisfactory” FDA-approved treatment option “available to diagnose, monitor, or treat the disease or condition involved and that the probable risk to the person from the investigational drug, biological product, or device is not greater than the probable risk from the disease or condition.”
Products in question need to have successfully undergone phase I study and remain under clinical investigation. Manufacturers would not be required to provide access to the investigational drug, and it would be up to the company as to whether it collects compensation for the product or requires data collection on the drug’s effects as part of providing access to the product.