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Obama Allows California to Adopt Car Emission Standards - New Day for State Regulatory Authority

In a positive step forward for federal respect of state regulatory powers, President Obama directed the Environmental Protection Agency (EPA) to reconsider a previously denied waiver to allow California to set more stringent auto emissions and fuel efficiency standards than required by federal law.  In a statement by the White House, President Obama said "the federal government must work with, not against, states to reduce greenhouse gas emissions."  The directive represents not only greater respect for state authority, but also a sharp break from the climate policies of President Obama's predecessor. 

"Gentleman's Agreement" Drives Health Care Costs in Massachusetts, Highlights Need for "Public Plan" Option in Health Reforms

In 2000, the CEOs of the largest hospital system and largest insurance company in Massachusetts shook hands on a plan to manipulate the health care market and ensure each other greater profits and market-share, an extensive report by the Boston Globe has revealed.  Under the wink-and-a-nod handshake deal, Blue Cross insurance agreed to raise reimbursement rates to Partners HealthCare - the largest hospital system and private employer in the state - in exchange for Partners' insistence that other insurers pay them at least the same rates paid by Blue Cross.

Ballot Initiatives 2008

This Dispatch is a roundup of what ballot initiatives will appear on state ballots across the country this November.  Whether it's workers rights, energy policy, education, transit, abortion or health care, ballot initiates give voters a chance to directly vote on an issue.

Court Upholds Employer Health Care Responsibility Policies

In a case with national implications for state health reform across the country, the Ninth Circuit Court of Appeals this week in Golden Gate Rest. Ass'n v. San Francisco upheld the employer responsibility provisions of the San Francisco universal health care plan.  The decision follows a preliminary decision earlier in the year that allowed the plan to be initially implemented.

Paid Sick Days on Ballot in Milwaukee

Milwaukee has a paid sick leave referendum on the ballot for November that would allow employees to take leave for medical treatment, preventive care, or diagnosis for themselves, as well as to care for a close family member who is sick or who needs diagnosis or preventive care. Additionally, employees would be allowed to use the time to deal with domestic violence or sexual assault (for example, using accrued time to flee to safety.)  Employees at firms with 10 workers or less could accumulate up to 40 hours, whereas larger companies would have to provide up to 72 hours of paid sick leave.

Addressing the Shortage of Primary Care Physicians

According to The Boston Globe, a national shortage of primary care doctors is hitting Massachusetts especially hard.  The state's 2006 health insurance mandate has resulted in an additional 439,000 newly insured residents trying to seek care from an already over-stressed medical profession.  According to an annual survey by the Massachusetts Medical Society, wait times for new patients to see primary care doctors are running an average of 50 days, though some doctors report delays up to 100 days.

Health Insurance Regulation Advances in California

To address the misuse of health insurance premiums, legislators in California recently passed tougher standards regulating how insurance companies use premiums.  The law is designed to put teeth into the basic expectation that health insurance premiums paid by families and businesses should be used by insurance companies for actual medical care.  Sponsored by State Senator Sheila Kuehl, legislators passed SB 1440, which creates a "medical loss ratio" of 85% - or "care share" - requiring insurance companies to spend at least 85-cents of every premium-dollar on actual medical care.  Governor Schwarzenegger has yet to act on the bill, but the legislation was amended at his request to exempt new plans from the 85% threshold for the first two years they are available, signaling that his signature is likely.