Beyond their traditional duties of legally representing state agencies and serving as an advisor to the Governor, state attorneys general over the last two decades have proven themselves defenders of everyday people in the name of the public good. One definition highlights this transformation as:
In laymen’s terms, this translates into ‘standing up for the little guy.’ There are numerous examples of state AGs helping consumers in the area of health – these include fighting big tobacco, protecting consumers through better drug labeling and combating chronic illness by supporting a tax on some sugar-sweetened beverages.
Yet that role seems lost, as AGs across 20 states have politically aligned themselves against a Democratic administration. This group of AGs is using a joint lawsuit to voice their opposition to an Affordable Care Act (ACA) provision labeled the individual mandate, or the requirement that all citizens hold health insurance. The AGs maintain they have a responsibility to protect regular people from being forced into a health care marketplace. A healthcare marketplace, by the way, that we are all already members of by way of an undisputed federal law entitled, the Emergency Medical Treatment and Labor Act (EMTALA) – the right to receive health care regardless of insurance status at your local emergency room.
Meanwhile, we have witnessed an unprecedented power shift during the 2010 mid-term elections that flipped state party majorities and rescinded a solid Democratic federal majority. Many AGs lost their seats to more conservative candidates. Thirty AG offices were up for election and the new AG make-up is 24 Republican, 25 Democrat, and one Independent. The party affiliation of AGs changed to Republican in 5 states, placing many at risk of new lawsuits aimed at overturning the ACA.
Yet amid this gloomy forecast, it is worth reflecting on and recounting the positive dimensions of the AG office and an AG’s tremendous opportunity to protect and serve the best interests of American consumers.
In September, Lainie Rutkow and Stephen Teret published a paper in the Journal of the American Medical Association (JAMA) outlining the role of the state attorney general and the positive impact these officeholders can have on America’s public health. Further, the authors contend the idea that AGs would rally against provisions in ACA that seek to protect the most vulnerable in our country – those without health insurance – is diametrically opposed to their mission and their responsibilities to consumers.
Below are examples of what AGs can do to protect consumers:
Tobacco – Mississippi’s Michael Moore led 40 AGs in successfully suing the tobacco industry to recoup expenses related to medical treatment through the state Medicaid program. A “master settlement” or grouped settlement for all states was reached in 1998, resulting in $206 billion for states.
Pharmaceuticals – A host of national partners including the federal AG and more than half of the state AGs reached a settlement with the pharmaceutical company AstraZeneca in April of this year regarding improper labeling of an anti-psychotic drug. The company will pay $520 million in damages to participating states. The drug is intended for patients with bipolar disorder and schizophrenia; however, as a result of its marketing campaign, the drug was being prescribed to children, adolescents and dementia patients – populations for which FDA approval was not obtained. This demonstrates the powerful role AGs have in protecting consumer’s health and the potential for insuring future health benefits and programming for the public that may result from financial settlements.
Obesity – Just this year, William Sorrell, the AG of Vermont held a summit with health professionals about ways to combat obesity, particularly among children. Sorrell suggests that taxing certain sodas and sweetened drinks could both curb consumption and raise revenue to the tune of $30 million annually. The use of the AG office to protect its citizens from chronic illness represents a creative avenue to positively affect policy.
In the case of the tobacco lawsuit, what made it so successful was a team effort. Attorneys general across states of every color (red, blue and purple) worked together in the interest of public health. This is in stark contrast to the politically motivated legal challenges against health reform. Maybe it’s worth reminding AGs why they were elected?
-- Eva Marie Stahl, Policy Consultant