CLEVELAND – Back in the year 2000, few people in Ohio believed a prescription drug bill with real benefits could be passed, not with a right-wing controlled State Legislature (some of whom call themselves the “caveman caucus”), an unfriendly governor, a weak Democratic Party and a drug industry ready to spend $16 million to prevent such a bill.
Three years later, the people won a major victory. Last month, the Ohio Legislature, voting 94-1 in the House and 32-1 in the Senate, passed into law “Ohio’s Best Rx,” which was signed by Gov. Bob Taft on Dec. 18. The drug industry’s lobbyists, the Pharmaceutical Research and Manufacturing Association (PhRMA), lobbied in favor of the bill.
How could such a “miracle” happen? Only through hard work, building a coalition involving thousands of people and having a clear goal. If people in your state need lower-cost prescription drugs, read on. You can make it happen!
What Ohio’s Best Rx guarantees
The agreement, now law, provides the following:
• Ohio’s Best Rx will cover all Ohioans 60 years of age and over, regardless of income.
• It will also cover uninsured people younger than 60 if their annual income is 250 percent of the federal poverty level or less. That means an annual income of not more than $22,450 for an individual, and $46,000 per year for a family of four. There will be no means testing. Applicants merely have to sign a statement that they have told the truth.
• Under the Ohio’s Best Rx program, participants will get the same discounts already negotiated for state employees and retirees. Under the law, the state may keep up to 5 percent of each manufacturer’s rebate for state administrative expenses. Consumers will pay a $1.00 dispensing fee.
• The Ohio AFL-CIO estimates the discounts may be 20 to 40 percent for eligible participants.
• Uncooperative drug manufacturers could have their drugs removed from the state employee health plan’s preferred drug list, and be required to get prior authorization from the state for any payments.
Year one: Getting started
Three years ago, upon hearing of an Rx bill just passed in Maine, the Cleveland AFL-CIO Retiree Council got a resolution passed at the state AFL-CIO convention calling for a campaign for a prescription drug fair pricing act. In January 2001, the council brought together four to five groups in the Cleveland area to talk about forming a coalition. Representatives came from the Retiree Council, UHCAN-Ohio (a health care advocacy group), a couple of unions, and a faith-based group. We concluded this was a prime issue, that a broad coalition could be formed, and that the Maine bill was a good model in that it cut prescription drug prices through negotiations rather than subsidizing the “drug lords.”
To prepare our base, we got mailing lists from different organizations, including most unions, faith-based and community groups, senior advocates and health advocates. Someone even went through the phone book and noted every group that sounded like it might have an interest in lower prescription drug costs.
We drafted a petition as a tool for educating the public. A resolution of support was drawn up for organizations to join the coalition. (Later, when a bill was introduced in the Legislature, we drew up a resolution of support for local governments to endorse.) We reproduced a few articles and research pieces that explained what kind of bill we were proposing.
These were mailed to over 250 groups. The mailing got 15-20 groups to sign on, and about 15 people showed up at our next meeting. We held monthly meetings with 20-35 people at every meeting, even three years later. Thus, the Coalition for Affordable Prescription Drugs was born.
Getting a bill
A few months later, the state AFL-CIO requested a bill from Dale Miller, a strong pro-union state representative. The Ohio Prescription Drug Fair Pricing Act was introduced in both chambers in May 2001. It was modeled after the Maine bill with some changes.
Now we had something tangible. In the next eight months, 20,000 signatures were gathered on our petitions. Our coalition grew because members systematically talked to other groups and got them to join. Eventually, the Coalition grew to 300 organizations, and included every union, groups from nearly every religious denomination, numerous community organizations, senior groups and senior centers, even managers of senior apartment buildings, an Elks Club and a church ladies’ auxiliary. In addition, some 70 local governments – city councils, village township boards and county commissioners – passed resolutions of support. A dozen of these bodies were led by Republicans.
Year two: Going statewide
In January 2002, a statewide coalition was formed. Co-chairs of the coalition were Bill Burga, president of the Ohio AFL-CIO, and Athena Godet-Calogeras, a member of the staff of UHCAN-Ohio. This was a critical combination. From the onset, labor was the key mover. It assigned staff to work on the campaign, including this writer. Most of the funds and much of the foot-power came from labor. As co-chair, Athena Godet-Calogeras was key in guaranteeing the coalition included faith-based and community groups as equal partners.
We were able to reach out to people in a dozen counties but were able to build local coalitions in only a few counties. With the addition of statewide organizations such as United Way, United Council of Churches, the Ohio AFL-CIO and 22 others, the coalition took on stature, respectability (in the eyes of politicians and business) and power. The statewide groups represented some 5 million members, and local groups additional thousands.
After a year of trying in vain to move our bill through the Legislature (no hearings were ever held), we talked about using the legislative ballot initiative. Ohio is one of a few states that have this vestige of popular democracy.
Under this law, we had to collect over 96,000 valid signatures of registered voters (3 percent of the number of voters in the last gubernatorial election). A minimum number of these signatures had to come from at least 44 of the 88 counties in the state.
Once the attorney general validated the signatures, our petition would go to the Legislature as a bill. The Legislature would have four months to pass our bill, amend it, or ignore it.
After four months, if they did nothing or passed something the coalition didn’t like, we could gather an additional 96,000. Once validated, our bill would go directly on the ballot for people to vote on.
There was little doubt, even amongst the opposition, that, once it was on the ballot, voters would pass it overwhelmingly, no matter how much money the drug lords put up to oppose it. After considerable discussion, the statewide coalition decided to proceed with the legislative initiative.
Now we were about to embark on a massive, statewide petition drive, relying solely on volunteers, to get 96,000-plus valid signatures. Previous statewide petition campaigns always involved hiring professional signature gatherers.
The petition campaign
After numerous delays by the state in approving the language of our petition (from July to mid-October), we finally started the drive. In barely eight weeks, during the colder months, covering the entire state, we succeeded in gathering 143,000 signatures, meeting the minimum number of signatures in 46 counties.
Our biggest effort was on Election Day 2002, when volunteers stood outside polls in the rain gathering 40,000 signatures, of which 22,000 were collected by AFSCME, the public employees’ union, statewide. This demonstrated what labor is capable of when it mobilizes its members.
We organized SOS days: Sign-up On Sundays for churches and Sign-up On Site for unions. Petitions were circulated at bingo parlors and craft shows, at meetings, religious services, in senior buildings and on street corners.
We turned in the 143,000 signatures to the Ohio Secretary of State 10 days before Christmas, 2002.
Year three: The challenge
PhRMA, representing the drug dealers, immediately filed suits in 45 county courts, seeking to invalidate our signatures. They were prepared to spend at least $16 million to defeat this effort. Their challenges were mostly technical. The main one was that where a signer signed for his or her spouse (mostly among the elderly), the entire petition should be thrown out.
Even after a number of court hearings in which thousands of our signatures were thrown out, we still had enough valid signatures.
Then, last June, a PhRMA rep suddenly contacted Bill Burga of the Ohio AFL-CIO about trying to resolve this issue. Despite our natural skepticism, the two sides met.
After six meetings, and consultations with our state steering committee, an agreement was reached. The GOP legislative leadership and the governor gave immediate support and promised quick passage without amendments. These promises were kept and the governor signed the bill into law on Dec. 18.
While we didn’t win everything, we won about 70-80 percent of what we were aiming for. A Prescription Drug Review Council comprising organized labor, consumer advocates, state legislators and representatives of pharmaceutical manufacturers will monitor the program and ensure participants are getting the best values possible.
One negative clause states that consumers who are “eligible” for coverage offered by their employer, but choose not to pay for that coverage, are not eligible for the new program.
This law is unique in three ways:
• Drug coverage is nearly universal and covers 75-80 percent of those without insurance. Most state plans are limited to seniors or the very poor.
• Drug prices will be reduced by 20-40 percent, with drug manufacturers giving rebates to the state. This is unlike programs in other states that subsidize the drug lords and their ever-increasing prices.
• The Ohio program is self-sustaining, with no need for an additional tax burden on the public.
The plan will go into effect by mid-year, 2004. That which had no chance of success has been won!
The fight for spin
What brought about this dramatic change? One of the drug company representatives mentioned the 143,000 signatures. I believe the GOP may have asked PhRMA to reach an agreement in order to prevent a ballot fight during the presidential elections. Eventually, the bill would have gone on the Ohio ballot. They could not allow this to happen during a presidential election. A ballot fight would make the GOP look bad and bring out voters who just might vote for the Rx bill and against the Republican Party that opposed it.
I also think they calculated that by negotiating an agreement they could limit the damage to one state and control the spin. The law is already being touted as something put forth by the drug companies, with the GOP’s support (and, in passing, the labor-led coalition). That is why we must publicize the people’s role in winning the impossible, to show that with a similar effort, this kind of victory can be won elsewhere.
We will have to drive home the lesson, especially with labor, that coalition-building is the only way to win and it must involve the membership. Victories won’t be won from the top alone (nor from the bottom alone).
Ohio’s Best Rx offers a clear alternative to Bush’s regressive Medicare drug bill recently passed by Congress. The Ohio bill, while only a partial solution, moves in the direction of providing lower priced medicines to large numbers of people without coverage. The federal bill takes a huge step toward destroying Medicare via privatization, and guarantees increasingly higher prices by prohibiting Medicare from negotiating lower prices with the drug lords.
John Gallo is coordinator for the Ohio Coalition for Affordable Prescription Drugs and on the staff of the Cleveland AFL-CIO Federation of Labor. He can be reached at firstname.lastname@example.org.