Week Six 2/16-2/22: Public Sector Influence on Healthcare Policy: Efforts to Aid the Uninsured

The public sector is the part of the government, such as the US Department of Health and Human Services (HHS), US Department of Housing and Urban Development (HUD), US Department of Labor (DOL), US Department of Education, US Department of Agriculture, and US Department of Treasury, that tries to provide health care and public services for the poor, underprivileged, uninsured, underinsured, and disabled to decrease health disparities (Welfare Information, n.d.). In the United States, the government tries to provide programs to help people that have low or no income. Welfare programs include Medicaid, Medicare, Women, Infants, and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), Housing and Urban Development (HUD), Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), tax discounts such as Earned income Tax Credit (EITC), Child Welfare Services, Head Start, and Work Study (Welfare Information, n.d.). Welfare benefits and economic assistance includes food stamps, vocational rehabilitation, unemployment compensation, housing and utility benefits, health care services (medical, prescriptions, dental, vision), alcohol and substance abuse programs, child care assistance, and direct cash payments (Welfare Information, n.d., Kraft & Furlong, 2015). The purpose of welfare is to try to encourage people to move from welfare to work according to the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by Bill Clinton (The Center for Media and Democracy, 2011). Poverty is defined as an annual income less than $23,850 for a family of four (Kraft & Furlong, 2015).

Since medical marijuana is not legal under the federal government, insurance does not cover it and it is not tax deductible (Campbell, 2014). However, people who participate in the Food Stamps or SNAP program do get a 50% discount on the cost of a registry identification card and the price is reduced from $150 to $75 for initial and annual renewal cards (Arizona Department of Health, n.d.). There is also no special tax on medical marijuana besides Arizona’s sales tax (Arizona Department of Health, n.d.). Medical marijuana in Arizona typically costs around $280-$400 an ounce out-of-pocket (GivingTree Wellness Center, 2015). A personal interview with Dr. Gina Mecagni (February 8, 2015), Medical Director of The Giving Tree Wellness Center, states that the costs to get a medical marijuana card are too high. Most patients have to pay an extra $150 on top of the state application to get a medical marijuana card to find a Medical Marijuana Evaluator, because most family physicians will not recommend medical marijuana (G. Mecagni, telephone interview, February 8, 2015). These visits usually cost $150 and are not covered by insurance (Hays, 2013).


Arizona Department of Health Services. (n.d.). Qualifying patients. Retrieved from http://www.azdhs.gov/medicalmarijuana/faqs/index.php?pg=qualifying-patients

Campbell, J. (2014). Is medical marijuana tax deductible? Retrieved from http://marijuanapatients.org/medical-marijuana-tax-deductible/

GivingTree Wellness Center. (2015). Phoenix menu: Flowers. Retrieved from http://www.givingtreeaz.com/product-category/phoenix-menu/flowers-phoenix-menu/

Hays, C. (2013). How to get a medical marijuana card in Arizona in 4 easy steps. Retrieved from http://blogs.phoenixnewtimes.com/jackalope/2013/09/get_medical_marijuana_card_arizona_mmj_weed.php

Kraft, M.E., & Furlong, S.R. (2015). Public policy: Politics, analysis, and alternatives (5th ed.). Thousand Oaks, CA: Sage.

The Center for Media and Democracy. (2011). 1996 personal responsibility and work opportunity reconciliation act. Retrieved from http://www.sourcewatch.org/index.php?title=1996_Personal_Responsibility_and_Work_Opportunity_Reconciliation_Act

Welfare Information. (n.d.). What is welfare state? Retrieved from http://www.welfareinfo.org/state/


9 thoughts on “Week Six 2/16-2/22: Public Sector Influence on Healthcare Policy: Efforts to Aid the Uninsured

  1. Lynn,
    Yesterday we had this rampant discussion at our work place about whether medical Marijuana is doing the job it is intended to do or not . One of the points that stuck out in the whole discussion is that if one can get Marijuana out in the streets so easy, then having a medical Mariiuana card is only enhancing the problem of illegal Marijuana use. A lot of people who want to use Marijuana somehow gather the money, pay for the card and keep it as a License to use Mj whenever needed . If thats what the card is doing, why don’t we legalize it, tax it high, and use the tax money to pay off the State’s debt? When we look at the side effect profile, doesn’t some of those pain medication we have been prescribing for years have even more side effects than medical Mj? Are those legal Alcohol and Cigarettes good for your health?

    Again, this is not my personal opinion and I do not personally agree with any of these substances, but as we talked earlier, it is difficult to draw a line where we can weigh benefits over loss once anything becomes a law!
    What is your opinion on this?


  2. This is a very interesting, controversial topic. In my experience in pediatric oncology, more patient’s families have been asking about medical marijuana and when it is appropriate to utilize for pediatric cancers. I was surprised to read participants in the Supplemental Nutrition Assistance Program (SNAP) are offered a discounted rate for medical marijuana card. This surprised me because medical marijuana use has nothing to do with nutrition! After reflecting on it further, I can understand how the database for individuals in the SNAP program could be used to help indentify this vulnerable population and offer discounted rates in other arenas aside from nutrition.


  3. The problem with the medical marijuana card is that users of medical marijuana can be a paranoid bunch and often fear having their names on a list which is accessible by government entities. This should not be because having a medical problem that marijuana is recommended for should be protected health information. The card simply can be thought of as a “get out of jail free” card from Monopoly, if something happens during use or transport, the user will not go to jail as long as its being done within state guidelines for use.

    There are only a relatively small percentage of medical marijuana users that have a card making it difficult to say the program is a success. I do know some patients who have a card, but cannot afford the dispensary prices so they still purchase the substance on the streets, however once it is in there possession it becomes their legal property. Other states like Colorado have identifying data from the original legal grower that must stay with the product cutting down on the illegal aspect.


    Monopoly game and trademark card “Get out of jail free!”- 1934


  4. Lynn,

    Thank you for providing such a great detail over public sector and how it relates to medical marijuana. I was unaware that medical marijuana was not tax deductible. So a patient who is legally prescribed medical marijuana and goes to the dispensary every month or so, they can not use the expense on their taxes under medical costs? That is a shame because some of these patients greatly benefit from medical marijuana and if they were prescribed Percocet, for example, instead of marijuana they could use the receipts from the pharmacy for tax deductions. If the federal government was to endorse medical marijuana as a treatment, then would patients be able to deduct the expense associated with it as medical costs?


  5. What is the reasons for giving Food Stamps participants a discount on medical marijuana cards? It is almost encouraging them or giving them a free pass to use marijuana. Is there any way to tell if people are buying from a dispensary or off the streets? very interesting subject, brings up a lot of questions.


  6. Lynn, this is a very helpful review of public programs for medical marijuana. Thank you for that. Just last week, I had a patient comment that he wishes his VA benefits would cover his medical marijuana. I advised him to not hold his breath! (no pun intended). I am interested to see how your thoughts evolve regarding policy recommendations for NP prescribing. -HMR


  7. Lynn – I thought you did a great job outlining how the public sector of the government helps diminish health disparities. Additionally seems like people who need financial assistance will get a discount price with the medical marijuana card, but the price of medical marijuana is so high I don’t know how someone on welfare or food stamps would be able to afford it. Is there anything currently to help people who can’t afford medical marijuana besides the discounted card price/


  8. Hi Lynn,

    As you learn more about this subject, I was wondering what your thoughts were now on NPs prescribing medical marijuana? Is this something you feel strongly that you would like to be able to do?

    You previously indicated that the majority of patients have a card for pain (71%) and those aged 18-30 are the largest buyers. Dr. Mecagni, whom you have interviewed, expressed her concern that patients have to travel to undesirable locations and pay high costs for the card and product. I wonder is there a specific population that she is concerned is begin prevented from availing of medical marijuana by the above barriers beyond just the 18-30 years-old chronic pain patients?


  9. I was unaware out of pocket medical marijuana expenses were so high in Arizona. As the law is currently written, and how policies are implemented, medical marijuana seems very cost prohibitive to the average healthcare consumer. Indeed, the described onerous process to just get an identification card seems like a high hurdle. Oregon has had a medical marijuana program since 1998 (Oregon Health Authority, n.d. a), and fees to acquire a card range from $200 to $20 (VA or SSI) depending on insurance; Oregonians with Medicaid or SNAP pay about $50 (Oregon Health Authority, n.d. b). Of course, this will all be moot in July of this year, as last year recreational marijuana possession legislation passed which will allow anyone 21 years or older to have up to 1 oz in public and up to 8 oz at home (Crombie, 2014). This includes possession of up to 4 plants (Crombie, 2014). Nonetheless, I’m eager to see the statewide impact of marijuana legislation in Oregon, and other states such as Arizona, especially in the healthcare arena.
    Crombie, N. (2014, Nov. 5). Marijuana legalization Q&A: What’s next for Oregon? The Oregonian. Available from: http://www.oregonlive.com/politics/index.ssf/2014/11/marijuana_legalization_oregon.html#incart_maj-story-1
    Oregon Health Authory. (n.d. a). The Oregon Medical Marijuana Act (OMMA). Retrieved from: https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/475a.aspx. Accessed: 2015, Feb. 26
    Oregon Health Authory. (n.d. b). Medical marijuana program: Frequently asked questions. Retrieved from: https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/top20.aspx#fees. Accessed: 2015, Feb. 26


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