One State's Trash = Another's Treasure? Or Torment?

Right now, states have absolutely no control over the amount of trash they must take from outside their borders nor where it comes from.

The Supreme Court has ruled that states refusing garbage coming in from other states are infringing on interstate commerce. As a result, the only recourse for states is Congress.

Consequently, states like Pennsylvania are in a bind over the available space for waste and costs of garbage disposal. The Keystone State accepted 9.8 million tons of out-of-state garbage from New York, New Jersey and 26 other states and countries in 1998 - and that was almost half of the state's total trash.

But Congressmen Jim Greenwood and Ron Klink, both from Pennsylvania, hope to change that. They have proposed legislation that would restore states' power to control the flow of trash over their borders.

Under the bill, states couldn't totally ban out-of-state garbage, but they could reduce the amount to as little as 20 percent of all trash sent to their landfills and incinerators.

Opponents of controlling the flow of trash across state lines say it limits competition, creates inefficient local monopolies, increases costs and interferes with interstate commerce. For states like New York, it is far more expedient and less expensive to ship waste across state lines to Pennsylvania than to try to site a new, in-state landfill.

But most state and local government officials argue that some kind of control on the influx of trash is needed so that financing can be found to expand or upgrade existing facilities, make sure that sites are environmentally sound and maintain revenues for solid waste management. They also point out that state recycling efforts are often undermined when waste from other areas is shipped in.

Yet even as they wait for congressional action, some states are attempting to deal with out-of-state trash. The Virginia legislature passed a law limiting dumping at state landfills and prohibiting trash shipped in barges on state rivers.

However, in June the district court for the eastern area of Virginia preliminarily enjoined the commonwealth from enforcing the statute. The court found that the law is likely to "discriminate" against out-of-state garbage.

Representative Samuel Smith of Pennsylvania has proposed legislation that puts a three-year moratorium on permits to increase waste disposal capacity. The bill also would cap capacity, require approval for municipal trash companies to operate in the state and require a host community agreement before permits are issued for new or expanded waste facilities.

At present, there are approximately 40 states with some kind of flow control statute. But because they can't control the flow into or out of their states, the statutes are ineffective. Thus, for many states, the fate of waste facilities, landfills and the environment rests with Congress.

A new law in Texas allows doctors to negotiate the terms of their contracts with health plans under the watchful eye of the state attorney general.

This law, a first in the nation, lets doctors deal directly with insurers. It gives them the ability to negotiate and voice their concerns about patient care as a group without the threat of antitrust violations. Patients' interests are also protected under the law with prohibitions against boycotts or strikes.

The collective bargaining debate and physician unions are not new ideas, although they've recently attained a higher profile. In fact, doctors' unions have been in existence since 1972 and the three largest have over 23,000 members. However, the latest trend toward unionization seems to be a backlash against managed care.

According to the language of the Texas law, "...there are instances in which health plans dominate the market to such a degree that fair negotiations between physicians and the plan are unobtainable absent any joint action on behalf of physicians. In these instances, health plans have the ability to virtually dictate the terms of the contracts they offer physicians."

Federal antitrust laws severely limit the ability of independent contractors, like doctors in private practices, to bargain collectively. Existing physician unions represent mostly salaried doctors who work for hospitals and clinics. The National Labor Relations Board must approve new unions and doctors sometimes have had trouble justifying their creation. Physician unions can participate in collective bargaining under certain circumstances without violating antitrust laws.

Since Governor George W. Bush signed the law in June, the formerly anti-union American Medical Association House of Delegates has voted to form a labor organization of its own, although it prefers the term guild to union. This new organization will, at best, represent the 108,000 physicians who are salaried employees (there are currently over 620,000 doctors involved in patient care).

A pending federal bill, the Quality Health Care Coalition Act of 1999, sponsored by Representative Tom Campbell of California, would reform federal antitrust laws to allow self-employed physicians to bargain collectively with health plans.

For more information see State Health Notes, issues #261 and #298, or call Gretchen Flanders, [phone], or send e-mail to [e-mail].