Q&A: Rep. Marsha Judkins on health, housing, and drug transparency

Rep. Marsha Judkins was elected in 2018 to represent District 61 in the Utah House of Representatives. Her committee assignments include Health & Human Services, Social Services Appropriations, and Transportation. 

Three weeks into session, I spoke with Rep. Judkins about efforts to bridge the gap between health policy and housing policy,  the recent revelation that Utah sends workers abroad to buy medicine, and the importance of transparency to lowering the cost of prescription drugs. 

  

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Michael Goldberg: I want to ask you about H.B. 211 , which is a bill you are sponsoring in the Business and Labor Committee that concerns renter expense disclosure requirements. This bill would amend an owner’s duties under the Utah Fit Premises Act to, essentially, hold landlords to a higher standard in terms of the information they’re mandated to disclose regarding expenses that renter may be obligated to pay under their lease agreement. Homelessness has become an issue of principal concern in cities across the western states, both large and small, and Salt Lake City is certainly no exception. Most experts agree the connection between stable housing and health status is clear: one can’t be well if one is housing insecure. Can you talk about that connection and the degree to which it’s driving conversations among legislators about how to bridge the gap between housing policy and health policy?

Rep. Marsha Judkins: We do talk about that connection a bit, probably not as much as we should. The fact that the bill is being heard in the Business & Labor Committee and not in the Health & Human Services kind of shows that that disconnect. It is a tougher sell and tougher audience in the Business & Labor Committee than it would be in the Health & Human Services Committee. Though we do talk about the connection, we have some other big affordable housing bills that we’re looking at this session. I don’t think that people or legislators make that connection quite as readily as say, the connection between addiction and homelessness.

Honestly, my eyes were opened last summer, when I attended a meeting that was held with a group called Circles. They mentor and try to find housing for low income families. These women were there — most of them moms with kids — and they talked about the hard times they had trying to find places to rent with evictions on their record or addictions in their background or whatever it was. It broke my heart to hear how difficult it was and what their housing situations were. So when I was approached later to run this bill, I was really happy. It made feel like I could do something about this. I have received emails from moms who have experienced homelessness, and just the trauma for their kids of trying to find a place, or being in a place they couldn’t afford with having undisclosed fees they suddenly were having to pay etc. I think you’re spot on that we need to look at this as a “health disparity. And on the other hand, it affects all socioeconomic classes. I heard people who could afford a pretty nice apartment but they still ran into the same problem.” 

MG: Can you tell me more about H.B. 207 – the insulin access amendments which you’ve cosponsored? In particular, and I realize this might sound like a simplistic question, can you explain why their needs to be an incentive structure in place to get health benefit plans to reduce the required copayments for insulin?

MJ: A lot of the reason for that is because there’s so little transparency. So, you talk to the pharmacy benefit managers and they say, “Oh, it’s pharma’s fault, they are charging too much money.” And it’s true, they are. Pharmacy companies are requiring insulin users among others to pay for their research and development not on insulin, just on other drugs they’re trying to develop. But then you have the pharmacy benefit managers and they aren’t super transparent either. So we can’t really see what’s going on inside of there, and they can just point to each other and blame each other. And pharmacy benefit managers need to supply pharmacies. Though they have negotiating power, they don’t have all power. Then you’ve got the plans, and they want to get paid, these are all mostly for-profit companies. And then you’ve got the patient getting squeezed at the bottom. It’s hard to blame a company for trying to make a profit when that is their goal and yet, it is hard to look at them with compassion when they are, honestly, causing death among people who should be able to afford medication. I think that it’s one of those things where you could always point the finger at one of those players. So unless we don’t put an incentive in, there won’t be much of one.”

MG: I’m sure you read the recent reports which revealed that the insurance plan for Utah government employees has been sending workers abroad to buy prescription drugs. Essentially, they decided two years ago that they had to do something to curb prescription drug costs. The solution they came up with was to pay for workers to travel to Canada or Mexico to buy the same medications they’d been getting in the United States, just at much lower prices. Can you sound off on this arrangement and how you and your colleagues plan to address this issue going forward?

MJ: We did have a bill last session that would allow the importation of pharmaceuticals from Canada. There’s also going to be unintended consequences and this is unexplored territory because you’re not allowed to do that. I think if we could open up the market that way, that seems to me like it would possibly pressure companies here to curb their prices a little bit. If PEHP sees that it’s cheaper to send people to Mexico or Canada, fly them there to buy their prescription medication and fly them back, there’s obviously a real problem. The federal government controls so much, and pharmacies and pharmacists have to follow these federal laws. That’s where it gets tricky — we have a federal government that so far, hasn’t done a whole lot in this arena. So we’re kind of up against some brick walls on what we can and can’t do. And then like I said, because we don’t have transparency, we can’t see what’s happening with all these different players so it’s difficult to know what is the best course of action to take.I really appreciate the efforts my colleagues have made in this arena to shed light on this issue. In terms of HB 207, I think it’s going to pass. I know there’s a lot of sympathy in our state legislature for these consumers. But that’s the thing, we can pass stuff but actually making it happen is much tricker. We only can regulate insurance companies that are here in Utah, which I believe is only about a third of the insurance market here. So if we try to control insurance providers here, they are trying to compete with national insurance providers and we’re taking the legs out from under them. So it’s a complicated problem and we need to be careful.”

MG: Is there anything else you’d like our Utah readers to keep an eye on this session?

MJ: We’ve gotten awards for being for the best run state in the nation, yet have some real problems with mental health. In Utah, every day two people commit suicide. And we’re not a big state. To me, we need to really focus on what our priorities are in this state. Where should we be putting our funding? We have a lack of funding in our state mental hospital, so we’re sending people who are mentally ill to jail or to prison because we don’t have space to treat them. That’s inappropriate. I think we need to look at what we can do for these families.”     

This conversation has been edited for clarity and length.