HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

States have always been at the forefront of healthcare regulation, and innovation.  Here’s a summary from Health Affairs of what’s likely on the Governor’s agenda’s.

The National Governor’s Association Center for Best Practices – Health Division is very active in creating forums for model state healthcare policy.  They have invited EMS to the table on numerous occasions. 

This is also why part of NAEMT’s current strategic plan is to support state EMS associations engage at the state level and catalog model state EMS legislation.

Governors Set The Agenda For Health Care

Heather Howard

FEBRUARY 1, 2019

Against the background of the federal government partial shutdown, 36 governors (new or re-elected) have been sworn in this year, many of them announcing ambitious agendas on health care. Even before the shutdown, prospects for health care legislation emerging from a divided Congress were unlikely, and governors have jumped into this breach and seized the opportunity to set robust agendas. 

A review of the governors’ inaugural, state of the state, and budget addresses reveal a wide range of state health care initiatives, including expansions of health insurance coverage, efforts to address the affordability of health care, and a continued focus on the opioid crisis and increasing access to behavioral health services. 

Coverage Expansions

One clear theme from the governors has been a focus on expanding health insurance coverage. In Maine, Governor Janet Mills’ first action was an executive order directing the Department of Health and Human Services to implement “expeditiously” the expansion of Medicaid approved by the voters in 2017 but opposed by the previous governor. Three states—Idaho, Nebraska, and Utah—are implementing expansions of Medicaid approved by voters in 2018 ballot initiatives, and Kansas Governor Laura Kelly proposed a path forward on expansion. In Wisconsin, a state that covers residents up to 100 percent of the federal poverty level on Medicaid, the new governor issued an executive order starting the process to expand Medicaid up to 138 percent of the federal poverty level, which will increase federal funding to the state. 

Some governors signaled their intent to pursue even more far-reaching efforts to increase coverage. Several states are actively considering proposals to leverage Medicaid to further reduce the numbers of uninsured. In New Mexico and Colorado, there are proposals for a Medicaid buy-in, to make coverage more affordable for consumers and to improve access to care. Washington State is considering a public option, with plans procured by the Washington Health Care Authority, home of Washington’s Medicaid program, Apple Care. Plans would be available for purchase on the state health insurance Marketplace. These proposals may gain traction in other states and add fuel to national debates on universal coverage. 

California’s governor unveiled an ambitious package, which includes expanding state-funded coverage to undocumented immigrants from ages 19 to 26, enhanced subsidies to make coverage more affordable for those purchasing Affordable Care Act (ACA) plans, and a plea to President Donald Trump and Congress for “Transformational Cost and Universal Coverage Waivers...that provide the path to single-payer health care.” Together, the initiatives would “bring the state closer toward health care for all.” 

Protecting ACA Coverage Provisions

Facing uncertainty resulting from the recent legal challenge to the ACA, some states are looking to codify ACA protections in their own laws. Governors in Nevada, New York, Rhode Island, and Wisconsin are focusing on protecting provisions related to preexisting conditions and guaranteed issue. For example, in Rhode Island, the governor called for ACA protections, such as essential health benefits, to be enshrined in state law to guard against repeal efforts or court action. Similarly, in Wisconsin, the newly elected governor signed an executive order directing state agencies to provide him with recommendations to ensure that people with preexisting conditions are able to obtain health insurance. 

Affordability

After Congress effectively repealed the individual mandate to purchase health insurance in late 2017, experts predicted higher premiums and uninsurance rates. California, Nevada, and Rhode Island are considering implementing a state-level individual mandate, following the lead of the District of Columbia, New Jersey, and Vermont, to avert the negative consequences of repeal. Proposals in Colorado and Rhode Island call for a reinsurance program to help stabilize premiums, following seven other states that have received federal approval of a Section 1332 waiver to help bring down premiums through reinsurance.

Many governors mentioned the burden of rising health care costs on their states, but Colorado Governor Jared Polis offered a novel idea: the creation of an Office for Saving People Money on Healthcare, to be led by Lieutenant Governor Dianne Primavera. He noted, “We aren’t giving this office a fancy name to make it SOUND important. Instead, we’re giving it a simple name because it IS important.” 

Prescription Drugs

As rising prescription drug prices draw increased attention from the Trump administration and Congress, so too are states confronting the impact of increasing costs on residents and state health care programs. Colorado proposed allowing prescription drugs to be imported from Canada, an idea that Vermont is already pursuing. However, the big news on this front was California Governor Gavin Newsom’s first act—an executive order consolidating the state’s purchasing authorities to create the country’s largest single purchaser for prescription drugs and eventually to include private purchasers. Governor Newsom noted, “We will use both our market power and our moral power to demand fairer prices for prescription drugs.” 

Behavioral Health And Addressing The Opioid Crisis

With the opioid epidemic showing no sign of abating, governors across the political spectrum vowed to step up efforts on treatment and prevention. Governors in Colorado, Iowa, New Hampshire, Rhode Island, and South Carolina focused on the need to address behavioral health in schools by training teachers to recognize potential signs of depression and suicide, and allocating more resources for school personnel. Additionally, the governor of Iowa is calling for comprehensive behavioral health reform and is focusing on shoring up the children’s mental health care system in the state. 

States have always been at the forefront of health care innovation, spurred by the local nature of health care and a combination of necessity borne of balanced budget requirements and our federal system. Notable this year is the bold tone many new governors are taking, with talk of “guaranteed health care,” “health care is a human right,” “health care is a fundamental right,” and “health care is a basic human right.” Clearly, for health policy observers, the states bear watching in 2019.