A new report in the Health Affairs Blog speaks to the extent to which a lot of the current action around healthcare policy has shifted in the moment from the federal to the state level, with major implications for providers, payers, and consumers.
As Heather Howard wrote on February 1, “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,” she wrote, “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.”
Even as the federal government went through a partial shutdown from December 22, 2019, through January 25, 2019, the nation’s governors were taking action on a number of fronts.
As Howard reported, “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.”
What’s more, she noted, “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.”
And, “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,’” Howard noted.
Among the areas of greatest activity right now are efforts to protect provisions of the Affordable Care Act, on the part of governors in Nevada, New York, Rhode Island, and Wisconsin; forward movement in the legislatures of California, Nevada, and Rhode Island to implement a state-level individual mandate, following the lead of the District of Columbia, New Jersey, and Vermont; the creation of an Office for Saving People Money on Healthcare, led by Colorado Governor Jared Polis; and efforts by the legislatures of Colorado, Vermont, and California to rein in the rising cost of prescription drugs.