When it comes to state policy, a couple of keywords come to mind in describing the year ahead: flexibility and experimentation. These key terms might sound familiar, as they drove state-level policies in 2018. With expected gridlock between our new divided Congress, states could be the ones to drive major health policy activity in 2019.
This year, it is expected that states will continue to seek flexibility from the federal government and experiment with policies aimed at increasing access to health care with an even stronger emphasis on affordability and managing costs.
‘State of the State’ Health Care Themes
More than half of states’ governors have delivered their “State of the State” addresses, shedding light onto what states will prioritize legislatively this year and in their fiscal year 2020 budgets. Three major themes from their addresses were lowering health care costs; increasing access to substance use disorder treatment; and expanding mental health services.
Specifically, states want to lower health care costs for patients across the system, with a focus on prescription drug prices, hospital prices, and state Medicaid program costs. Notably, Colorado created the first Office of Saving People Money on Health Care to lead the state’s initiatives to reduce patient out-of-pocket costs for prescription drugs, hospital visits, and health insurance, as well as increasing price transparency more broadly. Additionally, Nevada’s Patient Protection Commission will evaluate the states’ efforts to address prescription drug price gouging.
States also emphasized the need to increase access to substance use disorder treatment in the context of the opioid crisis. Several states indicated plans to create non-offender programs to keep people with substance use disorder out of the prison system. Rhode Island went a step further, announcing plans to create a new job training program specifically for people recovering from opioid addiction.
Nearly all states discussed enhancing mental health services, with the spotlight on substance use disorder, along with increasing mental health care in schools.
2019 State Health Policy Trends
Similar to last year, some state policymakers in 2019 will remain focused on exploring avenues to save money in state-invested programs and pushing new, lower-cost coverage options. Specifically, states will leverage flexibilities to:
- establish Medicaid work requirements through section 1115 waivers;
- test out alternative coverage options in their insurance marketplaces through section 1332 waivers; and
- expand access to less generous, lower-cost plans exempt from Affordable Care Act (ACA) coverage requirements, including association health plans, short-term limited duration plans, and a state-run plan proposed by Idaho in 2018.
Meanwhile, other states will focus on reinforcing key ACA coverage provisions (in case the law is invalidated) and experimenting with more affordable coverage options, such as:
- creating insurance mandates (as we have already seen in New Jersey, Vermont, and Washington, D.C.);
- requiring coverage for pre-existing conditions (as recently proposed in Maine and Wisconsin); and
- offering public insurance options, like Medicaid buy-in (an idea being spearheaded by New Mexico [Senate Memorial 3 and House Memorial 9] with several other interested states) or offering a Medicare-like plan (as recently proposed in Washington state).
In the coming months, states will release their fiscal year 2020 budgets, which will demonstrate the specific policies and programs governors propose to invest funds. The association will continue to track these efforts and report on recognized trends.