2019 was a robust year for policymaking at the state level, with many policies directly affecting essential hospitals and their communities. Throughout the year, governors and state legislators focused on increasing access to affordable care and lowering health care costs.

States also zeroed in on social and economic factors that influence health in their immediate communities, including initiatives to combat the maternal mortality crisis and the ongoing opioid epidemic. Efforts to lower prescription drug prices and protect patients from unexpected medical bills from out-of-network providers also were policy priorities for states in 2019.

Notable State Health Policy Trends

Expanding Affordable Coverage

In 2019, states enacted policies to boost insurance coverage affordability and access. Washington state implemented a first-in-the-nation public option, which requires the state agency to contract directly with at least one private insurer to offer individual market coverage on the exchange. Colorado passed a similar bill that requires the state to develop a proposal for an affordable coverage option.

Some states focused on expanding eligibility for Medicaid coverage. Maine expanded its Medicaid program in January 2019, two years after voters approved the expansion through a ballot referendum. Other states, like Montana, approved waivers to continue their states’ expansion with conditional changes, including applying work requirements as a condition of Medicaid eligibility.

Surprise Billing

States continued to enact surprise billing protections for consumers throughout 2019. As of September 2019, 25 states passed legislation to protect patients from surprise medical bills. States like Nevada passed legislation that holds the patient harmless and only requires policy holders to pay applicable cost sharing amounts.

Many states, like Florida, required a dispute resolution process between providers and insurers that would require an arbiter to negotiate a lower price for the consumer. Others focused on enhancing consumer education and awareness of out-of-network billing.

Opioids and Substance Use Disorders

As the opioid epidemic continues to affect communities nationwide, states have responded by realigning policies and funding to mitigate the crisis. States like Virginia, California, and Maine focused on boosting funding for programs for substance use disorder  screening, prevention, and treatment — including expanding access to Naloxone — and setting prescription guidelines for providers. Others, such as New York, worked to align resources by connecting data collected from law enforcement and state public health services, including by displaying data on internal dashboards.

Prescription Drug Prices

States continued to target the high cost of prescription drugs, passing a record 26 drug pricing bills. Many states, including Montana, New Mexico, and Wyoming, enacted policies to increase pharmacy benefit manager (PBM) transparency. These policies include the prohibition of “gag clauses” between pharmacists and PBMs, which prevent pharmacists from disclosing to customers a drug’s cash price if it is lower than the out-of-pocket cost under insurance.

Other states, like Colorado, created wholesale drug importation programs to import drugs from Canada at lower prices. While importation policies will require federal approval, the Trump administration’s continued support for such policies lays the groundwork for state experimentation.

Maternal Mortality Crisis

High maternal mortality rates gained the interest of state lawmakers in 2019. Many states, such as North Carolina and Illinois, boosted funding for maternal health programs and created task forces to reduce maternal mortality through data tracking and prevention efforts.

States in 2019 introduced more than 80 bills to improve maternal health, including proposals to expand access to doula care, enhance data collection, and increase the postpartum Medicaid coverage period for low-income mothers.

Looking Forward

Despite Congress’ work in 2019 to target health priorities like prescription drug costs and surprise billing, little progress was made given the current political climate and gridlock at the federal level. Yet it was a prolific year for state-level policymaking, with states tackling important issues for essential hospitals and their communities.

As national policymaking becomes increasingly polarized and stalled, we predict states likely will lead in innovative policymaking, confronting pressing health policy issues in the absence of federal activity.