States Are Ready to Act

If you’re looking for health care policy reform, the states are where the action can be found. New and innovative reform initiatives are underway, driven by the need to quickly address the most pressing local issues.

For the last six months, United States of Care has been listening and learning from the health care leaders who are advancing these initiatives. We’ve been gathering information and gaining on-the-ground knowledge of the different approaches to improve health care for their citizens. Our aim was to tap into this expertise to inform our decisions about where we can best support state efforts.

Our listening tour included visits to four states and conversations with policymakers, advocacy organizations, business leaders and others in 20 more. We connected with states of all political affiliations in every region of the country.

The experience was invaluable. We built new relationships and gained insights that have influenced the focus and direction of our work. Across the states we visited, a few themes were clear:

The desire for action on health care is strong

Americans are tired of congressional gridlock and want actionable ways to make improvements in their own communities. Public polling consistently ranks health care as the No. 1 issue for voters, and the people with whom we spoke echoed that sentiment.

Further, states are not waiting for Congress or federal officials to act. They are addressing pressing issues by taking matters into their own hands. For example:

• More than a dozen states are considering Medicaid buy-in policies to address cost and access to coverage.
• Vermont, New Jersey and the District of Columbia have passed legislation to establish their own individual health care mandates, replacing and reaffirming an important component of the Affordable Care Act that Congress repealed.
• Seven states have received waivers to create reinsurance programs intended to control premiums for health insurance.
• In 2018, legislators in 42 states introduced bills intended to curb prescription drug costs.

Bipartisanship is emerging across the country

We are encouraged by state leaders who are willing to work together across party lines to solve health care issues for their constituents. These officeholders are often more sensitive to local conditions and attuned to the needs of their constituents than national officials; at times, that can encourage a spirit of pragmatic problem-solving often lacking at the federal level.

• Citizens across the political spectrum are stepping up and demanding change when they feel their elected leaders are not taking necessary action. Four traditionally red states – Idaho, Nebraska, Utah and Montana – have ballot measures this year to expand Medicaid or continue expansion.
• Legislators in Oregon and Maine convened bipartisan and multi-stakeholder working groups this year, focused on a substantive study of policies to improve access to care and address high costs.
• In New Mexico, a broad bipartisan majority of the legislature voted to take steps toward a Medicaid “buy-in” program, which would give people an additional affordable option by allowing them to buy into the Medicaid program that already forms the foundation of the state’s health care market.

States are eager for help and shared learning

We also learned that states need help as they embark on ambitious efforts to reform health care. Through our conversations, we identified specific gaps in the states’ ability to develop and advance policies in line with our mission, and we are developing a strategy to fill those gaps. Important state challenges include:

• Limited time: Many legislatures meet for a short period of time compared with Congress. Forty-one states have part-time legislatures, and 60 percent adjourn by May, which means that policy development, analysis, and coalition-building must happen quickly.
• Limited access to expertise: Smaller states, particularly those with part-time legislatures, may lack full-time staff or easy access to policy expertise. State legislators must master many issues and many don’t have the time to delve deeply into the complexities of health care policy.
• Coalition building: Part-time legislators and staff often are short on resources to manage stakeholder relations or focus on building broad political support.

What’s next?

As our first engagement, United States of Care is partnering with advocates in New Mexico as they explore policy options to create a Medicaid buy-in proposal. We are providing public opinion research and technical support, connecting state leaders with national experts, and offering strategic outreach to stakeholders.

As we end 2018, we will make decisions about other formal engagements in states depending on need and opportunity. We look forward to continuing to work with experts and advocates from across the country to support state solutions, and we are grateful to the many health care leaders who shared their views with us over the last several months.

Please stay in touch!

Follow us on Twitter @usofcare. You can also follow me @allison_otoole.