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Resources, State Efforts

Reflections on State Progress and Accomplishments Pre-Pandemic

Published On April 3, 2020

By: Erin Huppert, Joanna Dornfeld

State Capitol

Earlier this year, USofCare forecasted that much of the work state legislatures were doing to improve health care access in 2020 would lay the foundation for bigger gains in 2021.  

But that was before the COVID-19 pandemic. 

No one could have predicted its impact on our country – or how it highlighted the many cracks in our current health care system. USofCare is committed to supporting state leaders as they manage the immediate crisis, and aim to inform opportunities for more transformative change in the medium- to longer-term.

We are highlighting some of the work USofCare had been doing before the pandemic because we hope it will be a good indicator of where progress is possible in 2021. Legislatures across the country have (rightly so) either recessed or adjourned – in many cases mid-session – to prevent the spread of the virus among legislators and members of the public.  

Governors and their teams are managing the health emergency and legislators remain hard at work but are now laser-focused on addressing the immediate impacts of the pandemic and a looming recession. Last week, USofCare released the COVID-19 Priorities Checklist for State Leaders and are preparing additional recommendations for state leaders to consider in the coming weeks and months.  We know policymakers and advocates in our partner states remain committed to the initiatives we were working on prior to the pandemic, and we look forward to reinvigorating those efforts when the time is right. 


For the past year, USofCare has partnered with the Colorado Consumer Health Initiative (CCHI), a respected consumer advocacy organization, and Colorado policymakers to support the development and passage of the Colorado Health Insurance Option. Colorado faces challenges similar to other states: 

  • 22 counties have only one insurance option in the individual market in 2020; 
  • the premium and cost-sharing options for plans are out of reach for many consumers; and 
  • Colorado has extreme price variation in what hospitals are paid across the state, with some hospitals’ rates being nearly 600% of Medicare. 

In 2019, USofCare conducted public opinion research, with an emphasis on rural areas, to ensure a broad swath of Colorado residents could communicate their needs, fears, and expectations about health care coverage and costs. We shared our findings with the Polis Administration, legislators, and key advocacy partners, which informed the Administration’s health insurance option proposal, released in late 2019. In  2020, we have been working closely with the Polis Administration, bill champions Representative Dylan Roberts and Senator Kerry Donovan, and CCHI on a strategic approach to pass the Colorado Health Insurance Option. This proposed legislation, if enacted, would save people purchasing this option up to 20 percent on their monthly premiums. USofCare retained a respected Colorado campaign manager to support the growing coalition with campaign management, strategic advice, and coordinating communication efforts. In addition, USofCare facilitated stakeholder outreach, coalition recruitment, and provided policy advice through an informal “policy cabinet” of experts from our Founder’s Council and beyond. The Colorado Option passed its first committee before the General Assembly recessed in response to the outbreak. While passage in 2020 is more challenging given the anticipated limited agenda when the Colorado General Assembly reconvenes, we laid important groundwork to build toward passage in 2021. Check out our blog to learn more about the proposed bill and how USofCare worked with stakeholders on the ground before the recess.


Over the last year, USofCare has actively worked with the CareforPA campaign to improve access to nurse practitioners in Pennsylvania.  Recent executive action by Governor Wolf to expand some scope of practice regulations during the public health emergency may inspire future legislative action.   Additionally, the USofCare team has been on the ground deepening USofCare’s relationships with advocates, General Assembly staff, and members of Governor Tom Wolf’s Administration.  Prior to the pandemic, our partners were focussed on the state’s transition to a state-based insurance exchange and a need to address underlying drivers of health care cost growth. We expect to resume this work after the immediate crisis subsidies – Pennsylvanians think health care is expensive, complicated, inefficient- and benefits the system, not people as evidenced by a pop-up listening session at LOVE Park by USofCare’s Real People. Real Talk team.  We intend to build on that strong public sentiment toward policies that improve access to affordable care.


Last month, month, USofCare testified before the Connecticut Insurance and Real Estate Committee to support The Connecticut Plan, which would allow small businesses, nonprofits, and union-negotiated health plans to buy-in to the state employee plan. The bill also directs the Connecticut Comptroller to develop a state option for individuals in partnership with the Connecticut Office of Health Strategy and Advisory Council on Health. The bill passed with bipartisan votes out of the Insurance Committee on March 10, before the Connecticut General Assembly recessed due to the COVID crisis.  USofCare and our Connecticut partners continue to assess opportunities for progress when the General Assembly reconvenes, and we are discussing ways to build momentum for passage in the 2021 session. The COVID crisis and recession are going to significantly impact Connecticut small businesses that employ half of the state’s workforce; the Connecticut Plan will provide relief to small businesses offering health care coverage and could enable more small businesses to offer health insurance.  


USofCare is partnering with a collaborative to improve mental health parity in Georgia – a state where Georgians are 4.2 times more likely to have to go out of network for an office visit for behavioral health services (compared to primary care).  Our initial work will provide technical assistance for policy proposals with a longer-term goal to develop a public education campaign to educate and persuade policymakers and the public about the need for equal access to behavioral health care. 

New Mexico

During New Mexico’s 30-day 2020 legislative session, USofCare supported our local partners who pursued legislation to establish a “health care affordability fund” paid for by replacing the ACA’s fee on health insurance companies, which is phasing out at the end of this year. While the “health care affordability fund” wasn’t signed into law this year, other bills to cap insulin co-pays, reduce prescription drug prices, and broaden the Health Insurance Exchange’s authority passed the Legislature and were signed by Governor Lujan Grisham.  


Texas has the highest uninsured rate in the country at 17.7%. In a recent survey, 55% of Texas residents polled said it was difficult for them and their family members to afford health care. More than 60% of Texans said they or a family member have skipped or put off care due to cost. We’ve been on the ground in Austin and Dallas in recent months deepening our relationships with partners, and look forward to returning soon. 

We are proud that USofCare more than doubled our state engagements in 2020, and look forward to working with our partners to build on these early successes to ensure that our mission – that every person in America has access to quality affordable health care – becomes a reality.