Health and Health Care in the 2017 State Legislatures: Opportunities, Threats, and What to Expect in 2018

2017 has been an eventful year for health and health care legislation in the states. Despite the challenges critical health programs face at the federal level, states have continued to move forward to pass health and health care bills to the benefit of their residents.

Families USA has reviewed hundreds of bills from all 50 states, as well as the District of Columbia, to assess the legislative trends of 2017. Advocates, policymakers, and other stakeholders can review these 2017 legislative opportunities, as well as some legislative threats to our goals, to inform plans for the 2018 state legislative sessions.

2017 State Legislative Sessions: The Opportunities

From legislation addressing prescription drug costs to expansion of Medicaid coverage for children, many states took action in their 2017 legislative sessions to ensure health care protections were created or remained in place for consumers. Here are some highlights from 2017 legislative sessions that marked wins for health care consumers.

1. Prescription Drug Pricing—California and Maryland lawmakers both passed first of their kind prescription drug pricing laws, nationally leading with groundbreaking drug price transparency and drug price gouging legislation, respectively.

• In October, California’s Governor Brown signed S.B. 17 into law, which will now require advance notice and justification to public and private health plans about significant prescription drug price increases- those of 16 percent or more over two years. Health Access California and their advocacy partners helped make this law a reality through their campaign to educate the public and the legislature about the need for prescription drug price increase protections in California.
• A few months prior in Maryland, an advocacy campaign led by Maryland Citizen’s Health Initiative and supported by Maryland Attorney General Brian Frosh led to the enactment of H.B. 0631, the first bill in the nation that protects consumers from price gouging by generic prescription drug manufacturers. The new law allows the state’s attorney general to sue generic drug manufacturers who engage in price gouging and return that money to consumers and others who pay for the drugs, or make the drug available at its previous price.

2. Network Adequacy—Much like in 2016, many states have continued to advance legislation to ensure health plans have adequate provider networks and accurate directories to help consumers identify in-network providers, and to protect consumers from surprise out-of-network bills at in-network facilities.

• Hawaii legislators enacted S.B. 387, implementing provider directory standards and requiring the insurance commissioner to develop quantitative, measurable network adequacy standards, based on the NAIC Network Adequacy Model Act.
• In Illinois, Governor Rauner signed H.B. 311 into law, creating the Network Adequacy and Transparency Act, which requires insurers to file network adequacy access plans with the insurance commissioner for prior review.
• Oregon led the way in surprise billing protection legislation, with advocates like the Oregon State Public Interest Research Group (OSPIRG) shepherding comprehensive protections against surprise out-of-network bills all the way to the Governor’s signature. Maine also enacted a bill to protect consumers from out-of-network surprise bills from in-network providers, which includes standards for provider directory accuracy.

3. Adult Dental Benefits— State Medicaid programs have a history of cutting dental benefits when budgets are tight and then expanding the benefits in better years. This year more states stepped up and extended the oral health coverage for adults.

• One of this year’s biggest oral health successes came with California’s budget restoring the state’s Medicaid adult dental benefit to be one of the most comprehensive in the country.
• Governor Ducey of Arizona also approved a state 2018 budget, which included funding for a limited benefit that gives adults coverage for dental care in emergency rooms up to $1,000.
• In the same vein, with the help of the Maryland Dental Action Coalition, Maryland enacted H.B. 1158, a combined bill that allows for use of emergency rooms for oral pain studies, while simultaneously authorizing an adult dental benefit for Medicaid (though not yet funding it). Massachusetts also commissioned a study to cost out restoring their benefit.

4. Community Health Workers (CHWs)—With the help of Health Equity Solutions, Connecticut Governor Dannel Malloy enacted S.B. 126. This act established a pathway to increase the use of CHWs in Connecticut’s health care system. Through creating a baseline description of CHWs and the value they provide, along with setting the stage for developing next steps on certification and sustainable funding for their work, this act lays the foundation for Connecticut to further develop its CHW program, and expand the use of CHWs to vulnerable populations.

5. Coverage for Immigrants—Oregon lawmakers signed S.B. 558 into law this session, which will allow for Medicaid benefits to be extended to undocumented child immigrants. Oregon is the seventh state to enact legislation to extend Medicaid coverage to children regardless of immigration status, following in the footsteps of California, Illinois, Massachusetts, New York, Washington, D.C., and Washington State.

2017 State Legislative Sessions: The Threats

While many states enacted laws to improve health and health care for consumers this session, there were also a number of concerning laws passed by states as well. As can be seen on Families USA’s State Waiver and Resource Tracking Center, quite a few states introduced legislation creating harmful 1115 and 1332 waivers to change state Medicaid and private market programs. Of particular concern are attempts to impose work requirements, cost increases, and other harmful provisions like drug testing for Medicaid enrollees.

More threatening waiver proposals are sure to arise in 2018, and advocates, health care stakeholders, and policymakers will have a key role in protecting against these threats. Advocates should also be aware of state budgets as a vehicle for moving harmful Medicaid legislation.

Remaining vigilant against a variety of harmful Medicaid waivers will be important in the upcoming 2018 legislative sessions.

Lessons for 2018

As 2018 draws nearer, it’s important to review the legislative trends of 2017 to inform planning for the 2018 state legislative sessions. States and advocates should look to helpful, productive bills for ideas and examples of legislation that could gain traction in their legislatures in 2018.

We urge you to stay in touch with Families USA for resources on the policies that present opportunities and threats in 2018, and to share with us your legislative agendas for the year. Together we can help consumer-friendly policies spread across the states and prevent the enactment of policies that jeopardize people’s access to high-quality, affordable care and improved health.