January 22 -- Healthcare
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HomeSpotlight Story | Bird’s Eye View | Budget & Taxes | Politics & Leadership | Governors | Hot Issues | Once Around the Statehouse Lightly
Last December, the SNCJ staff laid out its annual list of issues we felt would receive significant attention in statehouses across the nation in the year ahead. Although it is something we’ve done for many years now, no upcoming year had presented the possibility of as much uncertainty as did 2017. Sadly, that uncertainty – particularly over such critical issues as health care and the environment – has indeed become a constant factor and source of conflict throughout both federal and state governments.
Even amidst such chaos, however, state lawmakers and other elected officials have dutifully showed up and addressed many of the key issues facing their states.
“Yes, on the one hand there has been an extraordinary degree of uncertainty,” says National Governors Association Executive Director Scott Pattison. “But governors and lawmakers have also had a really powerful ‘can-do’ attitude that has kept things going.”
With that in mind, this week and next we’ll take a look at how a few of the issues we previewed have fared this year.
ACA Reform: This has unquestionably been the biggest issue of the year for many lawmakers. As of this writing, the United States Senate is weighing a vote on its own version of a bill passed in the House that would repeal President Barack Obama’s signature legislative achievement, the Affordable Care Act. But neither bill has proven popular with governors, who say the bills would not only take away health care for tens of millions of Americans but also impose massive cuts to Medicaid that would blow equally huge holes in their state budgets. Governors have weighed in with overwhelming bipartisan opposition to the proposals, with many echoing words written in a June Washington Post op-ed by Colorado Gov. John Hickenlooper (D) and Ohio Gov. John Kasich (R), who urged Congress to go back to the drawing board to find “a balanced and sustainable approach to health-care reform.” A vote on the Senate bill could come this week.
Meanwhile, lawmakers in some states have used the health care debate as a launching pad to introduce their own reform measures. One of the most notable was California’s SB 562, a bill that would have implemented a government-run single-payer health care system in the Golden State. The measure cleared the Senate on June 1, but Assembly Speaker Anthony Rendon (D) eventually shelved the measure in that chamber, calling it “woefully incomplete” for its failure to “address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters to make SB 562 a genuine piece of legislation.”
Another measure that drew nationwide attention came from Nevada, where Gov. Brian Sandoval (R) vetoed a bill (AB 374) that would have allowed any Silver State resident to buy into the state Medicaid health coverage system, regardless of income. In his veto message, Sandoval praised the effort but said the bill was lacking in details.
Prescription Drug Prices: According to LexisNexis State Net, this year about half of the states and Congress collectively introduced almost 90 measures intended to address soaring prescription drug prices. Most would either cap drug prices or force drug makers to be more transparent with how they devise pricing for at least some medications. A handful of states, including Maryland (HB 631), Louisiana (SB 59) and Nevada (HB 539), have adopted such measures this year, and New York adopted a law in April as part of the budget that imposes greater scrutiny on drug makers over their pricing. Several bills are also still pending in states like Alaska, Illinois, Massachusetts and California (See Bird’s Eye View in this issue), and a drug pricing ballot measure will go before Ohio voters in November. There is also word that the Trump administration is planning action. Although the Food and Drug Administration has no direct control over drug prices, in a June blog post FDA Commissioner Scott Gottlieb said his agency plans to encourage the development of more lower-cost generic drugs. The effort would likely have a limited impact, however, as the growth in drug prices is largely driven by newer drugs under patent and without generic competition.
Marijuana Regulation: Last November, voters in four more states – California, Nevada, Massachusetts and Maine – endorsed ballot measures legalizing limited recreational marijuana use. That inspired some observers to predict at least as many states would follow suit this year via state legislative action, something heretofore not done. But halfway through the year, no state legislature has come on board. Vermont came very close, passing a legalization measure through to Gov. Phil Scott (R) in May, but Scott vetoed the bill, citing his desire to see tougher penalties for those who violate pot regulations. He maintained his willingness to revisit the issue if lawmakers make certain changes.
Meanwhile, legalization bills are still alive in states like New Jersey and Delaware but no state appears likely to adopt one. As such, focus is now primarily on 1) how legalization states will address regulation and taxation issues for the almost $7 billion a year industry and 2) federal reaction to those efforts.
In regard to item #1, many eyes are on California, the first state to legalize medical cannabis use (via ballot measure in 1996) and undoubtedly the nation’s biggest weed market. Lawmakers in 2016 adopted a statewide regulation framework for the weed industry, which is set to go into effect in January, 2018. There is speculation, however, that state and local officials won’t be ready to go by then, though the state’s so-called “pot czar” Lori Ajax – Chief of California’s Bureau of Medical Cannabis Regulation, which is also tasked with overseeing regulations for legal recreation use – vows her agency will be ready to begin issuing dispensary licenses on time. Meanwhile, lawmakers in Massachusetts have passed legislation that either repeals (the House) or significantly alters (the Senate) the pot legalization measure voters endorsed last fall. As of press time, Bay State lawmakers are currently ensconced in a conference committee to work out a compromise.
Item #2 is also in doubt. U.S. Attorney General Jeff Sessions has made clear his intention to more vigorously prosecute drug offenses, including medical marijuana users. Meanwhile, there is an effort underway in the U.S. Senate to legally block the government from meddling in state drug policy. To date, President Trump has not indicated which path he is more inclined to follow.
Gender Pay Equity: At least 36 states considered measures aimed at closing the pay gap between men and women in 2016, with a half dozen - California, Utah, Nebraska, Delaware, Maryland and Massachusetts – adopting regulations making it harder for employers to pay female workers less than men for similar work. That trend continued in 2017, with the National Conference of State Legislatures reporting that at least 20 states introduced a total of 60 such bills in 2017. In June, Delaware Gov. John Carney (D) signed legislation that bars employers from asking job applicants about recent salary history, or from using that history as a screening tool. Oregon Gov. Kate Brown (D) signed similar legislation that same month. Bills remain pending in states like Connecticut and Pennsylvania.
Opioids: In a year of ongoing partisan hyperbole, one area of bipartisan agreement is the need to continue addressing the national opioid abuse epidemic that cost over 33,000 lives in 2015 alone. In that regard, states continue to enact stricter rules for how doctors prescribe opioid pain killers and for how those prescriptions are tracked, as well as easing access to the overdose-reversing drug naloxone. But state and local governments have also now implemented a more aggressive tactic: suing drug makers. In May Ohio Attorney General Mike DeWine (R) filed suit against five major pharmaceutical companies, alleging their marketing campaigns have created the opioid epidemic by misleading both doctors and patients. Similar lawsuits have previously been filed in New York, California, Illinois, Mississippi, West Virginia and by the Cherokee Nation. Missouri filed its own suit in June and Kentucky Attorney General Andy Beshear (D) has announced plans to do so as well. Approximately two dozen states, including Indiana, Colorado, Texas, Massachusetts, New York, Connecticut and Vermont, have also opened an investigation to determine whether drug makers have illegally marketed those drugs.