Home – Blue Wave Could Have Big Impact on Health and Employment Laws In 2019

Blue Wave Could Have Big Impact on Health and Employment Laws In 2019

 Issues like budgets and funding for education are staples of every legislative session in every state. In our second installment of our annual three-part legislative preview, we continue our look at other issues we think will keep lawmakers occupied in the coming year.


HEALTH CARE: Although the hue and cry heading into November’s mid-term elections was often centered on other issues, voters were most concerned with health care. As reporter Annie Lowrey wrote in The Atlantic a few days before the election, “Health care has become the single most important policy topic in the midterm elections — everywhere and nowhere, a strange kind of omnipresent sleeper issue. It’s not grabbing many national headlines, compared with the migrant caravan or the Supreme Court fight or violence directed against minority groups or the trade war, but it’s motivating voters in race after race after race.”


That isn’t likely to abate in the coming year, even though Democrats reclaiming the House likely will prevent Congressional Republicans and President Trump from completely overturning the Affordable Care Act. But any number of federal rules around issues like insurer subsidies and approving state-level plans definitely remain in play, including for those that violate tenets of the ACA


The end of the federal mandate for individuals to have health coverage or pay a penalty will also be part of the discussion. With several states already reporting a decline in ACA enrollment, there is growing concern among health advocates that the uninsured will again be flooding into emergency rooms, long the most expensive and least efficient medical care available. With virtually no chance that Congress will reinstate the mandate, some states will at least consider copying New Jersey by imposing their own mandate.


MEDICAID: Of the seven governorships that are moving from GOP to Dem control, all seven Democrats ran on a platform of expanding Medicaid or retaining expansion already undertaken in their states. Voters also endorsed ballot measures to authorize expansion in Idaho, Nebraska and Utah, bringing to 36 the number of states agreeing to broaden Medicaid eligibility to include those earning up to 138 percent of the federal poverty level. Attention will focus primarily on Kansas and Wisconsin, two of the states with incoming Democratic governors that support expansion but which face GOP-controlled legislatures where support for it ranges from uncertain to unlikely.


DRUG PRICES: States have made a number of efforts in recent years to control rising prescription drug prices, including bills to address pharmaceutical price gouging, removing so-called “gag orders” on pharmacy benefit managers and requiring greater transparency from drug companies seeking price hikes. With federal action on drug pricing bogged down, expect states to continue looking at numerous angles for controlling price increases.


NET NEUTRALITY: Net neutrality – barring telecoms and ISP providers from blocking or slowing down access to websites or other Internet services and content to coerce consumers into paying for their services instead – became a highly contentious issue in a majority of statehouses in 2018. According to the National Conference of State Legislatures (NCSL), 30 states introduced a total of 72 bills this year addressing net neutrality, with three adopting net neutrality requirements. A fourth, California’s SB 822,  would enact even tougher net neutrality requirements than those the FCC dropped earlier this year.


The wild card is pending litigation before the U.S. Court of Appeals in D.C., which is expected to rule in the spring on a lawsuit brought forth by 22 state attorneys general, consumer groups and even some tech companies seeking to overturn the FCC action. There are also two pending lawsuits seeking to overturn the California law, one by a collection of telecoms and the other by the Trump administration. California reached an agreement with the Department of Justice to hold off on implementing its law until the court rules.


If the court ultimately restores net neutrality, state laws would essentially become moot. If not, or if the case continues on to a possible Supreme Court challenge, another wave of state-level legislation, particularly in states that turned blue on Election Day, could be forthcoming.


GERRYMANDERING: With centennial redistricting drawing near and partisanship at a fever pitch, the interest in who will draw state and congressional district lines is intense. As reported in the SNCJ last month, at least 19 states this year considered bills to have those lines drawn by independent commissions rather than by lawmakers, while voters in four states approved measures in November to adopt commissions. Meanwhile, legal battles continue over how the lines in Maryland, North Carolina, Wisconsin, Texas and Virginia are drawn. Another is likely to be filed in New Jersey if majority Democrats there go forth with a plan to change the Garden State constitution to entrench their hold on Trenton. Meanwhile, eyes will be on Missouri, where voters approved a measure that creates a first-in-the-nation system using a mathematical formula to ensure fairness in how its lines are drawn.


SPORTS BETTING: In the months since the Supreme Court struck down a federal ban on sports betting, a half dozen states have gone all in on the opportunity to score big off the nation’s passion for wagering on sports. If the fiscal windfall in states like New Jersey is any indication of the money to be made, it shouldn’t be surprising that a whole lot more are looking to join them in 2019 (See Budget & Taxes in this issue). But doing so requires answering some potentially thorny questions, such as how much each state will tax sports wagers, both in person and online, and what kind of licensing fees states will charge to sportsbook operators. There is also the growing push from professional sports leagues to get their cut in the form of so-called “integrity fees” they say will cover their increased cost of ensuring the games stay above board.


OPIOIDS: In recent years states have undertaken a wide range of efforts to curb opioid abuse, including weighing in on at least 480 opioid-related bills across 45 states in 2018. But in spite of many states providing greater access to the overdose-reversing drug naloxone, limiting how doctors may prescribe opioid pain medications and significantly enhanced monitoring of drug prescriptions, opioid-related deaths continue to rise. With no end in sight, there will undoubtedly continue to be a staggering number of bills introduced in this area. One interesting possibility to keep an eye on is the use of cannabis for pain relief instead of opioid medications. Although the supporting data is limited, states like Illinois and Georgia are now openly promoting marijuana as an alternative to opioids.


PAID SICK LEAVE: Less than a dozen states currently have laws requiring employers to offer workers specific amounts of paid sick leave, something that has driven the issue more to the local level than to statewide applications. That could well change with Democrats taking control of all branches of government in several states next year. But opponents of such laws are also gearing up for a fight. In Michigan, the GOP-controlled legislature this month made sweeping changes to paid sick leave and minimum wage laws adopted last September as a means for keeping them off the ballot. And in Texas, a recent appeals court ruling invalidated a paid sick leave ordinance adopted in Austin last February. The ruling was specific to that city, but observers expect it will spark a challenge to a similar ordinance in San Antonio, and legislation has already been filed in the statehouse to bar local jurisdictions from adopting their own paid sick leave laws.


DISASTER LIABILITY: A battle is shaping up in fire-ravaged California over not only how to better protect against massive wildfires but also the liability of public utilities like Pacific Gas & Electric for its role in how many of those fires started. Similar debates could strike up all over the western U.S., as assuredly will those revolving around efforts to mitigate the impact of climate change.

For more analysis of 2019 hot issues, please join us on Tuesday, December 11th for State Net's complimentary 2019 Legislative Preview Webinar.  Register HERE