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Governors Tackle Health Care Costs, Coverage, and Quality in their State of the State Addresses

In their 2020 state of the state speeches, governors identified new health policy initiatives on a wide range of issues. As of mid-February, 42 governors had delivered speeches or outlined key budget priorities, and all addressed health issues – most commonly strategies to tackle health care costs and behavioral health issues. Below are highlights of the key health themes that governors raised.

Behavioral Health Issues

Mental health and/or substance use disorder issues were the most frequently mentioned by governors, with 33 commenting on these topics. Governors often cited efforts to increase access to behavioral health care services and initiatives to redesign and better coordinate care systems across agencies and providers.

The speeches recognized the significant challenges of addressing the needs of individuals with mental health issues. Gov. Kim Reynolds of Iowa asked legislators to provide sufficient funding to support the state’s strengthened mental health systems for adults and children. Others focused on children’s behavioral health with four governors specifically identifying the need to ensure that schools have an adequate number of mental health professionals. Others called for comprehensive insurance coverage and better integration of behavioral and physical health care that focus on the “whole child.”

View an interactive chart to discover how 42 governors’ addressed health care in their 2020 state of the state addresses.

Gov. Tony Evers of Wisconsin proposed specifically targeting the mental health needs of farmers by creating a new program that will help them access one-on-one counseling and connect them to peer support initiatives. In Colorado, Gov. Jared Polis highlighted a task force, created in 2019, that is assessing the state’s behavioral health system and developing recommendations for reforms. Another theme, raised by at least five governors, is the importance of better addressing the behavioral health needs of justice-involved individuals either prior to incarceration or as they transition back into community settings.

Combating the opioid epidemic continues to be a top priority, with 19 governors commenting on progress made in addressing the crisis. Gov. Brad Little of Idaho praised his state’s prescription drug monitoring program and noted a proposal to provide $30 million to help physicians and pharmacists identify and prevent opioid abuse. Multiple governors cited a number of successful strategies used to reduce overdose deaths, including increasing access to naloxone and outpatient treatment, medication-assisted treatment, and other targeted, data-driven and evidence-based efforts. Kentucky’s governor, Andy Beshear, pledged that any dollar received from the state’s ongoing lawsuit against opioid manufacturers and distributors would be used to end the epidemic.

Curbing Health Care Costs 

Twenty-one governors addressed health care affordability. California Gov. Gavin Newsom and New Jersey Gov. Phil Murphy proposed creating offices within their executive branches dedicated to reducing consumers’ health care costs and increasing price transparency. Gov. Eric Holcomb of Indiana is proposing the establishment of an all-payer claims database to increase cost transparency and improve information about hospital pricing and insurance reimbursement.

Connecticut Gov. Ted Lamont is proposing to curb the state’s annual health care cost increases to reduce the outsized impact of medical expenses on residents. Prior to his state of the state speech, Lamont signed an executive order establishing health care cost growth benchmarks and a primary care spending target.

New York’s Gov. Andrew Cuomo proposed expanding the state’s out-of-network surprise medical billing law to require hospitals and emergency room doctors to participate in the independent dispute resolution process to resolve surprise balance bills. Additionally, five other governors urged lawmakers to pass legislation to address surprise billing.

Two governors highlighted money-saving programs that could be expanded to larger populations. Gov. Ron DeSantis in Florida noted a patient savings plan for state employees that increases price transparency that has reportedly saved the state millions of dollars, and he argued that making a similar plan available throughout the state could result in similar savings for more individuals. Polis spotlighted a community purchasing alliance in a Colorado county that pools individuals and employers together and uses their combined purchasing power to negotiate prices with hospitals and doctors directly to save money. He wants to replicate the purchasing alliance model in other parts of his state.

Polis and other governors also recognized reinsurance programs that have reduced premium costs on their exchanges by about 20 percent. Virginia’s governor, Ralph Northam, asked state lawmakers to create a similar program.

Medicaid Reforms and Expansion

This year, 13 governors addressed Medicaid and/or Medicaid expansion. Eight governors commented on recent program improvements, the growth of overall program costs, or cost savings achieved through program reforms. Gov. Charlie Baker of Massachusetts commented that his state “cleaned up” the MassHealth program while achieving the state’s goal to limit increases in total health care expenditures. In New York, Cuomo said the state’s $6 billion financial deficit is primarily due to Medicaid costs and noted that the state will need to restructure financing arrangements with local governments. Gov. Jim Justice in West Virginia proposed creating a Medicaid Families First Reserve Fund of $150 million to ensure services are available to those most in need. In his speech, the Gov. Tony Evers of Wisconsin praised policymakers for extending access to care in rural areas by ensuring that Medicaid covered telehealth services.

Six governors spoke about the value of implementing Medicaid expansion in their states. Idaho’s governor, Brad Little, said that his proposed budget funds a full year of Medicaid expansion with a net-zero impact on the general fund by using the state’s Millennium Fund and county contributions to cover the state’s share. Both Gov. Laura Kelly in Kansas and Evers in Wisconsin advocated for passage of Medicaid expansion bills. Evers noted expansion would bring $1.6 billion in new federal investment to the state’s health care system and Kelly highlighted evidence that expanding Medicaid coverage reduces mortality rates, improves infant and maternal health, helps address opioid abuse, and strengthens rural hospitals.

Health Care Coverage and Access

Nineteen governors mentioned their efforts to ensure that individuals have health care coverage and access to care. They often mentioned state initiatives and proposals to increase coverage options, ensure protections for pre-existing conditions, and broaden access to services. Three governors proposed codifying certain Affordable Care Act (ACA) protections in state law.

Bill Lee, Tennessee’s governor, mentioned the state’s Health Care Modernization Task Force is looking for ways to provide access to high-quality, affordable health care plans, and spoke of plans to increase funding for rural health clinics to improve access to dental care and make investments in the health care safety net. Newsom highlighted plans to strengthen coverage both through Medi-Cal and Covered California. Polis in Colorado explained how the state’s public option proposal will help to both reduce costs and provide greater choices for consumers. Three governors lauded their state-based exchanges’ successes, while Murphy of New Jersey shared plans to establish a state-based exchange. Similarly, Govs. Janet Mills of Maine and Northam of Virginia noted legislation to establish state-based marketplaces to better meet the needs of their residents and address increasing premiums and decreasing enrollment.

In Oklahoma, Gov. Kevin Stitt shared plans to use the Trump Administration’s Healthy Adult Opportunity Medicaid demonstration to expand coverage through a block grant for certain adult populations. The plan – SoonerCare 2.0 – would include work or community engagement requirements and premiums while also providing treatment for substance use disorders.

Prescription Drug Costs

Twelve governors addressed rising drug costs – an increase from last year when seven governors spoke about the topic. The most comprehensive proposal came from California’s governor, whose budget proposes:

  • Expanding the state’s authority to consider drug prices in other countries when negotiating for state supplemental rebates;
  • Leveraging the purchasing power of the Medicaid program to negotiate rebates on behalf of targeted populations outside the program; and
  • Increasing the state’s purchasing program by expanding partnerships with local pharmaceutical purchasers.

The governor’s budget also includes a single market for drug pricing that would combine state purchasing power and create the state’s own generic drug label through partnerships with generic drug manufacturers.

Michigan Gov. Gretchen Whitmer, Polis of Colorado, and New Hampshire Gov. Chris Sununu all supported drug pricing transparency. Illinois Gov. J.B. Pritzker noted his state capped out-of-pocket insulin costs at $100 for a 30-day supply, and three other governors urged lawmakers to pass similar legislation.

Polis and DeSantis of Florida also mentioned their states’  efforts to implement wholesale drug importation programs, while Cuomo, Sununu, and Gov. Lujan Grisham of New Mexico urged their lawmakers to enact a similar program. In addition to a wholesale drug importation program, Cuomo also wants to grant the New York Department of Financial Services additional enforcement authority over spikes in drug costs and to register and regulate pharmacy benefit managers.

Health Care Workforce

Ten governors raised the issue of the health care workforce, with most proposing ways to address provider shortages. Four governors highlighted plans to invest state general funds or to create loan repayment and scholarship programs to help attract providers to underserved areas. To help develop and sustain rural practices, Alabama Gov. Kay Ivey recommended creating a pilot program to incentivize primary care physicians and nurse practitioners to establish services in medically underserved areas and asked legislators to support other rural health initiatives to increase care access. Gov. Kim Reynolds of Iowa shared plans to increase the state’s capacity to provide obstetric services through a fellowship and tele-mentoring program that will train family practice physicians to specialize in this type of care. Mills of Maine noted that the state is providing $75 million over two years to nursing homes, in part to help fulfill their workforce needs. In Washington State, Gov. Jay Inslee highlighted the state’s multi-employer, multi-union health care apprenticeship program.

Other Health-Related Issues

Most governors mentioned other health-related accomplishments and proposals. These included reducing tobacco and vaping use among youth, family and medical leave, and maternal health. Governors in seven states expressed concerns about the rate of tobacco use by youth. California’s Newsom supports a tax of $2 per 40 milligrams of nicotine in vaping products that will go into effect in 2021, while New York and Rhode Island governors applauded lawmakers for banning flavored e-cigarette products last year.

Five governors praised their states’ paid family and medical leave policies, and others expressed support for implementing these types of initiatives. Sununu of New Hampshire urged legislators to pass a bill to establish a voluntary paid family leave program, Lee of Tennessee proposed 12 weeks of paid family leave to eligible state employees, and Gov. Phil Scott of Vermont indicated he would soon be introducing a voluntary paid family leave plan. Gov. Lujan Grisham of New Mexico highlighted her proposed Senior Dignity Fund to provide seniors and their caregivers with support.

Four governors expressed support for maternal health programs. Whitmer of Michigan plans to expand access to home visiting programs, particularly for women of color, and Virginia’s Northam urged lawmakers to pass a health equity budget that would give new mothers access to care for a year after their baby is born. Lee of Tennessee proposed expanded prenatal and postpartum coverage, including a pilot program to extend postpartum coverage to 12 months for mothers covered by Medicaid.

Many governors also mentioned the importance of social determinants of health and public health initiatives. Next week, the National Academy for State Health Policy (NASHP) will release a chart and blog that highlight how governors plan to address health-related social and economic factors in 2020, including education, housing, jobs, and the environment, among other topics.

Given the wide range of health initiatives proposed by governors, it is clear states will continue to pursue innovative health policies and programs in 2020. NASHP will track many of these proposals as they take shape.

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