The State of State Health Policy: Governors’ 2017 State of the State Addresses

State of the StateState of the State speeches provide governors with an opportunity to highlight recent policy successes as well as
outline key plans and issue areas of focus for the coming year. These speeches are generally strong indicators of governors’ main priorities and sometimes also include specific proposal suggestions and funding recommendations for deliberation by legislatures.

Currently, there are 33 Republican governors, 16 Democrats and one Independent. Nine states—Delaware, Indiana, Missouri, New Hampshire, North Carolina, North Dakota, South Carolina, Vermont and West Virginia—swore in new governors in 2017. As of March 1, 2017, 46 governors have outlined policy priorities through State of the State speeches, budget, or inaugural addresses.[1] The description and chart below summarize some of the main health-related themes from these speeches.

See a state-by-state comparison

Key Health Themes
The vast majority of governors—42 of the 46—addressed health issues in their speeches, with behavioral health and Medicaid as the most common topics. This is the highest number of governors commenting on health issues since NASHP began tracking governors’ speeches in 2015.

General Behavioral Health Issues

Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 33 mentioning these issues in some way. Governors frequently highlighted strategies that have been implemented or that they plan to implement to increase access to behavioral health services.

Alabama

Plans to increase funding for home-based behavioral health services for low-income children.

Arkansas

Proposed budget requests $5 million for mental health stabilization centers and crisis intervention training to identify and assist individuals with mental illnesses.

Colorado

State has expanded access to mental health care and improved integration of physical and behavioral health services. Interest in developing a comprehensive behavioral health plan to promote a more efficient and effective system.

Georgia

Proposed budget includes $2.5 million to improve access to community behavioral health services for the state’s full child population in Medicaid and CHIP.  Requests legislature to remove barriers related to mental health treatment for veterans, with funding proposed for state employee training on services for veterans (this funding complements current budget for $3 million in bonds for a sub-acute rehab facility for behavioral health services for veterans with PTSD or traumatic brain injuries). Proposed budget also allocates for a women’s veterans coordinator position to work with female veterans who experienced military sexual trauma.

Idaho

State has successful Behavioral Health Crisis Center program, with three community facilities operating as alternatives for jail or emergency room visits for individuals with mental health and substance abuse issues. Proposed budget includes funding to cover remaining costs of fully implementing other planned facilities, and $10.3 million for an adolescent mental health facility and remodeling of an existing secure mental health facility.

Iowa

State has successfully transitioned to a community-based mental health system.

Montana

Noted greater commitment to providing full spectrum of mental health services and autism services; expanded mental health services to National Guard members and veterans. Requests legislature to continue funding for full spectrum of mental health services, including individuals covered by Medicaid expansion. Noted the state leads the nation in youth suicide and proposing $1 million to implement evidence-based pilot programs.

New Hampshire

Proposed budget increases funding for behavioral health workers by $3 million to improve community mental health safety net.

New Jersey

State invested an additional $127 million for mental health and substance abuse treatment and expanded successful recovery coach program, which places counselors in emergency rooms for individuals in need of treatment; proposing additional funding again. While individuals have increased access to substance use disorder treatment through Medicaid, legislature should ensure that individuals who do not qualify for Medicaid and cannot afford private coverage for behavioral health treatment or face insurance denials receive at least six months of drug rehabilitation treatment. Budget also proposes $5 million to expand pediatric behavioral health pilot program.

Pennsylvania

State has invested over $20 million in expanding addiction treatment options.

South Dakota

Have invested significantly in behavioral health services, and substance abuse treatment programs have been successful. Mentioned state’s methamphetamine (meth) epidemic; working to prevent meth from being transported into the state and providing education and treatment services.

Utah

Highlighted issues of drug addiction and homelessness and importance of state role in addressing the drug trade. Also plans to focus on underage drinking, alcohol abuse, and impaired driving; as well as teen suicide.

Virginia

State’s Healthy Virginia initiative has expanded services to individuals with serious mental illnesses. Plans to fund community service boards to provide immediate services for individuals experiencing behavioral health crises.

Washington

Mental health system needs to be more prevention-focused, patient-centered and community-based to provide individuals with more appropriate treatment.

Wyoming

Held symposium on suicide prevention, which will become an annual event.

Behavioral Health: Heroin and Opioid Abuse

The issue of heroin and other types of opioid abuse and overdoses were specifically mentioned by 21.

Alabama

State is highest painkiller prescribing state, but addressing opioid abuse issue through laws passed in 2012 and 2013 and a state council to build on existing efforts. Also noted state has joined in a compact with other governors to fight opioid addiction.

Alaska

Mentioned the opioid epidemic as an extreme challenge, and while naloxone bill was helpful, state also developing a comprehensive plan focusing on five key strategies: limits on prescriptions; strengthening prescription drug monitoring program; reclassification of opioids; restricting transport of opioids and heroin; and provider education.

Arizona

Implemented efforts such as limiting prescriptions, providing better treatment and confiscating trafficked drugs; requesting medical board to require continuing provider education on the topic.

Georgia

Signed executive order for Department of Health to permit naloxone to be provided over the counter, and state pharmacy board has reclassified naloxone as a Schedule V exempt drug. Requests legislature to codify executive order provisions, strengthen prescription drug monitoring program, and educate healthcare providers on the issue.

Indiana

Overdose deaths have increased by 500% since 2000 because of opioid epidemic. Effective syringe exchange program being coordinated by public health nurses and plans to allow counties to establish more of these programs. Plans to promote prevention, treatment and enforcement, and has assigned a senior staff person to focus on the issue. Will be limiting amount controlled substances, prescriptions and refills along with enhancing penalties for pharmacy robberies and upgrading police labs.

Kentucky

Allocated $12 million over next two years to address heroin and substance abuse issues.

Maine

Law enforcement efforts to address the opioid crisis have been effective. Proposed budget provides an additional $2.4 million in opioid addiction treatment services for the uninsured that will fund 359 openings for therapy and medication-assisted treatment.

Maryland

One of the first actions as governor was to create a task force to address opioid crisis, and state is in the process of implementing their recommendations that address the issue from all angles: education, treatment, interdiction and law enforcement. Requested legislature pass additional bills related to prescription limits. Also noted that majority of governors from both parties would like to see federal government engagement in collaboration with state and local partners to address what has become a national crisis.

Massachusetts

Progress in addressing the opioid epidemic, with schools for health and dental providers mandating classes and continuing education about opioid therapy and pain management. Opioid prescriptions are down by 15% and providers are using new prescription drug monitoring program. State has expanded addiction services spending by 50%and distributed NARCAN kits to first responders. Budget proposes to add $2 million to enhance law enforcement drug trafficking efforts and have joined into a compact with other governors about addressing the opioid issue.

Michigan

Heroin overdoses have doubled since 2009 and state needs to better address the issue. Acknowledged work of a legislative task force and passage of a Good Samaritan law to promote individuals to seek assistance for themselves or others without concern for prosecution. Mentioned plans to invest in an automated prescription system. Expanding state police program where individuals can go to certain stations and seek treatment help.

New Hampshire

Opioid crisis is the most critical public health and safety issue for the state, and should continue investing in law enforcement (reinstating Granite Hammer initiative to enhance law enforcement responses), prevention, and especially treatment/recovery services. Will provide loan forgiveness for providers working on front lines of opioid crisis.

Nevada

Highlighted that one state resident dies of opioid overdose each day, with the problem growing over the past decade and now reaching epidemic proportions. Acknowledged passage of a Good Samaritan overdose prevention act, which helped increase enrollment in the prescription drug monitoring program from 16% to 81% and expanded access to overdose reversal medications. Summit held involving over 500 stakeholders, and introducing legislation based on their recommendations to provide additional training and protocols for providers.

New Jersey

Implementing new rules to reduce prescription limit for opioid-based pain medications from current 30 days to 5 days without additional patient assessment to address the issue of prescription painkillers leading to opioid abuse. Facing Addiction Task Force created to address prevention, treatment and recovery and will also create a Governor’s Task Force on Drug Abuse Control to coordinate efforts among state agencies. Called for federal government to remove substance abuse treatment barriers such as the prohibition of using federal Medicaid funds for inpatient treatment in Institutes for Mental Diseases. Noted need to reduce barriers for supportive housing for individuals in recovery and increasing funding by $1 million for college housing programs for students in recovery. Also adding specific curriculum in all schools on opioids.

North Dakota

Opioid crisis needs to be treated as a chronic disease and requires collaborative action at the state and local levels, involving law enforcement, faith-based organizations, nonprofits and the judiciary.

Pennsylvania

Proposed budget includes funding to assist communities affected by heroin and opioid abuse and state is taking a more aggressive and effective approach to address the issue. Provided law enforcement with greater resources to address drug trafficking, have given first responders access to naloxone, have destroyed unused prescription drugs, redesigned prescription drug monitoring program, and enhanced education efforts and treatment services.

Rhode Island

Budget proposes funding increase for treatment and prevention to address overdose crisis and funding to support addiction recovery housing.

Tennessee

Plans to expand substance abuse and crisis intervention treatment services and supports to address drug and opioid addiction.

Vermont

Addressing opioid abuse is one of the state’s main priorities and will establish an opioid coordination council and a director of drug abuse prevention position, along with convening a state convention on the issue. Plans include providing enhanced treatment, prevention measures and stricter enforcement.

Virginia

Proposed budget includes $5.3 million for increased substance abuse disorder services and tools to prevent opioid overdoses. Planned reforms include limiting opioid prescriptions written in emergency rooms to 3 days, new requirements for all prescription narcotics and allowing community organizations to distribute naloxone.

Washington

Noted need to address root causes of chronic homelessness, such as opioid addiction and mental illness.

West Virginia

Mentioned need to address the state’s drug problem in particular related to abuse of prescription drugs and to invest in treatment facilities.

Behavioral Health: Criminal Justice

Twelve governors also spoke about the issue of behavioral health within the context of better addressing the needs of justice-involved individuals as they transition back into communities and/or providing mental health and substance use treatment services rather than incarceration when appropriate.

Alabama

Will be investing in improved and more comprehensive rehabilitation programs in prisons, which will include enhanced substance abuse re-entry treatment services.

Arizona

Noted signed executive order so that people reentering community from prison have the opportunity to be treated with drug that can block painkiller addictions.

Illinois

Noted need to address underlying behavioral health issues of justice-involved individuals as they transition back into communities.

Kentucky

Noted increased treatment options for justice-involved individuals transitioning back to communities.

Massachusetts

Progress on providing behavioral health treatment rather than incarceration when appropriate. Plans to implement improvements at corrections-supervised mental health hospital and expand the clinical program offered by $37 million.

Nebraska

Corrections department implemented new risks/needs assessment tool, enhanced mental health services and developed a health plan for incarcerated individuals.

New Jersey

First certified drug abuse treatment facility for prison inmates will open in spring 2017.

New York

Commented that jails have become the mental health system of last resort.

North Dakota

Highlighted that many individuals are incarcerated due to drug offenses and that treatment services should be enhanced to both assist individuals and reduce state costs.

Oklahoma

Noted that 75% of new prison admissions are for nonviolent offenses that are often drug related. Proposed budget includes new funding for substance abuse treatment for justice-involved individuals, including a $50 million bond issue to build substance abuse rehabilitation wings on existing prisons.

South Dakota

Have expanded alternative sentencing options for drug offenses and will expand treatment for justice-involved individuals, with reduced charges if treatment completed. State criminal justice and mental health task force found mental illnesses need to be identified sooner in jails; will promote legislation to help law enforcement use crisis intervention services, reduce unnecessary jail admissions, and increase number of providers available to screen for mental illnesses in jails.

Virginia

Noted that because many individuals with behavioral health issues are ending up in jails, is proposing increased funding to expand mental health screenings at local correctional facilities.

Medicaid Program Operations, Services, Reforms and Costs

In total, 21 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 15 governors provided general comments about their states’ Medicaid programs, such as commenting on recent program improvements, the growth of overall program costs, or cost savings achieved through program reforms.

Alaska

Mentioned the need to rein in Medicaid costs, and noted that legislature had passed a Medicaid reform bill designed to address rising costs.

Colorado

Over the last 6 years the state has pursued programs designed to control Medicaid costs, in particular by emphasizing preventive care and disease management tools. Hospital provider fee could potentially be modified to control costs and better serve rural hospitals and clinics.

Georgia

Working with legislators to improve Medicaid coverage of autism treatments for individuals up to age 21. Also mentioned major funding source for Medicaid is the hospital provider fee and that legislative action is needed for its reauthorization.

Illinois

Focusing on reducing fraud and abuse has saved hundreds of millions of dollars in Medicaid.

Iowa

Modernizations have been implemented in the state’s Medicaid program, such as the addition of value-added services and more coordinated care, and these types of reforms and innovations along with a focus on health outcomes resulted in a savings of $110 million.

Kansas

State’s move to Medicaid managed care has resulted in improved health outcomes and a savings of $1.4 billion; will be launching KanCare 2.0.

Maine

State’s Medicaid program has been realigned to prioritize needs of elderly and disabled individuals. Also noted that waitlist for home and community based services for individuals with intellectual disabilities or autism is too long.

Michigan

Noted success of Medicaid’s Healthy Kids Dental program; enrollment has grown from over 400,000 kids in 2010 to more than 1 million, with reach in every part of the state.

Minnesota

Wants to continue the provider tax, which funds health coverage for thousands; proposes to repeal the 2019 sunset of the tax because it provides essential funding for health care and is especially important now with federal uncertainty around health care.

Nevada

Proposed budget is larger in part due to increases in Medicaid caseload and includes $11.5 million in new funding to expand the home and community based/frail elderly waiver to provide more services for seniors in their homes.

New Hampshire

Advocating for an accounting of the Medicaid program to reconcile payments with actual costs.

New Mexico

Mentioned state has connected more families to services such as Medicaid.

South Dakota

Priority is Medicaid payment reform for individuals who are Medicaid eligible and also Indian Health Services eligible.

Tennessee

Noted that non-discretionary increases in TennCare have been caused by general health care cost increases and in particular higher pharmacy costs. Plans to open more places in the CHOICES program for individuals with developmental and intellectual disabilities.

Wisconsin

Mentioned state covered all individuals under the poverty level in Medicaid through the state’s own efforts and the state has high rates of coverage.

Medicaid Expansion

Twelve governors specifically mentioned Medicaid expansion in their speeches. Seven, Alaska, Iowa, Michigan, Minnesota, Montana, New Jersey, and Pennsylvania, commented positively on expansion. Four others were governors that have not implemented expansion, with two governors (Kansas and Wisconsin) expressing continued opposition to expansion and two others (North Carolina and Virginia) indicating support for pursuing expansion. Kentucky’s governor noted that the state’s pending expansion waiver to move from a traditional to an alternative model could lead future state efforts.

Alaska

Described personal stories of residents that benefited from increased access to care through expansion, and that state received over $316 million in federal funding through the expansion, which has allowed the state to reduce Medicaid spending by more than $15 million.

Iowa

State’s 1115 waiver for Medicaid expansion has resulted in more individuals receiving health coverage and in reductions in uncompensated care.

Kansas

Indicated that not implementing Medicaid expansion was the right choice for the state, especially given that ACA repeal is likely

Kentucky

State’s Medicaid waiver request will be an opportunity to lead within the context of ACA changes and in terms of long-term viability of the program.

Michigan

Highlighted the success of the state’s Medicaid expansion waiver in providing over 400,000 preventive care visits and 2.8 million primary care visits, while saving the state hundreds of millions of dollars and hospitals’ uncompensated care costs decreasing by nearly 44% on average. Also noted that state’s expansion model could inform federal-level health care changes.

Minnesota

Noted state’s success in health coverage, with over 250,000 gaining coverage and now 96% of individuals are covered, and that Medicaid expansion has helped rural hospitals and it should be preserved.

Montana

Mentioned that rate of uninsured has dropped from 20% in 2013 to only 7%, with 67,000 residents now having regular access to health and mental health care, in large part due to expansion.  Expansion has financially supported rural hospitals.

New Jersey

Medicaid expansion has resulted in a five-fold increase in access to substance use disorder treatment since 2013.

North Carolina

Highlighted the issue of uninsured individuals and that state should implement the ACA’s Medicaid expansion because it will provide coverage, create jobs and prevent closures of rural hospitals.

Pennsylvania

Noted that Medicaid expansion has increased access to substance use disorder treatment.

Virginia

Highlighted that while the future of the ACA is uncertain, the option to expand Medicaid currently remains and it could provide approximately $300 million annually to cover behavioral health services. Proposed budget allows for the governor to expand Medicaid if enhanced federal funding continues beyond 10/1/17, and even if it does not, state policymakers should all agree that 400,000 individuals without care is a problem.

Wisconsin

Noted that had warned that using federal Medicaid expansion funds would hurt state taxpayers and believes state made the right decision in not implementing expansion.

State Health Care Costs (Non-Medicaid)

In addition to mentioning health care costs within the context of Medicaid, 17 governors also spoke about state health care costs more broadly; often mentioning costs associated with state employee health benefits.

Alabama

Concern about the impact of the rising cost of health care on the entire health care system.

Alaska

Cuts in the Department of Health and Social Services resulted in the closure of six public health centers. Mentioned need to address the broader challenge of rising health costs and that state employees are paying more for health care coverage. Envisions a future where the cost of health care is not out of reach for small businesses and individuals.

California

Noted that because California has fully “embraced” the ACA, the tens of billions of federal dollars that could be lost if the law is repealed would significantly impact the budget.

Colorado

Mentioned the importance of individuals receiving care in appropriate settings to help reduce costs and that state is examining the underlying drivers of health care costs.

Idaho

Proposed budget includes $15 million to help school districts cover the costs of higher employee health insurance premiums.

Illinois

Commented that past inappropriate spending devastated human service organizations that serve vulnerable residents such as individuals with behavioral health issues and disabilities.

Indiana

Highlighted that the opioid epidemic impacts every sector, including increasing health care system costs.

Iowa

Health care costs are a priority as the second largest driver of the state budget is health and human services spending. To address the rising cost of health benefits for public employees recommend replacing current model with one statewide health care contract with a uniform benefit system that would reward individuals for participating in healthy behavior promotion activities.

Michigan

Will be forming a workgroup to address the issue of retiree health care and pensions that have $14 billion in unfunded liabilities.

Montana

Created Governor’s Council on Health Care Innovation which engages industry leaders to focus on improving health outcomes and reducing costs.

Nebraska

New efficiencies in health and human service application processing have been implemented and resulted in state savings.

Nevada

Proposed budget includes increased funding for state employee health benefits.

New Hampshire

Proposed budget addresses rising state employee retiree health costs by having both state and retirees share in the increase.

North Dakota

Highlighted the potential of harnessing technological forces to improve health outcomes and lower costs.

Oklahoma

Wants to raise cigarette tax to address current health care needs and the $1.62 billion in health care costs caused by smoking. Also convened leaders from health care industry and the state to strategize on ways to promote prevention and improve health outcomes.

Rhode Island

Mentioned state was successful in cutting $100M in health care costs without cutting eligibility or benefits.

Tennessee

Noted the state’s $1.2 billion obligation for retiree health care and increased health insurance costs for state employees.

Health Care Workforce

Eight governors noted issues related to the health care workforce, primarily commenting on strategies to address provider shortages.

Alabama

In 65 of the state’s 67 counties there is a physician shortage and state is 40th in the number of physicians per capita and last in the ranking for dentists. Highlighted that state expanded funding for loan repayment program for healthcare providers.

Georgia

State nearing completion of three-year plan to align physician reimbursement rates with Medicare rates to help retain high quality providers in state’s Medicaid program.

Idaho

State ranks low in the number of providers per capita, and many are nearing retirement. Stakeholder groups are developing plans to address physician shortage by increasing medical residencies and proposed budget includes $2.4 million to fund residency programs in graduate medical education. Also a new college of osteopathic medicine is scheduled to open in 2018.

Kansas

Noted that 92 of state’s 105 counties are considered medically underserved and 87 counties are underserved for dentists. Will invest $5 million in new residency programs to address these shortages and plans to establish a new privately funded osteopathic school. Proposed budget includes funding for a dental school because state does not currently have one.

Maine

Commented that state may be losing doctors, dentists and psychiatrists due to state’s tax policies.

New Hampshire

State has serious workforce issues in nearly all areas of health care; creating a $5 million workforce initiative program to identify how to address issue.

Rhode Island

Proposed budget includes increase in pay for home health workers who care for individuals with developmental disabilities.

South Dakota

Health care workers are especially needed in state’s rural areas; Recruitment Assistance Program helps communities attract and retain providers and Frontier and Rural Medicine program gives medical students clinical training in rural areas.

Culture of Health

Eight governors mentioned the issue of more broadly addressing population health and building healthy communities.

Alabama

Great State 2019 plan addresses a wide range of social issues, including health care, such as focusing on reducing preventable diseases in rural areas and investing in autism services for low-income children.

Colorado

Would like Colorado be the healthiest state in the nation; promoting healthier behaviors such as involving children in outdoor activities and building new school fitness centers.

Delaware

Noted that need to break the “poverty to prison pipeline” to make the capital city healthy again.

Illinois

Governor’s Cabinet on Children and Youth brings together all state agencies that serve children to ensure youth are healthy, safe, well-educated, moving toward self-sufficiency, and have opportunities to succeed.

Michigan

Mentioned concept of “place making” to make the state a great place to live, work, and play.

Montana

Noted that a healthy economy depends on health of state residents.

New York

Wants to make Brooklyn new model for healthcare by incorporating prevention strategies related to lifestyle and community development (e.g. access to healthier foods, more recreation facilities, and community based clinics).  

Utah

Highlighted need to address issues of intergenerational poverty and homelessness.

Miscellaneous Health Issues 

Many governors mentioned other specific health topics in their speeches, either as recent accomplishments or as future plans. These included topics such as supports for seniors, disabled individuals, and/or children, as well as efforts to address broader social issues affecting health.

Alaska

Strengthened partnerships with tribal health organizations to provide enhanced services at a cost savings to the state.

Arkansas

Requests that legislature direct some of the tobacco settlement funds to help reduce the disability waiting list and additional funding should be provided to better address needs of children in foster care.

Hawaii

Noted residents are among the healthiest in the nation, and that state has long supported health care access. Proposing $10 million over two years to support the state’s cancer center and promote health care innovation.

Illinois

Mentions reducing lead in drinking water is a social justice issue.

Maryland

Given that some individuals do not have sick leave from their jobs, suggests a compromise policy of requiring larger companies to provide paid sick leave and encouraging small businesses to do so by providing them tax incentives to offset costs.

Massachusetts

Plans to sign executive order on creating a Council on Older Adults focused on helping seniors live more vibrant and purposeful lives. Also proposing to fund a down payment toward increasing state support for municipal health insurance.

Michigan

Created public health advisory commission to strengthen state and local public health services and provide recommendations. Noted efforts to reduce waiting list for in-home senior services; were successful but now have another waiting list. In Flint, progress has been made to make the water safe again but not done; provided $27 million to help with lead pipe replacements, over 600 pipes replaced, and over 24,000 individuals affected are now enrolled in Medicaid.

Minnesota

Proposed budget includes increases to support young children, including visiting nurses for teen parents. Also noted need to improve water treatment systems to ensure water is safe and citizens’ health is protected.

Mississippi

Noted new medical schools and research centers in the state and improvements made to foster care system.

Montana

Created Office of American Indian Health to improve health outcomes for Native Americans. Proposing to provide funding for respite care to help seniors remain in their homes and questions why legislature is considering reducing community nursing home funding.

Nevada

Noted more individuals have health insurance than ever before.

New Hampshire

Mentioned that health care remains a critical need; another critical area of public health and safety is drinking water, and state should invest in infrastructure improvements. Also mentioned significant waiting list for services for developmentally disabled individuals; includes funding increase of $57 million. Also state should make long-term care services part of managed care and promote home and community services.

New Mexico

State has increased investments in early childhood home visiting services.

New York

Noted medical research industry is advancing through public private partnerships.

North Carolina

Noted the high cost of health insurance generally for families.

Pennsylvania

Mentioned state passed medical marijuana law for children. Proposed budget includes funding to help seniors receive care at home and is continuing to focus on improving these services including through new Community HealthChoices program. Other recent actions for seniors included state court case to protect their coverage, lottery funds for community centers and improved access to nutrition assistance.

Rhode Island

Noted all workers should have access to sick leave.

South Dakota

Plans to reorganize administration of long-term care services for all populations in one division to provide a more integrated approach to care delivery, along with increased efforts to promote home and community based services.

Virginia

Noted state funded two new veterans’ health care centers.

Washington

Noted state will ensure women have access to care and family planning services.

Wisconsin

Fostering Future’s initiative trains state employees to provide trauma-informed care for youth in the child welfare system.

Wyoming

While state leaders need to be budget conscious, need to keep in mind justice-involved individuals, disabled persons, the health care that is being provided or not provided to state residents, and the next generation.

Future of Health Care

With the transition to a new presidential administration, 13 governors commented about their perspectives on potential changes that may occur to the Affordable Care Act (ACA) and Medicaid financing. Some governors indicated interest in potentially gaining more flexibility and authority in Medicaid, whereas others expressed concern about possible coverage losses that could occur due to federal health policy changes.

Alabama

With the new federal administration states will likely have an important role in the repair/replacement of the ACA and stressed that states are best equipped to address their healthcare needs. 

Arkansas

As more authority is returned to states in certain areas such as healthcare, states have a unique opportunity to innovate and reinforce values of work and responsibility.

California

Highlighted that state has provided health coverage to 5 million more residents and will work to protect this health coverage.

Colorado

Noted that 94% of residents are now insured and that basic health care should be a right and not a privilege.

Georgia

Cautioned against implementing any significant health policy changes until know more about any federal-level changes, and noted that would like some of those changes to include greater state flexibility in Medicaid program design.

Idaho

Mentioned need to assist individuals who fall in the ACA coverage gap, but encouraged legislature that while waiting on potential federal-level policy changes, the state should look to local partnerships and marketplace innovations to improve health care access and affordability.

Kansas

Believes state made right choice by not implementing key provisions of ACA, saying that majority of exchanges have “failed”.

Kentucky

Commented that Medicaid should be preserved for those it was intended to cover—medically frail, children, pregnant women, those with dependents, and those truly in need.

Minnesota

Noted that ACA has been successful but has fallen short in providing affordable health care for all, with premiums costing more but often offering less coverage and those not qualifying for subsidies facing high deductibles and other costs and not being able to retain providers of choice. With any federal-level changes, believes that coverage of pre-existing conditions and young adult dependent coverage should continue, along with Medicaid expansion. Stated that that essential health benefits are important in providing complete coverage. Urged legislature to pass a premium relief bill and implement reforms to avoid 2018 increases. Urged legislature to carefully consider effects of their proposed change on the state’s existing policies and practices; should seek stakeholder input. Would support reinsurance if carefully designed. Noted state exchange’s significant operational improvements. Wants legislature to consider options for increasing competition in the individual market. One option would be to offer a public option (sold through state exchange, with subsidized premiums for lower-income individuals); encouraged legislature to pass a measure by April so it possibly could be available for 2018.

New York

Believes that progress on affordable health care is at risk; believes individual health is public health, that good quality and affordable health care is a right, and will work to protect coverage, Medicaid and overall health care system.

Oklahoma

Believes the ACA has contributed to making health care unaffordable. Intends to submit a plan to federal officials that will focus on reducing regulations to create cheaper plans, encouraging investments in private health accounts and utilizing successful local programs like Insure OK.

South Dakota

In response to potential changes to Medicaid financing, will advocate for equitable federal allocation and for resolution to the Indian Health Service funding issue, along with more flexibility in the program.

Washington

Noted success of providing hundreds of thousands of residents with health care and will work to protect coverage gains of the ACA.

[1] As of late February 2017, the governors of FL, LA, OH and OR have not announced the date of their addresses or have not yet held their speeches.

View the 2016 State of the State Chart here.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation