How Governors Addressed Health Care in Their 2018 State of the State Addresses

In their state of the state speeches, governors highlight policy successes and outline key proposals they want their legislatures to address. This year, governors highlighted health care issues such as Medicaid, behavioral health, and the opioid epidemic as policy priorities in these speeches.

Currently, there are 33 Republicans, 16 Democrats, and one Independent among the nation’s governors. Kansas, New Jersey, and Virginia swore in new governors in 2018, and 36 governors will be elected this fall. As of late February, 43 governors included health care policy priorities in their state of the state speeches, budget proposals, or inaugural addresses. This is the highest number of governors commenting on health care in their speeches since NASHP began tracking them in 2015. The descriptions and chart below summarize the governors’ health-related themes.

Click a health topic below to read how individual governors are tackling the issue. Download/View a pdf version of this chart.

General Behavioral Health Issues

General Behavioral Health Issues
Mental health and substance use disorders were the most commonly cited health issues, with 37 governors addressing these issues. Governors frequently highlighted strategies they had implemented or planned to implement to increase access to behavioral health services.

Georgia Created Commission on Children’s Mental Health to recommend ways to improve state mental health services for children. Budget proposal includes $22.9 million in funding based on the commission’s recommendations.
Hawaii Dedicated more money to mental health treatment and services, including to the homeless population.
Idaho Identified the need for cost-effective ways to address acute substance abuse and mental health issues. Noted appreciation of legislature’s support to create behavioral health crisis centers in four areas, which help reduce use of more costly emergency rooms and jails. Requested $2.6 million for FY 2019 to build three more crisis centers.
Iowa State redesigned its mental health system in 2013, resulting in improved access and modernized services. It currently invests $2 billion in mental health services. Requested legislature to remove a cap on sub-acute beds and asked all stakeholders to develop a sustainable funding structure for crisis centers to increase access to residential access centers that provide short-term crisis care.
Massachussetts Budget will include more than $83 million in new funding for Department of Mental Health to strengthen community-based services for adults with serious mental illness. Services will integrate behavioral and physical health, provide active outreach and engagement services, residential supports, clinical coverage, and include peer and recovery coaches as part of the treatment team.
New Hampshire Commented on mental health crisis in the state, but noted state has made strides in addressing needs of mental health system. Provided funding for 60 new beds for community-based transitional housing and created a fourth rapid response mobile crisis unit. A state working group has prioritized the issue and is developing a comprehensive 10-year plan for the mental health system.
New Jersey State has provided 60,000 behavioral health screenings, psychological services through schools or community service centers to 10,000 families, and drug addiction treatment services to more than 3,500 people affected by Hurricane Sandy.
New Mexico State is providing more behavioral health services than at any point in its history.
Rhode Island Noted lack of access to mental health care; will propose legislation to require health insurance companies to cover addiction and mental health treatment.
South Dakota Noted importance of serving individuals with mental health problems through community-based approaches, and that the state needs to demolish, sell, or repurpose vacant state-owned institutions or those in disrepair. Mentioned state’s methamphetamine epidemic, and is addressing the issue through an education campaign that includes a prevention toolkit, expanding access to treatment, ensuring providers are trained in evidence-based treatment models, and a drug interdiction task force.
 Utah Mentioned that suicide has become leading cause of death among young people, and created a task force to address the issue.
Washington Identified need to continue work on mental and behavioral health care, commenting that passing a budget would allow for expanded capacity in mental health system.
Wisconsin Noted that last year the state provided schools with resources to add mental health services.
Wyoming Mentioned state has addressed issues of bullying and suicide prevention through its Safe2Tell initiative for individuals to report suicide threats. Suicide prevention has been a statewide initiative for several; years and the state is holding its third annual suicide prevention symposium.

Behavioral Health: Heroin and Opioid Abuse

Behavioral Health: Heroin and Opioid Abuse
Thirty governors specifically addressed heroin and other types of opioid abuse and overdoses — an increase from 21 in 2017 and 13 in 2016.

Alabama Established the Opioid Overdose and Addiction Council.
Alaska State leaders recently issued a declaration of emergency for the opioid crisis and established an incident command structure to coordinate responses.
Arizona Noted that in past year more than 800 residents died from opioids. Have taken steps to address issue, such as reducing doctor shopping, making naloxone available, and setting prescription limits, but seeks a more aggressive approach. Last June, state declared the crisis a public health emergency, and medical, addiction, and public safety officials have provided recommendations. Will call for a special session to focus on the issue.
Arkansas Noted the need to continue addressing the opioid crisis.
Colorado Included the need to halt the opioid epidemic in list of issues to address in this legislative period.
Delaware Strengthened oversight of opioid prescriptions, expanded access to substance abuse treatment, and better coordinated efforts to help those battling addiction.
Florida Noted that the state attorney general has been a leading voice in the fight against the opioid epidemic. Proposes to invest $53 million to address issue, also proposing legislation to prevent drug addiction on the front end, reduce the ability for dangerous drugs to spread, provide support to vulnerable individuals, and ensure law enforcement officers have necessary resources.
Illinois Highlighted state efforts to address opioid epidemic, such as the 24/7 Helpline to connect individuals to resources, requiring drug prescribers to register for the prescription drug monitoring program, and permitting first responders to use medication to stop overdoses. Determined to reduce projected opioid deaths by more than one-third in the year ahead.
Indiana Continuing to attack opioid epidemic through treatment, prevention, and enforcement. Working to integrate technology needed to help physicians access a prescription drug monitoring program, and this year plans to require physicians to use this system before issuing an opioid prescription. Plans to increase the number of opioid treatment locations, improve reporting of drug overdose deaths, and strengthen enforcement efforts.
Kentucky Noted fighting the opioid crisis as a focus for 2018. Allocated $34 million to address the issue, and provided additional funding for pregnant women who are addicted.
Maryland Opioid-related deaths last year exceeded deaths from firearms and motor vehicle fatalities combined. Last year, it was the first state to declare a state of emergency in response to the crisis. The state has committed $500 million toward the issue and substance use disorders generally, with a four-pronged approach focused on education, prevention, treatment, and enforcement.
Massachusetts Progress made from three years ago when overdose deaths were very high — overdose deaths have declined 10 percent for the first time in over a decade and opioid prescribing has declined 29 percent. Since 2015, the state has added 1,110 treatment beds, increased spending on treatment by 60 percent, upgraded the prescription drug monitoring program, required teaching to medical and other professionals about opioid therapy and pain management, increased access to Narcan, and expanded education, screening, and treatment programs. Plans to add more treatment beds and increase spending on addiction services by more than $200 million over next five years. Noted the need to address Fentanyl because of an increase in overdose deaths associated with this drug. A proposed bill makes it easier to arrest and convict dealers. Expressed support for the CARE Act that will provide a framework for community-based, aftercare addiction services, expand school-based education, and broaden paths to treatment for people dealing with addiction.
Michigan Noted the opioid crisis and the dramatic increases in addiction and overdose deaths in the last several years. The lieutenant governor has been a leader on the state task force and the state recently passed legislation to address the issue. Highlighted Angel Program, a state police program that enables individuals to go to certain stations and seek treatment help without fear of arrest.
Mississippi The state created a task force in 2016 to address the opioid epidemic and develop recommendations that are being implemented, led by the Department of Public Safety and the Bureau of Narcotics.
New Hampshire Most serious challenge is opioid crisis. Last year, it directed new funds for prevention, treatment, and recovery, and this year will be opening a youth addiction treatment center. Needs to expand focus of recovery programs by engaging employers. Will be launching Recovery Friendly Workplaces initiative to address addiction in workplaces and increase access to treatment.
New Jersey Noted legislation passed last year to address opioid crisis, though acknowledged there are still too many opioid-related deaths. State has strongest limit on opioid prescriptions, which has decreased prescription rate by over 15 percent. Has a shared prescription drug monitoring program with 15 other states designed to reduce doctor shopping and pill mills across state borders. Since 2011, through its Project Medicine Drop program, the state has collected 88 tons of opioid pills for proper disposal. Created a way for pharmacists, doctors, nurses, and others to report suspicious use or sale of opioids, and placed limits on amounts pharmaceutical companies can pay doctors to minimize monetary influence in prescribing habits. Also expanded availability of Narcan, and the ReachNJ program works to reduce addiction stigma and connect families with treatment.
New Mexico Noted that the state is restricting the use of narcotic medications.
New York Mentioned need to address growing opioid epidemic with more prevention, education, enforcement, and treatment services, along with new efforts to sue certain distributors.
North Dakota Commented on addiction and overdose deaths, mostly related to opioids and fentanyl. Expressed the need to address issue on a multi-dimensional front and approach addiction as a disease when designing treatments. A statewide task force has helped reduce prescriptions of opioids, while encouraging appropriate prescribing. Have also worked to bring attention to new addiction recovery approaches and promote access to Narcan. Should address the issue through prevention, early intervention, treatment, and recovery.
Oregon Commented on need to address opioid crisis.
Pennsylvania Expanded response to opioid crisis by providing law enforcement with necessary tools and increasing access to addiction treatment for individuals.
Rhode Island State has made overdose crisis a top priority, resulting in an 8 percent reduction in overdose deaths in 2017. Noted the need to invest more in recovery/treatment efforts. Will add a new job training program for individuals in recovery.
South Carolina Mentioned high rates of death due to opioids and heroin. Need to address the issue through a “full court press” of awareness, information, and treatment. Has declared the issue a statewide public health emergency to allow for wide use of state resources. State task force has developed a comprehensive informational website, is setting disposal protocols, and physicians are educating individuals about dangers of opioids. Proposes $10 million for treatment, prevention and education.
South Dakota Noted the need to address opioids. The state’s prescription drug overdose death rate is relatively low (second lowest in nation), though over-prescribing is an issue in the state. Legislation passed last year requires pharmacies to use statewide database for painkiller prescriptions and participate in the prescription drug monitoring program. Mentioned laws passed in 2015 and 2016 that increase access to naloxone by giving supplies to first responders. Highlighted need to take many approaches involving providers, private organizations, law enforcement, communities, and individuals. State medical association is also providing resources for physicians to better recognize and treat opioid addiction and appropriately prescribe. Board of Pharmacy is establishing permanent drop-off sites for certain expired, unused, and unwanted prescription drugs. In 2016, established an advisory council on opioid abuse that supports developing capacity for medication-assisted treatment. Planning for a new media and school-based opioid prevention campaign in 2018.
Tennessee Commented that the opioid epidemic is crippling the state and the nation. Noted recent announcement of a plan, TN Together, to address the crisis by focusing on prevention, treatment and law enforcement, and develop provisions to limit the supply of opioids, provide funding for treatment, and combat illegal sales and trafficking of opioids.
Vermont Need to continue to combat opioid crisis, last year funded a new treatment center. Also created Opioid Coordination Council to identify prevention, treatment, recovery, and enforcement strategies. Will develop proposals to help individuals in recovery transition to workforce, and increase number of treatment professionals.
Washington Commented on the need to continue to work on the opioid issue.
West Virginia Mentioned the need to stop the drug epidemic and that state university researchers are looking at ways to curb addiction.
Wisconsin  Commented on the need to continue to work on the opioid issue and has signed 28 bills dealing with the challenge. Urges legislators to pass recent recommendations from a bipartisan commission.
Wyoming Commented that overdose deaths have decreased, but that leading form of drug abuse for 12 to 25 year olds is still prescription painkillers. State will launch educational campaign targeting teens and young adults.

Behavioral Health: Criminal Justice

Behavioral Health: Criminal Justice
Eight governors also spoke about improving behavioral health services to better meet the needs of justice-involved individuals as they transition back into communities and/or providing mental health and substance use disorder treatment services rather than incarcerating individuals when appropriate.

Arkansas Funding is in place for four Crisis Stabilization Units, which are expected to have a major impact on those suffering from mental health issues and ease the burden on county jails and hospitals.
California Need more mental health and drug treatment programs and better training and education in the context of reforming the overall criminal justice system.
Georgia Criminal justice system reforms include increasing number of accountability court programs, such as drug and mental health courts.
New Jersey Noted completion of a conversion of a state prison to an inpatient drug treatment facility. State has also made drug courts available statewide.
North Dakota Acknowledged that about 75 percent of people in the criminal justice system have an addiction and they should receive treatment while incarcerated. Treatment services rather than incarceration should be provided when appropriate and noted the state’s new “Free Through Recovery” initiative.
Oklahoma Commented that there should be solutions other than incarceration for non-violent offenders in need of substance abuse treatment and that too few of these individuals are receiving this treatment.
South Dakota Noted significant impact of the methamphetamine epidemic on criminal justice system. State has the highest juvenile incarceration rate in the nation but most are non-violent offenders. There has been some progress in expanding capacity of drug and DUI courts and community-based treatment programs. Legislation passed requires jail time for individuals who use drugs while on probation or parole, and expands availability of 24/7 HOPE probation for drug offenders. Reforms have also included functional family therapy for juveniles and expanded capacity in specialty drug and DUI courts for adults. Noted state’s lower recidivism rate for justice-involved individuals who need and complete substance use disorder treatment in comparison to the overall criminal justice population.
Wisconsin Planning to implement reforms to juvenile justice system, will focus on smaller facilities with some providing mental health and substance use disorder treatment and trauma-informed care.

Medicaid Program Operations, Services, Reforms and Costs

Medicaid Program Operations, Services, Reforms and Costs
In total, 19 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches, compared to 21 last year. Ten governors addressed their states’ Medicaid programs, such as commenting on recent program improvements, the growth of overall program costs, or cost savings achieved through program reforms.

Alabama Fewer people are eligible for Medicaid than a year ago, and as a result, Medicaid will require less general fund appropriations than expected.
Arkansas Noted that state has come a long way in reforming its welfare programs and there are fewer individuals on Medicaid than when governor took office (117,000 individuals left Medicaid in 2017—many of whom found work). This has resulted in returning nearly $500 million in new Medicaid spending to the federal government. Remaining growth in Medicaid spending is the result of the change in the federal match rate, elimination of $50 million in one-time funding for Medicaid, and normal cost increases. Commented that more reforms are necessary, but much has been accomplished without reducing benefits. Will focus on the enforcement of current eligibility requirements through more efficient determination process and breaking down government silos. Also, in 2016, asked for Medicaid transformation initiatives to produce at least $835 million in savings over the next five years. The state is on track to meet that goal due to the Legislative Health Care Task Force.
Illinois Healthcare Fraud Elimination Task Force, in collaboration with the inspector general, has helped root out Medicaid fraud, resulting in $450 million in taxpayer savings.
Iowa Last year, state modernized the Medicaid system, moving to a patient-centered approach through managed care. Commented that prior to her tenure there were mistakes made in its implementation, and so took action to address issues with new staffing, working with managed care organizations to ensure good outcomes, and individualized patient care.
Massachusetts Discussions with legislature and other interested parties about MassHealth have been helpful, and thinks that shared goals of quality care and long-term sustainability can be achieved.
Mississippi Need to address Medicaid cost increases, caused in part by poor health choices that lead to higher mortality rates and disabling conditions, which must also be addressed. The state’s goal is to prevent poor health from getting worse and focus on getting Medicaid patients well. Also noted the need to both manage the program’s current needs and ensure sustainability for future demands while addressing waste, fraud and abuse. Asked legislature to properly frame the Medicaid Technical Amendments Act. Has tasked the Department of Human Services (DHS) and Medicaid to jointly identify beneficiaries’ needs and more effectively address them, and noted is considering moving Medicaid eligibility determination to DHS. Commented on waiver request to implement work requirements for Medicaid enrollees to help move individuals from government health care to employer-sponsored health care.
New York Health care investments must continue, and Medicaid and CHIP programs must be preserved.
Oklahoma Commented that the state should not reduce rates paid to providers in order to address budget issues.
South Dakota Has asked the Department of Social Services to pursue a waiver to implement Medicaid work requirements. Proposes to pilot the program in two counties where there is the greatest availability of employment and training resources. Indicates state will provide interim resources, such as childcare assistance and premium assistance, to families as they transition off Medicaid. As state waits for approval of waiver, it will begin a voluntary program in July.
Wisconsin Noted that the state’s Medicaid waiver covers all individuals earning less than the poverty level.

Medicaid Expansion

Medicaid Expansion
Ten governors addressed Medicaid expansion in their speeches. Five governors commented positively on expansion or the potential for expansion, while Maine’s governor commented negatively on moving forward with implementation of his state’s voter-approved expansion.
Six governors referred to work requirement proposals for certain Medicaid enrollees that they had submitted to federal officials or that they plan to pursue (in some states these requirements would apply only to the expansion population, while others want to apply them more broadly).

Alaska Commented that 40,000 additional Alaskans now receive health care since the state expanded Medicaid, and that expansion gave the state $500 million in additional federal dollars.
Arkansas Anticipates state will receive federal approval to implement a work requirement for the Arkansas Works program before the end of the state’s legislative session, and indicated it would be one of the most stringent in the country. Believes able-bodied, working age adults without dependents should be working or in training, and stated that the only long-lasting solution to lowering the cost of Medicaid is to help more people earn their way off the program.
Indiana Mentioned pending federal approval of Health Indiana Plan extension, which will include expanded substance use disorder treatment services and efforts to transition certain individuals to employment (at time of speech extension had not been approved).
Kentucky Noted recent approval of 1115 waiver and that Medicaid for able-bodied working aged men and women without dependents will change. (Addressed in the context that the state is going to lead on the front of reforming entitlements.)
Maine Agreed to obey the law requiring Medicaid expansion, but thinks it is bad public policy to give able-bodied people a “free ride.” Noted that although believes expansion will plunge state into financial disarray, he called on the legislature to appropriate funds for implementation and identified four principles to guide the decision on how to fund the expansion:

  • No tax increases on families or businesses;
  • No use of the Budget Stabilization Fund;
  • No use of other one-time funding mechanisms; and
  • Full funding for vulnerable individuals still waiting for services, and no reduction of services or funding for nursing homes or people with disabilities.

Noted that it is important for the elderly and mentally and physically disabled to be prioritized. Also, Medicaid agency cannot hire and train the additional staff needed or cover the state’s share for new enrollees without additional funds.

Michigan Highlighted success of the state’s Medicaid expansion waiver that covers 675,000 people, with 80 percent now receiving annual physicals and avoiding emergency room visits.
New Hampshire Commented that state is in process of developing a state-specific design for Medicaid, specifically seeking to add viable work requirements for expansion population while maximizing flexibilities and options.
New Jersey Noted benefit of Medicaid expansion in relation to drug treatment, and that the state has a federal waiver to open additional treatment beds and connect patients with recovery coaches after drug overdoses.
Pennsylvania Commented positively on state’s implementation of Medicaid expansion and reducing uninsured rate to historic low.
Virginia Noted that he strongly supports Medicaid expansion, both to cover uninsured residents who lack access to care and to benefit state economy and rural hospitals (Gov. McAuliffe).

State Health Care Costs (Non-Medicaid)

State Health Care Costs (Non-Medicaid)
In addition to addressing Medicaid costs, 11 governors also spoke about state health care costs more broadly, and most stressed the need for more affordable health care.

Alaska Working internally and with other states and the federal government to explore options to reduce overall health care costs. Has reduced health care premiums by 26 percent through a reinsurance program that is being replicated across the country.
Colorado Fixed the hospital provider fee, which prevented the closing of rural hospitals. The state has some of the most high-cost counties in the country for health care spending and 14 rural counties have only one Affordable Care Act (ACA) plan available. Noted that federal policymakers need to move past the fight over the ACA, which has helped reduce bankruptcy caused by medical debt in the state by 60 percent.
Connecticut Noted that affordable health care is under assault by federal policymakers, and without action premiums will rise and life-saving treatments will be out of reach.
Delaware Noted that health care costs are the biggest driver of state budget growth, accounting for 30 percent of the budget. Called for state government and hospitals to come together to find a solution.
Maine Noted state has paid off hospital debt using the liquor bond, though it should have been implemented incrementally rather than all at once. Identified $800 million in capital investment of hospital projects on the drawing board. Noted that state has reformed health insurance to lower costs.
Maryland Called on the legislature to address health insurance rate increases caused by the failures at federal level and to develop bipartisan solutions to stabilize rates.
New Jersey Mentioned the need to address costs associated with state employee health benefits.
New York Started year with $4 billion deficit compounded by a $2 billion cut primarily due to federal government funding changes and health care.
North Dakota Noted significant amount of the budget is allocated to health care.
Pennsylvania Commented that the state has been able to reduce health care costs.
Vermont Reached an agreement to return $13 million to taxpayers through health care premium savings due to renegotiation of health insurance coverage for school employees.

Health Care Workforce

Health Care Workforce
Twelve governors addressed issues related to the health care workforce, primarily strategies to address provider shortages. This is a significant increase from eight governors who mentioned health care workforce in 2017 and five in 2016.

Alabama Proposed funding for loan repayment programs for dentists and physician assistants who agree to work in underserved/rural areas.
Idaho Commented that health care is an economic driver and leads employment growth (accounting for 46 percent of overall job growth), but noted state’s chronic shortage of physicians and other providers, especially in rural areas. Highlighted upcoming opening of a new osteopathic medicine school, which will bring more residency opportunities for physicians. Budget will recommend funding for 11 new residencies in certain regions. Currently has 40 seats for Idaho medical students in the regional medical education program consortium with four other states that also lack medical schools.
Iowa Highlighted investment of $4 million for a new psychiatric medical residency program to bring in more psychiatrists, and a new partnership with Des Moines University and the National Alliance on Mental Illness to provide new doctors with training to identify mental health issues.
Kansas Opened new medical education building at University of Kansas School of Medicine that will provide openings for an additional 50 doctors each year. Commented on need to end shortage of rural physicians and dentists, which has chronically plagued the state, by training more professionals.
Mississippi Created a new medical school at the University of Mississippi to train physicians to address the state’s shortage of medical professionals with a goal to add 1,000 new physicians by 2025. Also noted that the medical profession is a significant economic driver in the state.
Missouri Noted the need to grant reciprocity of health care licenses from other states (provided example of dentistry).
Nebraska Has improved efforts to issue licenses more quickly for medical professionals (e.g., has reduced nurse licensing processing time by about one-third since 2015).
New Jersey Noted that due to state efforts over a number of years, universities have expanded medical health sciences education programs. Rutgers University has a medical school, schools of public health, and a cancer institute, and receives more National Institutes of Health funding than before. Rowan University gained an osteopathic medicine school and now has two medical schools.
New Mexico Should recognize certifications from other states, in particular nurses, and requested legislature pass an interstate nursing compact bill. State has dramatically expanded health care workforce, especially in nursing.
North Dakota Mentioned the state’s shortage of health care providers and nurses.
Oregon Noted that health care is one of the largest growing industries in the state, and recommends training opportunities should be improved and expanded, such as developing apprenticeship-type programs in different health care and other fields, and better aligning training and requirements for home care and community-based care delivery professions to ensure a career ladder for people entering these professions.
South Dakota Focused on building the overall workforce in the state, and noted privately-funded donations matched with state dollars for the Build Dakota Scholarship Fund (began in 2014), which provides scholarships for students to attend technical institutes who then promise to work in the state after graduation. Includes fields such as surgical technology and nursing. Requested legislature pass a bill to develop an interstate licensure compact (noting doctors as one of the examples) with governors of nearby states, allowing professionals to move to another member state and practice for 18 months (enough time to earn another license in their field).

Culture of Health

Culture of Health
Nine governors mentioned the need to improve population health and building healthy communities through efforts such as targeted investments to address health and social disparities.

Connecticut Characterized health care as a basic human right that should never be out of reach for anyone.
Delaware Highlighted a “healthier Delaware” as a priority for 2018.
Hawaii Highlighted that the state is one of the healthiest in the nation and has led the nation in health insurance coverage for decades.
Massachusetts Noted that United Health Foundation called the state the healthiest in the nation, and AARP has designated it as one of only two age-friendly states in the country. Noted state’s commitment to provide all residents with access to quality care and preserve its health insurance program put in place a decade ago. Will continue to advocate for bipartisan fixes to the ACA.
New York Creating a new health care initiative called Vital Brooklyn to address chronic social, economic, and health disparities by targeting investments in eight integrated areas to create a new model for community development and wellness (e.g., increasing access to open spaces, healthy food, and high quality health care services.)
Pennsylvania Will focus on building a stronger and fairer economy, healthier and safer communities, and new opportunities for the next generation.
Vermont Noted state frequently ranks as safest, happiest, and healthiest, but needs to focus on cost-of-living issues.
Virginia The state has regional health disparities that affect life expectancy that should be addressed through efforts such as better access to care and effective interventions for addiction or mental health challenges (Gov. Northam)
Washington Indicated state should strengthen relationship with counties to promote healthy communities.

Miscellaneous Health Issues

Miscellaneous Health Issues
Most governors mentioned other health topics in their speeches, either as recent accomplishments or as future goals. These included supports for seniors, disabled individuals, children in foster care, and women’s health, and efforts to address broader social and/or environmental issues affecting health.

Alabama Is negotiating with a new health care provider for the state’s prison system to expand and improve inmate health care at a reasonable cost.
Alaska Mentioned compact between Office of Children’s Services and tribal organizations to benefit children in foster care.
Arizona Prevented sending disenrollment notices to families with children enrolled in CHIP by providing state funding (governor also implored Congress to act on CHIP, because at the time of the speech, it had not yet funded the program). Noted the state has addressed problems in the child safety department and was recently recognized as best in the country for foster care reduction. Last year, expanded the Happy Babies initiative that allows new parents employed by state agencies to bring newborns to work and now private sector companies are interested in developing similar programs.
Arkansas State utilized $8 million last year from the Tobacco Settlement Fund to reduce the Developmentally Disabled Waitlist by 500. Noted the need to address the insufficient reimbursement of pharmacists who work in rural communities.
California State is leading on clean air initiatives, such as implementing appliance efficiency standards, promoting renewable electricity and zero-emissions vehicles, and other measures to reduce air pollution. Also noted passage of water bond that invests in safe drinking water, conservation, and storage.
Colorado Family planning initiative has helped reduce the abortion rate among teens by 64 percent. Commented that state has “swelled our ranks in health care with 600,000 more enrollees while prioritizing value.”
Connecticut Noted that state built one of the most successful health care exchanges in the nation and that just this year more than 100,000 residents found health insurance through the exchange. Wants to pass a bill to improve state’s paid sick leave law, which was the first in the nation in 2011.
Delaware Announced support for paid parental leave for all state employees.
Illinois In response to outbreak of Legionnaires’ disease at the Quincy Veterans Home two years ago, partnered with the US Centers for Disease Control and Prevention to install a $6 million water treatment system and instituted water flushing and purification best practices, resulting in a substantial reduction in Legionnaires’ disease and detectable legionella in water systems.
Indiana Noted that the state regularly ranks among the worst for infant mortality, and so is implementing a Levels of Care program to assure that the highest-risk babies are delivered at hospitals with the facilities to meet their needs, and set a goal to become the best state in the Midwest for infant mortality rates by 2024.
Iowa Last year state passed a law prohibiting late-term abortions. Requested legislators to develop a bill focused on improving water quality.
Kansas Noted that infant mortality rate is at the lowest point in state’s history. Would like the state to lead the country in developing new treatments using adult stem cells. Noted that with the passage of legislation “protecting and honoring life,” there have been 17,000 fewer abortions in the past six years.
Kentucky Plans to fix its foster care and adoption system, as it now has 8,500 children in foster care and more than 2,400 eligible for adoption. Will provide additional funding for the Department for Community Based Services, including $10.8 million for a new program specifically targeting adoption and foster care.
Maryland Commented that legislation to provide paid sick leave is close to passing. State has enacted clean air standards that are stronger than 48 other states and nearly twice as strong as the Paris Accords.
Massachusetts Noted that Health Connector had initial challenges, but just finished its third consecutive positive open enrollment period, providing more than 240,000 working families with affordable health care coverage. Pledged that regardless of federal-level actions, no woman in the state will be denied reproductive health care services.
Michigan Noted that Flint has continued to have good water quality results and they are continuing the replacement of lead service lines.
Mississippi To address systemic issues related to poor school and student performance, has created an Early Childhood Advisory Council with experts in education, health care, child welfare, mental health, and early childhood learning. Noted improvements in foster care system through creation of the Department of Child Protection Services. Noted planned expansion of children’s hospital, which along with other facilities and changes (such as building a new medical conference center) will help build a medical corridor/zone. Also highlighted plans for construction of a long-term palliative care unit, which will offer a home-like treatment facility for medically fragile children. Highlighted the new “medical city” in Harrison County, where there is a new pharmacy school, a nursing and simulation center, and the National Obesity and Diabetes Research Center. Commented that the health of the state’s population continues to lag behind most of the nation, with a need to encourage more preventative health care to address obesity, substance abuse, and sexually transmitted diseases.
Missouri Made it easier for foster care children to obtain birth certificates without fees, and noted passage of Foster Care Bill of Rights and improvements to adoption process, along with other associated legislative initiatives. Also noted that the Department of Natural Resources has worked to ensure that state has achieved safest drinking water in almost 20 years.
Nebraska Commended legislative efforts to protect injured first responders from losing health insurance. Noted significant increase in number of children coming into child welfare system due to parental methamphetamine use, and recommended additional funding and creation of task force.
New York Cited health concerns related to the plume of contamination caused by industrial waste from manufacturing facilities in Oyster Bay, and that state will provide $150 million to address issue. Also noted environmental threats to drinking water. Has made historic investments in health care, which will keep health care industry as a strong and vibrant economic engine, and is investing in building new hospitals. Encourages legislature to enact the Contraceptive Care Act. Noted the need to address homelessness, especially the needs of those who are sick and/or mentally ill.
Oklahoma Noted efforts implemented to address needs of abused and abandoned children by increasing the number of foster care homes (highest number of gains in these homes in the nation).
Pennsylvania Commented positively on state’s upcoming implementation of medical marijuana availability and its help to individuals in pain. Noted state has expanded opportunities for seniors to receive home health care.
Rhode Island Passed legislation last year for worker sick leave. Highlighted that nearly every state resident has health insurance, and that premiums on the exchange are the lowest in the nation.
South Dakota Noted state’s emerging biotech sector, which includes development of a new facility for a company known for developing human antibodies aimed at preventing and treating cancer, autoimmune diseases, and infectious diseases. Discussed issue of infant mortality and associated task force led by governor’s wife, who worked with doctors, nurses, tribal health workers, social workers, and the Department of Health to research the issue. Birthing hospitals have followed through on one recommendation to reduce early elective deliveries. Additional resources provided to educate pregnant women about the dangers of tobacco use have led to declines in usage since 2011. There are also efforts to promote safe sleep practices, and state infant mortality rate overall has gone down to its lowest levels.
Vermont Noted state has been a leader in expanding access to health care and should continue building on this by focusing on prevention while moderating costs. Will continue to test voluntary pilot program that has more than 5,000 providers participating (including most hospitals) that pays for care quality rather than quantity. Will continue to evaluate if this pilot meets state goals of better health, quality and sustainable costs. State will be proposing additional prevention-focused efforts.
Virginia Noted that when regulations risked closing nearly all of the state’s women’s health clinics, the state took action to protect access to care. Noted being first state in the nation to functionally end veteran homelessness (Gov. McAuliffe). Committed to continuing personally caring for patients at Virginia’s Remote Area Medical clinic and also providing coverage to more residents. Highlighted the issue of nearly 400,000 residents who are one illness or accident away from bankruptcy because they lack insurance (Gov. Northam).
Washington Need to ensure women’s health care rights, such as full access to contraception, including long-acting reversible contraception. Noted passage last year of best paid family leave program in the nation. Noted investments in health care system, with state biotech companies developing new cancer treatments. Urged legislators to address public safety and health by supporting measures to reduce gun violence. Commented that climate change is a threat to the health of the state and its children and businesses.
Wisconsin Cited the Fostering Futures initiative started last year to focus on incorporating trauma-informed care for foster care children. Commented that the state’s health care systems are ranked first in the nation for quality, and that the percentage of people with access to health coverage is one of the best. Noted that eight years ago, about 4,000 people with disabilities were on long-term care service waiting lists, and many counties were not included in long-term care programs. With expansion of long-term care services this year, the state will be able to eliminate waiting lists for all children needing long-term care services. Is now seeking permanent federal approval of a waiver to provide SeniorCare (a state prescription drug assistance program). Since it was first approved in 2002, the state has requested an extension of SeniorCare four times.
Wyoming Noted state’s 10-year homelessness plan, and the need to create a skilled nursing center for veterans.

Future of Health Care

Future of Health Care
With debate and uncertainty at the federal level, eight governors commented about potential changes that may occur to the Affordable Care Act and health coverage in general. Many indicated they would take action to increase access to affordable health care no matter what changes occur at the federal level. Some specifically mentioned reforms to stabilize their individual insurance markets and constrain premium costs for consumers.

California Noted the state boldly embraced the ACA by enrolling 5 million more people in Medi-Cal and 1.3 million in Covered California. Expressed appreciation that ACA repeal did not occur in Congress in 2017.
Connecticut Stressed the state must act to ensure insurance marketplace stability and constrain premium costs. Urged legislature to pass a bill that preserves the most vital elements of the ACA, including the individual mandate, making it clear that in Connecticut health care is a fundamental right. Also wants to pass a law that ensures birth control remains cost-free, irrespective of what happens at the federal level.
Idaho Commented on importance of making health care more accessible and affordable, and how the state can ensure there is an adequate supply of trained workers in health care and STEM fields. Noted that despite some uncertainty on federal level health policy, the state has proposed ideas, such as the Idaho Health Care Plan proposal, as a way to be both conservative and compassionate. Highlighted this was not Medicaid expansion and strongly emphasized support for it. While state funds will be needed, the plan will lower health costs for families.
Iowa Prior to ACA, commented that state had an insurance market with relatively low costs and high participation, but that market is collapsing now. Indicated Iowa will continue to call on Congress to repeal and replace the ACA, but meanwhile the legislature should pass legislation to increase access to affordable insurance.
New York Noted that federal government is trying to “roll back health care for the poor,” and identified health care as a human right that the state will protect and preserve.
Oregon Promised to protect health care for state residents from federal level efforts that threaten care.
Rhode Island Commented that when Congress sought to repeal health care coverage, the state spoke out against it and emphasized that the state will continue to protect coverage.
Wisconsin Proposed the Health Care Stability Plan, which will include focus on passing a state law to guarantee coverage of pre-existing conditions (the state Assembly has already passed legislation). Also proposing through the plan that the state provide assistance to cover premium costs for people seeking coverage through the individual market by creating a reinsurance program through a 1332 waiver.

View the 2017 State of the State Chart here.
* As of late February 2018, the governors of LA, MT, MN, NV, NC, OH, and TX had not yet held their speeches or did not have a 2018 address planned.
**Jeff Colyer became governor of Kansas on Jan. 31, 2018, after Sam Brownback was confirmed as U.S. Ambassador-at-Large for International Religions Freedom.
***Ralph Northam was sworn in as Virginia’s governor on Jan. 13, 2018. Information from former Gov. McAuliffe’s state of the state speech and Gov. Northam’s inaugural address are both reflected in this chart.

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