Governors use their annual state of the state addresses to showcase recent successes and define their policy priorities for the year ahead. By late February, 45 governors had delivered speeches outlining plans to address a wide range of health and related issues in the coming months. All mentioned their states’ responses to COVID-19, frequently praising frontline responders and public health agencies and applauding their states’ agile interagency actions to address the pandemic.
However, the issues governors addressed do not exist in silos. Many of these important topics, including equity, broadband, mental health, and justice, are themes woven throughout their addresses. Below are highlights of the key themes that governors raised.
Every governor framed his or her state of the state address through the lens of COVID-19. Of those, 34 governors discussed specific plans for COVID-19 recovery. Twenty-seven focused on plans for expedient and equitable vaccine distribution and 11 governors discussed plans for community recovery.
Governors emphasized the importance of getting doses into arms quickly while prioritizing an equitable distribution – they highlighted state plans to build pop-up and mass vaccination clinics and deploy their National Guard units to aid in vaccination efforts. Several governors also highlighted innovative plans for community recovery both during and after the public health emergency ends. For example, Gov. Andrew Cuomo of New York announced his plan to build a public health corps to facilitate vaccination operations and share learnings and best practices to ensure New York is better prepared for future crises.
Governors also highlighted the importance of partnerships during the pandemic – between a state’s executive and legislative branches to pass emergency relief bills, as well as collaboration with other states to share workforce and supplies, such as the Northeast partnership between Connecticut, Rhode Island, Massachusetts, New Jersey, and New York.
Forty-one governors discussed education in their state of the state speeches — up from 34 last year. It is well documented that individuals with more and better education experience improved health outcomes, and Pennsylvania Gov. Tom Wolf identified education as a critical social determinant of health, saying “universal high-quality education leads to healthier people and healthier communities.”
The majority of governors addressed the impact of the COVID-19 pandemic on children, educators, and families. Fourteen governors underscored the importance of fully funding K-12 schools despite the tight budgets that states are facing this year and 11 governors emphasized the importance of safely opening schools. Governors proposed a variety of approaches to encourage schools to reopen so that children could get back to learning in-person:
- Arizona Gov. Doug Ducey proposed tying school funding to in-person learning as a way to incentivize schools to re-open their doors.
- Massachusetts Gov. Charlie Baker said his team has been “working with a number of lab partners to develop a weekly COVID testing program for kids, teachers and staff.”
- Nevada Gov. Steve Sisolak said that getting back to the classroom was the reason his state had “prioritize[d] our educators for vaccinations.”
Fifteen governors expressed support for expanded early childhood education programs, pre-kindergarten options, and improved childcare for young children. Participation in early childhood education programs has been linked to better health, higher educational achievement, and higher socioeconomic status in adulthood. But this year, two governors were also promoting it as a necessary childcare option for working parents, particularly mothers, who have had to leave the workforce to take care of children during the pandemic.
Recognizing the contributions that teachers have made throughout the pandemic was also a recurring theme. Fifteen governors proposed additional compensation for teachers through raises, bonuses, or increased pensions. Though some of these pay increases are aimed at improving teacher recruitment and retention, several governors framed them as a way to acknowledge the additional job challenges presented by COVID-19. Alabama Gov. Kay Ivey, for example, proposed a budget that included “a 2 percent pay increase as a way to express our state’s gratitude to our teachers who rose to the challenge during an unprecedented time for our state.”
In addition to acknowledging the challenges of the past year, governors also emphasized the variety of supports that children and families would need to recover from the pandemic. Ten governors proposed new college scholarships to alleviate financial stress for students and families, five introduced plans to increase support for low-income students and English-language learners, and four discussed the need for increased mental health supports as students return to school.
Thirty governors discussed broadband and the internet access during their state of the state addresses, up from 16 last year. The issue of broadband and internet access became a significant issue during the pandemic, especially as it related to equity in accessing on-line education and telehealth services. Maine Gov. Janet Mills noted that, “high-speed internet is as fundamental as electricity, health, and water. It is the primary way of connecting with others in the 21st century.” Though the digital divide existed prior to the COVID-19 pandemic, the public health emergency highlighted the importance of access to reliable Wifi and exacerbated existing disparities. Seven governors specifically commented on the need to reduce the digital divide, with New Jersey Gov. Phil Murphy commenting on the state’s progress from 2020, noting that in the past year it had worked to close the digital divide and today, 95 percent of students have the tools they need, and the state is working to close the gap to zero.
Thirteen governors also connected reliable broadband to education. Connecticut Gov. Ned Lamont noted how COVID-19 revealed that, “…too many students are left on the wrong side of the digital divide that exacerbates the achievement gap. Computers, internet access, and broadband – these are the tools essential to students’ success during COVID and for the foreseeable future.” At least 10 governors noted their fiscal support to ensure equitable access to broadband has increased across the state. Idaho Gov. Brad Little reiterated that for children to have a future, they need equal access to education. He spoke about how Idaho could benefit for years from a $50 million investment in broadband infrastructure, to support remote working and learning, especially in rural Idaho.
Eight governors also cited the urban/rural divide in broadband access and shared plans to expand broadband in rural areas. Oregon Gov. Kate Brown’s budget proposal would invest over $100 million in broadband expansion statewide, focusing specifically to provide access to rural communities that have been disproportionately impacted during the pandemic. Wisconsin Gov. Tony Evers noted that Wisconsin ranked 36th in the country for accessibility in rural areas and declared 2021 the “Year of Broadband Access.” His 2021-23 biennial budget proposes to invest around $200 million into broadband — nearly five-times the amount invested in the past three budget cycles combined.
Jobs, Livable Wages, and Unemployment Insurance
A total of 28 governors spoke about employment-related issues, focusing primarily on local economic growth efforts and workforce development to help connect individuals to higher-paying jobs. A few governors also commented on how their states’ unemployment systems were strained to capacity due to pandemic-related need.
Many governors mentioned planned investments in job training initiatives. Gov. Steve Sisolak commented on the creation of the Nevada Job Force that would engage leading businesses to fund and develop employment training programs, and also mentioned plans to establish a Remote Work Resource Center to connect individuals to job opportunities in other regions. Montana’s governor indicated that the current budget allocates funds for trades education by offering up to 1,000 scholarships a year and providing businesses with a 50 percent tax credit if they have employees who participate in the program. South Carolina’s Gov. McMaster proposed directing $60 million towards job skills training for high-demand manufacturing jobs and another $37 million for workforce scholarships and grants at technical colleges. Indiana’s governor advocated for continued investment in successful existing workforce development programs that have helped many individuals complete post-secondary education and obtain higher-paying employment.
In recognition of pandemic-caused job loss and the greater number of individuals relying on unemployment insurance (UI) who sometimes had difficulty accessing these benefits, governors in Illinois, Kansas, Wisconsin pledged to invest resources into UI system improvements. Governors in Delaware, Illinois, Kansas, Maryland, Tennessee stressed the importance of continuing to support small businesses as they begin to rebuild post-pandemic. Georgia’s governor commented that the state should promote “…job creation from those industries that are critical to health care and building on Georgia’s momentum to become a leader in all sectors of the health care industry.”
Twenty-three governors addressed environmental issues — down from 30 in 2020. Only Gov. Jay Inslee of Washington drew the explicit connection between the changing climate and the emergence of novel diseases like COVID-19, while most governors focused on the economic opportunity of investing in clean and alternative energy. Among governors’ top priorities was improving access to clean water:
- Gov. John Carney of Delaware: “We’ll again propose a $50 million investment in a new Clean Water Trust Fund. We will make sure that all Delaware families have access to clean drinking water. And we will place a special focus on those hard-to-serve families across our state.”
- Gov. Gretchen Whitmer of Michigan: “Last year, I announced the MI Clean Water Plan, a $500 million investment in Michigan’s water infrastructure. Direct dollars to communities for safe, clean water to residents. And it supports over 7,500 Michigan jobs. It’s time for the legislature to pass these bills so we can start rebuilding Michigan’s water infrastructure. I will keep working so every family in Michigan has clean, safe water.”
Twenty-two governors mentioned behavioral health in their state of the state speeches, including the effect of COVID-19 on mental health and substance use disorder. Arizona Gov. Doug Ducey identified impacts of COVID-19 “beyond the disease itself… opioid abuse, alcoholism, addiction, mental health issues, the sheer loneliness of isolation, suicide: there has been no daily count of these human costs, but they are real and they are devastating.”
Nine governors mentioned significant investments in their state’s behavioral health care infrastructure and services and eight governors addressed substance use disorder (SUD) prevention and treatment as a priority.
- Alabama Gov. Kay Ivey said the state is investing “$46 million investment to expand 96 beds at the Taylor Hardin facility in Tuscaloosa and another $6 million for an additional crisis diversion center.”
- In Montana, Gov. Greg Gianforte plans to use tax revenues from the sale of recreational marijuana, state and federal funding to create a $23.5 million fund to provide a continuum of SUD services.
- Missouri Gov. Michael Parson plans to invest in their workforce with “$20 million for 50 new community mental health and substance use disorder advocates and six new crisis stabilizations centers across the state.”
- Maine Gov. Janet Mills announced, “$7.5 million for mental health and substance use disorder, including community mental health and $2 million for our OPTIONS Initiative to dispatch mobile response teams to those communities that have high rates of drug overdoses — something that is more important than ever, given the increase in overdose deaths in Maine and the rest of the nation during the pandemic.”
Ten governors emphasized the impact of school closures on children’s mental health and made commitments to addressing the problem. Tennessee Gov. Bill Lee’s budget includes “$6.5 million in our mental health safety net which will be focused on providing services for school-aged children struggling with mental health issues.” South Carolina Gov. Henry McMaster’s budget includes a proposal so that all children in school have access to a mental health counselor.
Governors identified technology as an important tool in the delivery of behavioral health services. Four governors identified telehealth to increase access to behavioral health services and two governors mentioned support lines for their residents.
- Colorado Gov. Jared Polis, discussing telehealth stated, “….which isn’t just a useful innovation in a time of social distancing. It’s a convenient tool for folks who want to receive care from the comfort of their own homes, and it’s literally a lifesaver for many Coloradans in rural areas who may live far away from doctors and clinics and hospitals.”
In her state of the state address, New Mexico Gov. Michelle Lujan Grisham announced, “the nation’s first text-only abuse and neglect hotline for New Mexico children, providing them an outlet that research has shown they may be more comfortable using.”
Legal System Reform
In 2020, the murders of George Floyd and Breonna Taylor highlighted the need for criminal justice reform. This year, 22 governors referenced justice in their state of the state speeches, more than in 2020. Criminal system reform is a key health issue as corrections-involved individuals have high rates of chronic conditions and poor mental health outcomes.
In addition to legal system reform, governors addressed infrastructure investments in correctional facilities, expanding re-entry programs and treatment courts and the death penalty. Governors in four states, Connecticut, Kentucky, New Jersey and Virginia, have plans to legalize marijuana.
Ten governors mentioned reforming their state’s criminal legal system through a variety of policies, including banning chokeholds, limiting no-knock warrants, and eliminating mandatory minimums for nonviolent crimes. Virginia Gov. Ralph Northam addressed expungement in his speech stating, “rooting out inequities includes expunging the records of people who were convicted of this and certain other crimes in the past.”
Governors in Alabama, North Dakota and Tennessee addressed re-entry programs. Tennessee Gov. Bill Lee’s budget includes “$4.7 million for additional day reporting centers and evidenced-based programming for community supervision. This approach ensures that re-entry to society is done in the most safe and effective way possible for those who were formerly incarcerated.” Montana Gov. Greg Gianforte’s budget includes an investment in [drug] treatment courts. He stated, “…we must prioritize and invest in treatment courts. Treatment courts work. They reduce recidivism. They reduce drug use. They increase public safety. And they are much more cost effective than incarceration.”
Health and Social Equity
COVID-19 has laid bare health and social inequities, and 2021 state of the state addresses shows that achieving equity is a bipartisan goal – 21 governors discussed strategies to work towards equity. Reducing racial and ethnic disparities is of great interest to governors, several discussed racism and racial injustice, describing how communities of color, including tribal communities, were disproportionately impacted by COVID-19, and they expressed their commitment to improvement. To address this, two governors announced new positions dedicated to increasing equity:
- Delaware Gov. John Carney created a new position, Director of Statewide Equity Initiatives, designed to make sure those in state government are leading with equity. He noted, “…We’ve also worked hard to build a cabinet that looks like Delaware. We created the position of Chief Diversity Officer to focus on recruitment and retention of a diverse state workforce.”
- Indiana Gov. Eric Holcomb announced, “We’ll get our state’s first-ever cabinet-level Chief Equity, Inclusion, and Opportunity Officer to improve and report on diversity outcomes across state government.” He also announced the state’s plan to launch a diversity data dashboard.
Equity was also woven into governors’ speeches around various topics. Eleven governors addressed equity in access to jobs and health care, seven governors addressed the impact of inequities and education, five governors discussed the intersection of equity and women and children’s health – including New Jersey and Indiana’s governors announcing programs to reduce infant and maternal mortality. Seven governors discussed increasing equity in broadband and internet access and closing the digital divide:
- Hawaii Gov. David Ige announced that his legislative package includes a bill to create a Broadband and Digital Equity Office. This office will help enable the state to identify and secure Hawaii’s share of federal funds to enhance broadband infrastructure and digital equity programs.
New Mexico Gov. Michelle Lujan Grisham stated, “We will enact an equity-first budget for public education, ensuring money reaches students and schools in proportion to the socioeconomic needs of families in the community, laying the path to a public education system that truly delivers for students now and a hundred years from now, no matter their zip code, their family circumstances or the color of their skin.”
Medicaid, Coverage and Access to Care
While all states have experienced Medicaid enrollment growth due to the pandemic’s economic effects, only nine governors explicitly mentioned Medicaid in their speeches. Only Nevada’s Gov. Steve Sisolak commented on the program’s increased enrollment, and he indicated that the upcoming budget would reverse provider rate reductions due to revenues surpassing initial projections. Governors in Missouri and Oklahoma mentioned their states’ plans to implement Medicaid expansion in response to ballot initiatives that were passed last year, and as in the prior year, Gov. Laura Kelly in Kansas again advocated for the state to take up expansion.
Tennessee’s governor highlighted the state’s recently approved Medicaid block grant waiver and also noted planned investments in the health care safety net and extensions of Medicaid coverage for adopted youth and during the postpartum period. Oklahoma’s Gov. Kevin Stitt mentioned the state’s move toward Medicaid managed care as “the best way forward” and Indiana’s governor commented that implementing a managed long-term services and supports program within Medicaid would help families more easily navigate care options.
The broader topic of health coverage and access to care was cited more frequently than Medicaid, with 17 governors commenting on this issue. Most commonly, governors focused on the crucial role that telehealth has served over the past year in maintaining access to both health and behavioral health services. Governors in Hawaii, Idaho, Indiana, Iowa, Kentucky, Missouri, New York, and Texas advocated that expanded telehealth capacity should be sustained and strengthened after the pandemic, and Gov. Charlie Baker commented on Massachusetts’ recent actions to make its telehealth changes permanent.
Colorado’s Gov. Jared Polis noted plans to once again try to pursue a public option to expand coverage, commenting: “And we look forward to adding an affordable Colorado Option that will give Coloradans — especially in rural communities — more choice and savings, when it comes to selecting a health care plan.” Gov. Andrew Cuomo proposed expanding access to affordable coverage by eliminating premiums for 400,000 low-income New Yorkers, and New Mexico’s Gov. Michelle Lujan Grisham mentioned plans to create a Healthcare Affordability Fund that could potentially provide health coverage to 23,000 uninsured New Mexicans within a year.
Housing and Homelessness
Sixteen governors addressed housing or homelessness in their 2021 speeches. The COVID-19 pandemic has exacerbated the United States’ existing affordable housing crisis. Additionally, people experiencing homelessness are at an increased risk of contracting COVID-19. The CARES Act Emergency Rental Assistance Program allocated funding to states for rent and mortgage relief.
Six governors discussed their eviction prevention programs and eviction moratoriums. New Jersey Gov. Chris Murphy commented “as the pandemic literally hit people where they live, we instituted strong prohibitions against evictions and utility cutoffs to protect our families. We provided rental assistance to nearly 20,000 individuals and families facing immediate challenges.” In addition to eviction prevention, Illinois Gov. J.B. Pritzker “dedicated a record $275 million to help pay utility bills for those suffering COVID-related income loss. Homelessness is never acceptable, but in a pandemic it’s downright barbaric.” Two Governors, New York Gov. Andrew Cuomo and Oregon Gov. Kate Brown addressed homelessness, Gov. Andrew Cuomo stating, “homeless shelters must be available, safe and secure. It’s not just our moral obligation, it is our legal obligation.”
Eight governors addressed expanding access to affordable housing. Virginia Gov. Ralph Northam stated, “it’s also time to help people by taking more action on affordable housing. We have made record investments in the Virginia Housing Trust Fund that helps make more affordable housing available.” Oregon Gov. Kate Brown’s budget includes a $250 million dollar investment in affordable housing, homelessness prevention and rental assistance. Governors also identified strategies to address property taxes, exclusionary zoning and the cost of land as barriers for affordable housing.
Health Care Costs
Eleven governors addressed health care cost and affordability — down significantly from 2020, when 21 governors addressed the issue. This year, governors focused on lowering health costs for consumers affected by the economic impact of the pandemic. Several introduced strategies to lower consumers’ premium costs:
- Gov. Andrew Cuomo of New York proposed the elimination of health care premiums for more than 400,000 low-income New Yorkers.
- Gov. Phil Scott of Vermont directed his Department of Health Insurance Regulation to determine whether Vermonters are eligible for premium rebates due to low health care utilization during the pandemic.
- Gov. Phil Murphy of New Jersey highlighted the state’s successful launch of its State-Based Marketplace, which has lowered premiums for hundreds of thousands of New Jersey residents.
- Gov. Michelle Lujan Grisham of New Mexico mentioned plans for a Healthcare Affordability Fund that would dedicate resources to lowering health insurance premiums and protect consumers from burdensome out-of-pocket costs.
Governors in Connecticut, Oregon, Vermont, and Utah seek to curb their state’s health care spending through cost and/or quality benchmarks. Vermont Gov. Phil Scott proposed setting a cap on annual price increases for health costs. In New Jersey and Utah, governors expressed their commitment to improving price transparency and data sharing, emphasizing the importance of building resources to help consumers better understand health care costs.
Only four governors addressed rising prescription drug prices – a significant decrease from last year when 12 governors addressed the issue.
Health Care Workforce
This year, eight governors addressed health care workforce issues, with most proposing solutions to meet the increasing demand for providers during the pandemic. Governors in three states proposed educational initiatives to bolster health care workforce development, including a grant program introduced by Gov. Mike Parson of Missouri to fund new health care associate degree programs at community colleges. Gov. Pete Ricketts of Nebraska shared plans to expand the health care workforce by formalizing flexibilities implemented during the pandemic that allow licensed health care professionals from other states to practice in Nebraska, and governors from Kentucky, Idaho, and Nevada committed increased funds to address provider shortages. Two governors remarked on the importance of their volunteer workforce, with Gov. Ralph Northam of Virginia calling on retired nurses and doctors to contribute to the COVID-19 vaccination effort.
Other Health-Related Issues
A sampling of other health-related topics that governors mentioned included:
- Transportation: Twelve governors talked about the need for modernized and healthy transportation systems. Indiana’s governor promoted his plan to convert old train tracks into hiking and biking trails, and Colorado’s governor made the connection between multi-modal transit options, electrification of transportation, and cleaner air.
- Child Welfare: Six governors discussed the child welfare system, highlighting progress and the need for more reform. Arkansas’ governor made a commitment to preventing abuse and protecting vulnerable children in the foster care system. Tennessee’s governor announced an extension of Medicaid coverage for foster children that would ensure a more seamless transition to family’s health plans during the adoption process.
- Violence prevention: Arkansas’ governor urged state legislators to pass hate crimes legislation, Georgia’s governor highlighted the need to address sex trafficking, and Alaska’s Gov. Mike Dunleavy indicated that his budget fully funds the state’s domestic violence and sexual assault programs and includes $7 million to help prosecute individuals who commit sexual assault and domestic violence crimes. Montana Gov. Greg Gianforte addressed the crisis of missing and murdered indigenous individuals, who make up 7 percent of the population but account for 26 percent of missing persons.
- Medical supplies: New York’s Gov. Andrew Cuomo commented on the state’s medical supply chain being too reliant on overseas manufacturing and noted plans to incentivize state businesses to produce medical supplies.
- Food: Eight governors discussed food security, production, and distribution. Several governors commended the additional food security supports that were put in place to meet families’ needs during the pandemic. Oregon’s governor talked about new funding for wrap-around services in schools, including nutrition support.
- Wellness promotion: Oklahoma’s governor said that state leaders should address the high rates of obesity, diabetes, and heart disease among state residents.
Despite the significant challenges of addressing COVID-19, states are continuing to pursue innovative policies and initiatives to address a wide range of health and health-related issues, with many proposals developed directly in response to disparities highlighted by the pandemic. The National Academy for State Health Policy will continue to track many of these topics in the coming months.