Capitol Comments

The president's federal budget was released May 23 and the analysis of winners and losers began practically before the ink was dry, although almost all of Washington seemed to agree the budget was dead on arrival. Cuts to the Medicaid and Children's Health Insurance Program, or CHIP, alone total $616 billion over the next ten years. The budget also envisions saving $250 billion from partly repealing and replacing the 2010 health care law. Taken together, these Medicaid cuts are nearly half the nondefense discretionary funding cuts. To further understand just how important federal Medicaid funds are to states, CSG looked at 2017 federal funding flowing to the states. According to Federal Funds Information for the States, or FFIS, data, the federal Medicaid funding for 2017 is more than 50 percent of all federal grant funds flowing to states in all but four states.

A measles outbreak in Minnesota has reached 69 cases total and is costing public health departments thousands of dollars as they try to track, treat and control the spread of this disease. Among the 69 confirmed cases, 65 have been confirmed in people who are unvaccinated. In addition, 66 of the cases occurred in children under 18 as reported by the Minnesota Department of Health.

Medicaid Infographic

Medicaid is the second largest source of health care insurance in the United States, serving over 74.5 million people in some of our most vulnerable communities. Coverage is provided to low-income children, adults, seniors, and people with disabilities. Many Medicaid enrollees would be uninsured or underinsured without this coverage. The Medicaid program is funded with a combination of federal and state funds, with more federal participation in states with fewer fiscal resources.

CSG Midwest
In 2016, drivers distracted by their phones or other devices caused 1,230 crashes on Iowa roads, nearly double the number from a decade ago, state statistics show. This year, the state’s lawmakers passed two bills to crack down on these motorists.
CSG Midwest
Indiana has become the latest state in the Midwest to raise the gas tax and user-based fees to generate more revenue for its transportation infrastructure. The 10-cent increase on motor fuels takes effect on July 1; it will result in Hoosier motorists paying a total of 28 cents per gallon of gasoline. In subsequent years, through 2024, Indiana’s gas tax will be indexed to inflation, though annual increases will be limited to 1 cent per gallon.
CSG Midwest
Nebraska Gov. Pete Ricketts in April signed LB 195, also known as “Cheri’s Law,” requiring that women be notified of breast tissue density following mammograms. It had passed the states’ Unicameral Legislature by a vote of 48-0.
The law requires that written notice be given to women if a mammogram reveals heterogeneous or extremely dense breast tissue. Such tissue can make breast cancer more difficult to detect. Under the new law, mammography patients must be told that a finding of dense breast tissue is normal, and that notice is being given to raise awareness and so patients can further discuss risk factors and detection methods with their doctor.
CSG Midwest
Some Medicaid recipients in Wisconsin will have to submit to drug screenings and tests if federal officials give the OK to a demonstration waiver submitted by the state in April. This new requirement would apply to childless adults who are eligible for health insurance through the BadgerCare Plus program. As a condition of eligibility, individuals would have to complete a state-administered questionnaire. If the answers indicate possible abuse of a controlled substance, a drug test would be required. For anyone who tests positive, Medicaid eligibility would be contingent on completing a substance-abuse treatment program.
CSG Midwest
A quarter-century has passed since a U.S. Supreme Court decision limited the ability of states to collect taxes from the remote sales of out-of-state retailers. Legislators wanting to secure that taxing authority — which they say is critical to maintaining state revenue bases and helping brick-and-mortar businesses — believe a reversal of Quill Corp. v. North Dakota may finally be on the horizon.
“I do believe Quill will get overturned; it’s just a matter of time,” North Dakota Sen. Dwight Cook says. And one of the U.S. states most reliant on the sales tax as a revenue source, South Dakota, might bring the case that “kills Quill.”
A year ago, South Dakota lawmakers passed a bill requiring most retailers without a physical presence in the state to remit the state’s sales tax. SB 106 applies to sellers with 200 or more annual transactions in South Dakota or whose gross revenue from sales in the state exceed $100,000. This year, Indiana (HB 1129) and North Dakota (SB 2298) passed “economic nexus” laws of their own.
CSG Midwest
At a time of general wariness across the country regarding the use of standardized tests in schools (54 percent of respondents to a 2015 national survey said they are “not helpful”), Indiana lawmakers have tried to deal with a particular problem in their state.
“It came to a point where the ISTEP had become like the Ford Edsel,” Indiana Rep. Bob Behning says.
ISTEP+ is Indiana’s statewide assessment system, and over the past few years, its unpopularity grew amid reports of long delays in getting results, software glitches, scoring errors, and concerns about the amount of classroom time being spent on the test.
Last year, the Indiana General Assembly passed a bill ensuring that ISTEP+ would indeed go the way of the Edsel. This year, under a bill signed into law in April (HB 1003), lawmakers set parameters for a new assessment system, which will be known as I-LEARN and take effect during the 2018-19 school year. 
CSG Midwest
Take a look at the longer-term trends in maternal mortality rates, and you see one of the great success stories in modern-day public health: In 1900, for every 1,000 live births, up to nine women were dying of pregnancy-related complications; a century later, that rate had declined by almost 99 percent.
But the story told by more recent data is less clear, and more troubling.
According to the U.S. Centers of Disease Control and Prevention, the number of reported pregnancy-related deaths increased between 1987 and 2013 — from 7.2 deaths per 100,000 live births to 17.3 in 2013. Better reporting (for example, the addition of a pregnancy check box on state death certificates) is one explanation for the increase. Another reason, though, may be that pregnancy-related deaths are actually on the rise. The CDC notes, for example, that more pregnant women have conditions such as hypertension, diabetes and chronic heart disease that may put them at a higher risk of complications. 

Pages