Health

The Health Policy Group provides policy analysis and innovative programming for state health policy leaders in the legislative and executive branches. This group also develops many publications and health forums for state leaders.

State leaders need access to critical and timely health policy information. CSG staff works to provide officials with best practices and policy analysis, helping lawmakers identify the best health solutions for their states.

A new organization in Utah, the Utah Alliance for the Determinants of Health, has been formed to improve overall community health by addressing social needs such as housing instability, utility needs, food insecurity, interpersonal violence and transportation. These are all non-medical factors that influence a person’s health. Public health researchers suggest that social determinants of health may account for up to 60 percent of health outcomes.

Gag clauses are at the forefront of state policy decisions as state policymakers attempt to reduce the cost of prescription medications. Gag clauses are established in PBM-pharmacy contracts prohibit pharmacists from informing consumers, unless asked, about cheaper ways to purchase prescriptions or access more effective alternatives, i.e., a lower cost generic drug or newer brand name drug with better outcomes. From 2016 to 2018, 22 states enacted legislation to prohibit the use of gag clauses to provide consumers and pharmacists more ability to communicate about cheaper options. Another nine states have legislation still pending. Eight states have legislation regulating pharmacy benefit managers, or PBMs, through audits, licensing and maximum allowable cost statutes that do not directly address gag clauses. More than eight states have Maximum Allowable Cost (MAC) statutes and auditing and licensing procedures enacted, however they also address gag clauses or claw backs specifically in their bill.

In a 5-4 decision in National Institute of Family and Life Advocates v. Becerra, the Supreme Court ruled that a California law requiring licensed pregnancy clinics to disclose they don’t offer abortions and unlicensed pregnancy clinics to disclose the fact they are unlicensed likely violates the First Amendment. The State and Local Legal Center (SLLC) filed an amicus brief in this case asking the Court not to apply the highest level of scrutiny (strict scrutiny) to commercial speech or to every disclosure requirement adopted by states and local governments.

California law requires that “licensed covered facilities” that provide family planning or pregnancy-related services must disseminate a notice stating that publicly-funded family planning services, including contraception and abortion, are available. It also requires “unlicensed covered facilities” to disseminate a notice they are unlicensed. The author of the law noted there are nearly 200 licensed and unlicensed crisis pregnancy centers in California. These centers “aim to discourage and prevent women from seeking abortions.”

The National Institute of Family and Life Advocates (NIFLA) operates licensed and unlicensed covered facilities that don’t offer abortions. It argues these requirements violate its First Amendment right to free speech.

Former first lady Michelle Obama famously planted a vegetable garden at the White House to model good eating to youngsters. Famous restauranteurs such as Alice Waters have been involved in school garden projects for years. These garden programs feel good but now there is evidence that they may, in fact, do good.

A study soon to be published in Preventive Medicine found that students who grow vegetables in a school garden report increased availability of fruits and vegetables at home, particularly the youngest students. The study results were previewed by Journalist’s Resources, a project of the Harvard Kennedy’s School which curates scholarly studies and reports and makes them available on an open-access site.

Virginia Legislature Votes for Expansion

On May 30, the Virginia Senate voted, with 4 Republicans supporting the measure, to expand Medicaid eligibility to all individuals with income at or below 138 percent of the federal poverty line, according to the Washington Post. Later in the day, the House of Delegates approved the bill by 67 to 31. Gov. Northam, a pediatrician who campaigned in 2017 on expanding Medicaid, is expected to sign the bill.

Recent polls record the American public’s concern about health care costs—and analysis documents the increase in out of pocket costs, up 11 percent on average in 2017. Policymakers worry that national health care spending—reaching $3.3 trillion or $10,348 per person in 2016 according to the official federal estimate and accounting for 17.9 percent of gross domestic product—is unsustainable.

At a recent meeting I attended in Washington, D.C., a group of researchers and health care industry officials addressed the question “Why are Healthcare Prices So High, and What can be Done About Them?”

My biggest take aways were slides showing that 50 percent of healthcare cost increases are driven by the prices charged and that Medicare and Medicaid have been able to hold healthcare prices steady while private insurance has seen a 70% increase since 1996.

CSG Midwest
Starting July 1, Iowa will have “the strictest abortion law in the country,” the Des Moines Register reports. SB 359 requires doctors to test for a fetal heartbeat; if one is detected, an abortion cannot be performed, except when required to preserve the life of the pregnant woman or protect her from “serious risk of substantial or irreversible impairment of a major bodily function.”
CSG Midwest
A quiet health care revolution is under way as Midwestern states revamp their delivery of mental health services with an increasing focus on behavioral health, which integrates mental health and substance abuse treatments, and an expansion of mental health services to children.
CSG South

This SLC Regional Resource raises policy considerations and highlights the connections between the ongoing opioid crisis and the national shortage of organs for transplantation. In addition, this report looks at the history and process of organ donation and transplants; actions taken at the state and federal level to facilitate organ donation; and how the national opioid crisis is affecting transplant rates.

In April, the federal government released $485 million in grants to states to combat the opioid crisis. The amounts of the grants, the same in both 2017 and this year, vary from $2million to states with less population to $44.7 million dollars to California.

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