Top 5 Issues in 2017: Health
CSG Director of Health Policy Deb Miller outlines the top five issues in health policy for 2017, including Medicaid reform, ACA repeal and replace, prescription drug costs, social determinants of health, and the opioid epidemic.
Federal Medicaid Reform: Will States be Left Holding the Bag?
Medicaid provides health insurance coverage for 73 million Americans. In 2015, total expenditures topped $530 billion; 38 percent of that amount was state funding. It is all but certain that big changes are ahead for Medicaid under the incoming Trump administration, but the shape, fiscal impact and speed of those changes are likely to remain unclear before the sine die adjournment of many legislatures writing state budgets in 2017. States will have many questions as they examine federal proposals for a block grant or per capita caps or some other funding formulation intended to reduce federal funding in the long term. Promised flexibility for states may or may not offset those reductions.
Repeal and Replace the Affordable Care Act: How?
The Trump campaign promised to repeal and replace the Affordable Care Act. However, any details of replacement remain unclear. Will states resume a more active role in regulating the health insurance market? How will the Medicaid expansion that 31 states and the District of Columbia implemented be funded in the future? How will a replacement for the ACA provide affordable coverage? The Kaiser Foundation reports that in 2016, $32.2 billion in tax credits helped 9.4 million Americans purchase health insurance.
Dealing with the High Cost of Pharmaceuticals
Public opinion polls find consumers concerned with the high cost of prescription drugs and the increase in their out-of-pocket costs for medicines. States, as providers of health insurance to employees, retired employees, Medicaid enrollees and rising prison populations, share their concerns. States are exploring benefit management strategies, rebates and effectiveness research to leverage savings, while still providing access to life-changing treatment options. At the federal level, proposals have been made to allow importing less expensive prescription drugs from Canada and other countries and to negotiate bulk purchasing for the Medicaid and Medicare programs.
Social Determinants of Health
Increasingly, state decision-makers are taking a public health approach to improving health, pointing to high levels of spending that fail to generate positive health outcomes as compared to other nations. Social determinants of health—factors like socioeconomic status, education, physical environment, employment and social support networks—have a significant impact on health outcomes. To address the social determinants of health, states are linking broader social initiatives to health improvement, including early childhood education, school reforms, transportation and environmental policies.
The Opioid Epidemic: State Solutions
No state or community is exempt from the scourge of the growing opioid epidemic. According to the Centers for Disease Control and Prevention, opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999. Prescription drug abuse gives way to heroin and now the vastly more powerful and dangerous drug fentanyl. States are looking for solutions, expanding treatment program availability and risk reduction strategies such as syringe exchange programs and naloxone distribution. Changes in federal Medicaid funding, however, may impact the availability of affordable treatment programs. Medicaid expansion opened treatment options to new populations and federal parity laws require insurance coverage of behavioral health and substance use disorders equivalent to the coverage provided for physical health.