In Washington, the philosophical and political questions about the future of health care in the U.S. are swirling. A House bill to repeal and replace the Affordable Care Act and change Medicaid financing was considered early in 2017 and failed. Notably absent from the debate surrounding this bill was how to fix the underlying cost drivers of health care. If and when other proposals are considered, the question of cost drivers will likely be absent from those debates as well. The action to tackle affordability is in the states. Medicaid directors are transforming the way health care is paid for and delivered to contain costs and improve health outcomes. This transformation is taking place in partnership with consumers, providers and other payers.
As educational institutions, industries and other organizations develop career and education pathways through stackable credentials, credential holders, employers, students and communities are often confused about navigating the stackable credentialing process. This article highlights some promising models from across the nation as the industry driven momentum for stackable credentials continues to increase in the labor market.
While STEM education has captured policymakers’ attention, few states have taken a systemic approach to STEM policymaking to ensure program coordination, reach, sustainability and return on investment. However, a few states have taken strides to establish statewide coordination, adequate and reliable funding, and evaluation. Those states have demonstrated results, including increased recruitment of female and minority students. Public-private partnerships and structures to formalize the role of business and industry in developing and implementing STEM programs are additional means to enhance these efforts and ensure alignment with employment trends.
In the world of state emergency management and homeland security, 2017 has been a year of new faces, continuous threats and opportunities for innovation. Much like 2016, 2017 is on track to equal or perhaps surpass the challenges it may pose to state emergency management professionals. It began with the Trump administration tapping a retired military general for the top job at the U.S. Department of Homeland Security, and a former State Emergency Management Director to head the Federal Emergency Management Agency, not to mention 2017 has already had 25 presidential and emergency disaster declarations. State emergency management professionals used virtual disaster assistance and training, introducing a new wave of technology to combat the increasing challenges of disaster management. The challenge in 2018 will be to protect investments and still move forward with creative problem solving while state and federal budgets continue to become tighter and tighter.
In recent years, the rate at which women enter into state-level offices has slowed following several decades of gains in the late 20th century. Efforts to recruit women for elective and appointive positions will be critical in determining what the future holds for women in state government.
U.S. population trends are showing something of a dual personality when viewed from the perspective of the nation as a whole or that of its regions. Nationally, population growth has yet again hit a new low, foreshadowing a likely future of only modest gains. Yet, on a more positive note, there is a notable rise in migration flows within the U.S. relocating more residents to fast-growing Sun Belt states as the post-recession economy revives.
There are few areas of state government more important to finances and operations than procurement. Although there are no aggregated figures for 50-state spending on goods and services, the importance of the state procurement function is demonstrated by the substantial sums posted by individual states. An audit several years ago in Arizona put procurement spending at $9.8 billion, about 27 percent of the total state budget.1 An October 2016 report from New Mexico’s Legislative Finance Committee estimated the slice of the budget spent on goods and services at as much as $13 billion out of a total budget of $18 billion.2
The current economic cost of professional and occupational regulation directly impacts one quarter1 of the working population in the U.S. The number of professions or occupations requiring a government license is nearly one quarter2 of the current working population. The majority3 of this increase has been the result of the increasing number of professions or occupations requiring a license. Recent domestic evidence also shows that states vary dramatically in their rates of licensure, ranging from 12 percent to 33 percent.