Health costs account for about one-third of state budgets, ranging from financing Medicaid, to paying for state employees and other populations, such as prisoners. State legislatures make thousands of health policy decisions each year, including improving access to appropriate care, determining who should be immunized, licensing health professionals and facilities, and supporting initiatives to keep people healthy.
The Affordable Care Act of 2010 (ACA) brings substantial changes to the health care system. The Health Insurance Marketplaces or Exchanges opened for enrollment in all 50 states on October 1 and coverage begins on January 1. Half of the states opted to expand Medicaid for adults with incomes up to 138 percent of the federal poverty level, so far. In addition, the law put in place new health insurance regulations that affect premium rates, enrollee assistance and appeals and coverage for young adults and people with preexisting conditions, among other things. State legislatures considered more than 2,000 bills that relate to the ACA since its passage, with more state decisions likely in 2014.