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 or rejecting initiatives to keep people healthy. NCSL's web site provides health reports and updates listed by 50+ topics, on the right-hand column.
The Affordable Care Act of 2010 (ACA) brings substantial changes to the health care system. The Health Insurance Exchanges or Marketplaces opened for enrollment in all 50 states on October 1, 2013; year two enrollment begins Nov. 15, 2014. So far, 27 states opted to expand Medicaid for adults with incomes up to 138 percent of the federal poverty level. In addition, the law put in place new health insurance regulations that affect premium rates, enrollee assistance and appeals and coverage for people with preexisting conditions and young adults added to family policies, among other things. State legislatures considered more than 2,500 bills that relate to the ACA since its passage, leading to 500+ signed into law as of Dec. 2013. For 2014 there have been more state decisions and another 1,194 bills considered; more than 235 have been signed into law or adopted.