State Health Systems Innovations

5/23/2019

NCSL’s Health Program, through support from The Commonwealth Fund, seeks to help state legislators and their staff learn about promising health system reforms and policy innovations that promote a more efficient and effective health care system and improve Americans’ health.

Background

The health care system in the United States is the most expensive in the world yet we are not the “healthiest” nation.

When compared to other countries—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom—the United States ranks last or near the bottom on measures related to health indicators, such as access, efficiency and equity. That is not to say that the U.S. hasn’t made progress in the last few decades because we have. For example, death rates for heart disease, cancer, stroke and motor vehicle crashes have fallen. Life expectancy at birth is at an all time high—76.2 years for men and 81 years for women. Fewer people are smoking, the number of health care acquired infections is down and more people have health insurance, to name a few. But there is still room for improvement. 

State Health Care Transformations

The health care system is undergoing a critical transformation in both financing and service delivery. The reforms and changes aim to improve the efficiency and effectiveness of health organizations and services, reduce costs and improve people’s health. State and federal governments play important roles in promoting this transformation. The resources listed below include information on state health transformation initiatives as well as a database of related laws for 2015-2017. 

Project-related NCSL activities include large national meetings, smaller invitational or state-specific meetings, Webinars, and publications in several formats.The products and projects below fall into two categories: 

  • Web-based or web published material which is accessible for immediate use.
  • Meetings and discussions described, with selected materials available in electronic formats.

How Much U.S. Households with Employer Insurance Spend on Premiums and Out-of-Pocket Costs: A State-by-State Look - May 23, 2019. Millions of Americans with employer health coverage are spending large shares of their income on health care costs, according to a new Commonwealth Fund report. The analysis looks at what people in every state report spending on premiums and out-of-pocket costs for medications, copays, and dental and vision care. It is a complement to an earlier report that looked at employer-reported premiums and deductibles.

States Step Up to Protect Insurance Markets and Consumers from Short-Term Health Plans - May 2, 2019  In this report from the Commonwealth Fund, analysts take a look at the steps states took in 2018 to ban or limit short-term plans and to affect the value of these products. State action aimed to protect consumers from products offering inadequate coverage and misinformation while safeguarding the individual health insurance market. New laws were passed with bipartisan backing and with support from consumer and patient advocates and health insurers.

Court Strikes Down a Trump Administration Rule Designed to Circumvent the Affordable Care Act - April 5, 2019: On March 28, a federal district court in Washington, D.C., invalidated the core of a Trump administration rule designed to alter the federal government’s long-standing approach to regulating association health plans (AHPs). Researcher from Georgetown's Center on Health Insurance Reform (CHIR) have written about how the new rule poses significant risks to consumers, health care providers, and insurance markets by making it easier for AHPs to offer coverage that is exempt from key Affordable Care Act (ACA) provisions.

The Role of Medicaid Expansion in Care Delivery at Community Health Centers - April 4, 2019: More than 1,300 Federally Qualified Health Centers (FQHCs) operate across the United States, providing affordable primary care to medically underserved communities, regardless of patients’ insurance status or ability to pay. Research shows they save the health system money, in part by reducing the need for people to seek more expensive care in emergency departments, while also serving as a boost to the economy through job creation and the purchase of goods and services.This brief uses data from the Commonwealth Fund 2018 National Survey of Federally Qualified Health Centers to compare the experiences of health centers in states that have and have not expanded Medicaid.

Teleconference: Making Health Care Price Transparency Work for Consumers - Feb. 13, 2019

This teleconference sponsored by the Commonwealth Fund was moderated by Shawn Bishop, Vice President, Controlling Health Care Costs and Advancing Medicare, the Commonwealth Fund. 

Featuring:

  • The role of prices and importance of price transparency: Anna Sinaiko, Assistant Professor of Health Economics and Policy, Harvard T.H. Chan School of Public Health
  • What do we know about price transparency and how it works, or doesn’t work, for consumers: David Blumenthal, President, the Commonwealth Fund
  • How can pricing information be more meaningful and useful for consumers: Eric Schneider, Senior Vice President for Policy and Research, the Commonwealth Fund

How does your state score? Magazine Feature

Map showing health system performanceNew “scorecard” data show 50-state performance over time in restraining costs and improving access to health care. - August 2018: State Legislatures magazine, STATESTATS [more]

 

Health System Performance Legislative Staff Seminar  - New Orleans, Oct. 10-12, 2018

This invitational meeting, sponsored by NCSL and supported by The Commonwealth Fund (TCWF), brought together professional state health policy staff to learn about and discuss state strategies to improve health system performance, payment reform and service integration to make health systems more efficient and effective. Presentations and resources are now available to NCSL members.   Meeting materials:

Latest  on HEALTH INSURANCE at Legislaive Summit 2018: Now Online

insurance formOn August 1 attendees heard Latest Ideas for Fixing Health Insurance Markets.  As health insurance policymakers and purchasers—and the voices of constituents—how can lawmakers play an effective role in getting to the next phase? View or download all the speaker slides and handouts now live/archived online in webinar format plus10 speaker resources.  Experts from the Trump administration HHS, the insurers, the state regulators and a leading legal policy analyst. 

State Roles in Improving Health Systems in a Changing Federal Landscape - California, Dec. 10, 2017

This meeting provided 40 legislative participants with opportunities to: Review current resources on Medicaid innovations and health system waivers available to states; Review the latest proposed federal policy changes to Medicaid and the private insurance markets; Discuss state health innovations, including use of Medicaid 1115 Waivers and State Innovation Waivers (under Section 1332 of the Affordable Care Act), with specific state examples;Learn what’s new in the insurance market and about state strategies to address insurance and coverage challenges.

Improving Health System Performance - Professional Legislative Staff Seminar -Louisiana, Oct. 26-28, 2016

NCSL Blog Posts

Combined list of NCSL blogs related to Fund research and publications.

NCSL LegisBriefs

NCSL State Legislatures magazine

 

ISSUE BRIEF:

State Health Laws Databases

  • 2015-2017 Health System Innovations - State Laws at http://www.ncsl.org/default.aspx?tabid=28925  (Updated weekly; Summer 2017)
    ► So far, NCSL has identified more than 1,000 recently enacted laws and resolutions in all 50 states, D.C.and Puerto Rico (Between January 2015 and Sep. 2017).
  • Map of 2017 Innovations enacted laws and resolutions
  • Map 2015-16 Innovations
  • 2014 Healthcare Reform Legislative Database
    2014 Tally: As of January 2015 this database contained 1,194 bills and resolutions in 48 states and D.C. Of these, at least 203 are now enacted laws across 42 states and D.C. In addition, 32 resolutions have been adopted in 16 states.

Meeting Sessions

Legislative Summit, August 6-8, 2017, Boston, Mass.

Medicaid: Challenges and Opportunities (Preconference) Sunday, Aug. 6 | 7:30 am-12:00 pm Summary: States need to be ready to respond and adapt if Congress and the Trump Administration make changes to Medicaid. It may mean a new price tag—along with opportunities and challenges—for the states. Hear from the administration, health experts and others about what federal changes may mean for states and about some best practices for improving efficiency and effectiveness in state Medicaid programs.   Speaker: Josh Archambault, Foundation for Government Accountability, Florida
Speaker: Joycelyn Guyer, Manatt Health Solutions, Washington, D.C.
Speaker: Hannah Katch, Center on Budget and Policy Priorities, Washington, D.C.
Speaker: Kathleen Nolan, Health Management Associates, Washington, D.C.
Speaker: Trinity Tomsic, Federal Funds Information for States, Washington, D.C.
Track: NCSL Standing Committees
Health and Human Services Committee
Health and Human Services
Downloads:      
 
Summary: States need to be ready to respond and adapt if Congress and the Trump Administration make changes to Medicaid. It may mean a new price tag—along with opportunities and challenges—for the states. Hear from the administration, health experts and others about what federal changes may mean for states and about some best practices for improving efficiency and effectiveness in state Medicaid programs.
Speaker: Josh Archambault, Foundation for Government Accountability, Florida
Speaker: Joycelyn Guyer, Manatt Health Solutions, Washington, D.C.
Speaker: Hannah Katch, Center on Budget and Policy Priorities, Washington, D.C.
Speaker: Kathleen Nolan, Health Management Associates, Washington, D.C.
Speaker: Trinity Tomsic, Federal Funds Information for States, Washington, D.C

Fixing Health Care: What’s Next? Deep Dive session

  •   Tuesday, Aug. 8 2017 | 10:15 am-12:30 pm Summary:

    Federal proposals to replace the Affordable Care Act portend dramatic changes for states. From the most visible features such as health exchanges, insurance subsidies or credits and the Medicaid expansion, to lesser known provisions, such as payment reforms and financing sources, states face major unknowns.

    What You’ll Learn:
    • The latest developments from Washington, D.C., and what they mean.
    • What new responsibilities and opportunities states have to improve health systems.
    • How states have responded, including what’s working and what’s not.
    • About resources that you may use in your state.

      Presiding: Richard "Dick" Moore, former Senator & NCSL President, Massachusetts
    Presiding: Senator Deb Peters, South Dakota
    Speaker: Barbara Anthony, Pioneer Institute, Massachusetts
    Speaker: Joseph Antos, American Enterprise Institute, Washington, D.C.
    Speaker: Chiquita Brooks-LaSure, Manatt Health, Washington, D.C.
    Speaker: Sara Rosenbaum, George Washington University, Washington, D.C.
    Panelist: Kim Holland, Blue Cross Blue Shield Association, Washington, D.C.
    Panelist: Christopher Palmieri, Commonwealth Care Alliance, Massachusetts
    Track: NCSL Standing Committees
    Health and Human Services Committee
    Continuing Legal Education
    Deep Dives
    Health and Human Services
           
    Summary: Federal proposals to replace the Affordable Care Act portend dramatic changes for states. From the most visible features such as health exchanges, insurance subsidies or credits and the Medicaid expansion, to lesser known provisions, such as payment reforms and financing sources, states face major unknowns. What You’ll Learn:

    • The latest developments from Washington, D.C., and what they mean.
    • What new responsibilities and opportunities states have to improve health systems.
    • How states have responded, including what’s working and what’s not.
    • About resources that you may use in your state.

    Co-Presiding: Richard "Dick" Moore, former Senator & NCSL President, Massachusetts
    Co-Presiding: Senator Deb Peters; President-elect of NCSL, South Dakota
    Speaker: Barbara Anthony, Pioneer Institute, Massachusetts
    Speaker: Joseph Antos, American Enterprise Institute, Washington, D.C.
    Speaker: Chiquita Brooks-LaSure, Manatt Health, Washington, D.C.
    Speaker: Sara Rosenbaum, George Washington University, Washington, D.C.
    Panelist: Kim Holland, Blue Cross Blue Shield Association, Washington, D.C.
    Panelist: Christopher Palmieri, Commonwealth Care Alliance, Massachusetts
    RESOURCES:

Legislative Summit, August 9, 2015, Seattle, Wash.

What New with ACA

 

What’s Next with States and the Affordable Care Act?     - 9:45-11:15 a.m.

Session Resources:

Medicaid session

 

Beyond the Status Quo: Tackling Medicaid System Performance  -

Session Resource:


 

 

Legislative Update on Health Exchanges and Insurance Reforms, at NCSL New Health Leaders meeting, La Jolla, California, Nov. 3, 2015
Two days after health exchanges opened for business in all 50 states, NCSL’s Health Program staff provided a timely review of the latest, third round of open enrollment and current news on insurance reforms. The slide presentation by Dick Cauchi and Ashley Noble and a 9-page Resource Kit designed for legislators, featuring fall 2015 data and Fund materials, are available for download.

Legislative Summit, Chicago, Illinois- Aug. 9-10, 2016

Legislative Summit logo 2016Deep Dive - Targeting Health Care Costs |  You know that health costs continue to rise, challenging state budget writers and squeezing other program priorities. But, how much do you know about where the money goes? For example, about 5 percent of the nation's patients account for half of health care spending. What you'll learn: 
• Where health care spending goes.

• State strategies to allocate health money more efficiently and effectively while improving patients' health.
• Ways to reduce inefficiencies and waste in the health system.

Moderator: Steve Rauschenberger, president TMA; former Illinois Senaor and NCSL President (2006-2007), Illinois
Speakers:
Cathy Schoen, N.Y. Institute of Medicine; formerly The Commonwealth Fund, executive director, Council of Economic Advisors (1975-2016), Massachusetts (Slides and Commonwealth-based Chart Pack)
Marilyn Tavenner, president and CEO, America's Health Insurance Plans (AHIP), Washington, D.C.
Tarren Bragdon, president and CEO, Foundation For Government Accountability (FGA), Florida
Panelists: Samar Muzaffar, Medical director, Nissouri Medicaid (Health Net), Department of Social Services, Missouri
Natassia Rozario, associate director, Camden Coalition of Healthcare Providers, New Jersey
>Download:  Session slides and resources

Webinars

September 21, 2018 teleconference sponsored by The Commonwealth Fund, “Getting to Lower Prescription Drug Prices in The United States: How Do Other Countries Do It?”- online at: https://www.commonwealthfund.org/press-release/2018/international-prescription-drug-prices-teleconference 

The State of Health Insurance - 2017. NCSL hosted this Webinar on Jan. 6, 2017 to provide a federal and state-oriented look at the private health insurance market. Hear three national experts discuss developments and policy scenarios. Click Here for slides. Moderated by Richard Cauchi and Rachel Morgan, NCSL, Denver, CO; Speakers: Brian Webb (NAIC), Kim Holland, BCBSA; Timothy S. Jost, J.D.  Presented Jan. 6, 2017
Resource: Repealing Federal Health Reform: Economic and Employment Consequences for States by The Commonwealth Fund.

Health Insurance State Flexibility
This webinar provided an insightful and timely look at state options for health insurance. Several national experts will share 2015 perspectives on what consumers, state policymakers, regulators and industry professionals face..(Included Kevin Lucia, J.D., MPH, research professor and project director at Georgetown University's Health Policy Institute. Introduction and Moderator: Richard Cauchi, NCSL Program Director [bio] ► "Speaker Presentations" (PDF file-24 pages). Presented 4/24/2015.

Integrating Behavioral and Primary Health.  
People with behavioral health needs often also have physical ailments that add to the complexity and cost of their conditions.
(PDF file-available on request) Presented May 15, 2015

NCSL Health Topic Web Resource Pages

Access

Medicaid

Health Providers and Workforce

Private Market

Public Health

Social Determinants of Health

 

The Commonwealth Fund logoNCSL acknowledges the generous support provided by a grant from The Commonwealth Fund.