By NCSL Health Program Staff
States continue to move forward on their public health priorities. NCSL works with states as they craft legislation to improve their health systems and public health initiatives.
This two-part blog series highlights 10 active public health issues in state legislatures, with examples of policy actions underway in states to improve their public health systems and the health status of the residents of their states.
Reducing health disparities remains a common theme that runs through many public health initiatives, addressing differences in health status among various groups of people, including ethnic minorities and rural residents. Within the 10 topics listed, lawmakers also address some of the social determinants of health, such as improving access to care, promoting wellness through personal responsibility, fostering economic success and providing services that support healthy lifestyles.
Improving State Medicaid Programs
Medicaid, a partnership program financed by the states and the federal government, provides insurance and health care services to low-income people including the elderly and many people with significant disabilities. Many public health issues are linked to the problems of families living in poverty. Medicaid policies address innovations and improvements through:
- Changing Medicaid eligibility levels.
- Modifying provider payment structures to reward quality and good health results.
- Improving or streamlining the benefit package for enrollees.
- Coordinating services for complex patients.
- Expanding coordination of services through accountable care organizations.
- Focusing on quality measures and patient outcomes data.
Stabilizing and Regulating the Commercial Insurance Market
State policies regulate much of the private insurance market, including the state health exchanges, individual and many small employer plans and some large employer health insurance coverage:
- Addressing access and health cost containment options and initiatives.
- Balancing access, affordability and regulation of prescription drugs.
- Examining state-based bipartisan solutions to insurance markets.
Addressing the Opioid Crisis
State legislators express concerns about the increasing number of deaths linked to opioid misuse and overdose. State legislative actions to manage the crisis include:
- Creating and improving prescription drug monitoring programs.
- Providing guidelines for opioid prescriptions, including limiting the dose or quantity that can be given in a single prescription.
- Improving public access to opioid reversal drugs (naloxone).
- Expanding Good Samaritan Laws, which exempt from legal liability a person who attempts to give reasonable aid to another person in the event of an overdose.
- Expanding drug courts and services, increasing the diversion of nonviolent drug offenders, to redirect the emphasis on addiction as a criminal offense and move towards a medical treatment model.
Challenges to states include keeping up with the demand for treatment and recovery services, improving effective prevention efforts, and the lack of data on effective programming.
Improving Access to Mental Health and Behavioral Health Services
Many states are moving forward to integrate mental health services into primary care systems, ensuring that medical care includes access to mental health providers. Laws address:
- Providing insurance reimbursement for mental health providers.
- Integrating mental health and behavioral health into primary care visits.
- Reducing the role of law enforcement in response to crisis situations brought on by mental health issues, and ensuring that patients are taken to health care facilities in an emergency.
- Ensuring payment for outpatient mental health services in state programs (for example in prisons and through foster care, and that state mental health outpatient programs are eligible for Medicaid reimbursement).
- Expanding and diversifying the types of mental health providers for different levels of services or treatment,
- Expanding the role of peer support specialists, who use formal training and personal experience with a mental illness or substance use disorder to provide education, support and connections to other servicesfor their peers. State legislative roles include providing funding for peer support services or providing Medicaid reimbursement for peer support services.
Addressing Health Workforce Shortages
Most states have shortages of health professionals to address the health care needs of residents who live in underserved areas (such as rural areas, some urban areas, and specific communities like tribal groups). State policies address health care workforce shortages through:
- Expanding and diversifying provider types and levels of providers such as community paramedicine and dental therapists.
- Establishing training and credentialing programs or standards of care for new provider types.
- Providing funding support for medical education programs and loan programs.
- Modifying or expanding existing providers’ scope of practice.
- Expanding telehealth services and other new technologies that expand the reach of providers by using phones, internet and computers to provide services.
Part 2 of the blog series will address the next five areas, which include:
- Improving public health data systems.
- Reducing maternal and infant mortality, and improving maternal/infant health outcomes.
- Preventing adverse childhood experiences.
- Exemptions for vaccine requirements.
- Addressing the legalization of marijuana.