Health Overview


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 website provides health reports and updates listed by 40-plus topics.

The Affordable Care Act of 2010 (ACA) brought continued substantial changes to the health care system. In 2017-2018, Congress and the Trump administration took limited steps toward repealing, replacing or revising the law. The Health Insurance Exchanges or Marketplaces opened for 2019 enrollment from Nov. 1 to Dec. 15, 2018, while a dozen states extended deadlines and expanded marketing. For Medicaid, as of January 2019, 36 states and Washington, D.C., have opted to expand state Medicaid programs for adults with incomes up to 138 percent of the federal poverty level. In addition, the ACA continues to require health insurance regulations that affect premium rates, enrollee assistance and appeals, coverage for people with preexisting conditions and young adults added to family policies, among other things.

Hot Topics:

  • State laws and actions challenging certain health reforms (December 2018 update). Learn about state laws and actions in 22 states opposing or opting-out of elements of health reforms, updated for 2014-2018. This includes a special update on a Dec. 14, 2018, district court opinion declaring the ACA unconstitutional.
  • Prescription drug costs and access are in the spotlight again. NCSL's expanded Prescription Drug Policy Resource Center provides access to legislative activities, research and news.
  • Section 1332 waivers—state roles and legislation. The NCSL 1332 report shows 35 states with initial bills and 20 states with signed laws; now eight states are approved by HHS as of Jan. 1, 2019.

NCSL legislation databases for 2018. The Health Program hosts four active health databases. Users can search by state, topic, keyword and/or primary legislative sponsor. Results are available at no charge; users can now view full text and all other features. Status updates are added once a week for 2018 through late November. New 2019 measures will be added beginning in late January.

  • Health Innovations Database covers what state legislatures are enacting that changes Medicaid, private and commercial health insurance, access, health exchanges and other state action on health reforms. NCSL identifies more than 1,000 recently enacted laws and resolutions from 2015-2018 in all 50 states, Washington, D.C., and Puerto Rico. The 2018 laws were added as they were signed.
  • Prescription Drug Legislation Database provides tracking of both bills and new laws for 2018, plus 2015-2017 history on major policies affecting prescription drugs and biologic medicines.
  • Injury Prevention Legislation Database offers searches for bills and laws concerning drug abuse, pain clinics, rescue drugs, monitoring programs and others.
  • Health Scope of Practice Database was launched in January 2017, and features enacted laws and 11 interactive maps. 

[Updated for January 2019]