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.
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.
- 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
New “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
On 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.
- 2018 Action and Reaction in State Health Insurance Markets. What's Next for 2019? Much like Newton's third law of motion, 2018 proved to be a year of action and reaction for state legislatures and their insurance marketplaces. Posted Feb. 19, 2019, by Colleen Becker.
- 2018 Outlook for Health Insurance.
Could 4 million Americans drop health insurance this coming fall? Could new “skinny” health plans appeal to consumers who rarely see a doctor? Can a hard-to-explain new waiver lower your premiums? Now that the new federal tax cut law has altered a core provision of federal health law by repealing the individual mandate, what’s next?
-Posted Jan. 2, 2018, by Richard Cauchi; five links to Commonwealth Fund Pre-Con session agenda.
John Bertko, Covered California Sara Collins, The Commonwealth Fund | Presentation Kevin Lucia, Georgetown University Center on Health Insurance Reforms North Dakota Representative George Keiser (R) Maryland Delegate Dan Morhaim (D) Karen Shields, formerly with Centers for Medicare and Medicaid Services until October 2017 and now with Serco Americas Myra Simon, America’s Health Insurance Plans | Presentation Hemi Tewarson, National Governors Association
Value-Based Purchasing for Prescription Drugs
Everyone knows prescription drugs can be expensive. But what if the price of a drug was linked to whether it cured or improved the condition of a patient who used it?
-Posted Nov. 9, 2017 by Ashley Noble with link to Commonwealth Fund published issue brief on Outcomes-based Contracts for High Drug Spending | Permalink |
States Tackling 'Balance Billing' Issue
The practice of a provider billing a patient for the difference between what they received in reimbursement from an insurance carrier and what they actually charge for their services is known as balance billing, or a surprise bill, and it’s not uncommon.
-Posted July 12, 2017, by Ashley Noble; links to Commonwealh Fund issue brief: Balance Billing by Health Care Providers: Assessing Consumer Protections Across States
'One Care' for Complex Health Coverage.
People with multiple, chronic medical conditions are one of the most expensive populations to treat.
-Posted June 28, 2017, by Ashley Noble; links to The Commonwealth Fund case study of the Commonwealth Care Alliance
States Aiming Higher: New Health Systems Scorecard
The Commonwealth Fund has released a new 2017 Edition of "Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance." The report follows up on the Commonwealth Fund’s previous scorecards that analyze state performance and progress.
-Posted March 27, 2017; by Ashley Noble; links to "Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance."
Targeting High-Need, High-Cost Patients Can Save Money
Half of medical expenditures in the U.S. can be attributed to about 5 percent of the nation’s patients – those with high health needs.
- Posted Dec.19, 2016, by Richard Cauchi; links to Dr. Blumenthal PPT slides ; Survey of High-Need Patients (12/9/2016)
NCSL Report Details State Strategies to Improve Health Systems
Around the nation, states are implementing innovative strategies to “bend the cost curve” while ensuring that Americans have access to high-quality care.
-Posted Sept. 27, 2016 by Ashley Noble; links to ImprovingHealthSystems [PDF]
Value-Based Payments Changing Costs in State Medicaid
Where are states playing a leading role in driving value into the health care system
- Posted June 28, 2016, by Richard Cauchi; links to The Fund-supported National Association of Medicaid Directors (NAMD) report on “The Role of State Medicaid Programs”
Innovation Waivers: Can Your State Change the Health Law?
Beginning next January, a new state option, known as "1332 Waivers," within the Affordable Care Act (ACA) will take effect.
- Posted April 1, 2016, by Richard Cauchi; links to Commonwealth online publication
Health Survey Shows 50-state Progress, Challenges
States have made significant improvements in health systems performance over the past couple of years, according to a new report from The Commonwealth Fund, "Aiming Higher: Results from a Scorecard on State Health System Performance, 2015 Edition."
- Posted Jan. 26, 2016, by Ashley Noble; links to The Commonwealth Fund Scorecard
Five State-Run Marketplaces Using HealthCare.gov.
Nov. 1 marks the beginning of the third year of health insurance exchange or marketplace sales to residents of all 50 states and D.C.
- Posted Oct. 8, 2015, by Richard Cauchi; links to The Commonwealth Fund Issue Brief
Adequacy in Health Networks Can Be Difficult to Define
Federal law requires that most commercial health insurance plans have “adequate” networks of providers, but what constitutes “adequate” or “sufficient” is not explicitly defined under federal law.
- Posted Aug. 12, 2015, by Ashley Noble; links to The Commonwealth Fund Issue Brief
Making Progress in Safer Hospital Care
When facing a hospital stay, patients should not have to worry about dying from an infection acquired in the hospital.
- Posted June 2, 2015, by Ashley Noble; links to The Commonwealth Fund's Bending the Curve on Patient Safety
Quashing the Silos and Getting to Integrated Health Care
Federal and state governments as well as the private market are seeking ways to break down silos that hamper the delivery of high quality, efficient services.
- Posted Nov. 12, 2014, by Ashley Noble; links to The Commonwealth Fund's "State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment"
Choice of Health Insurers Expands 25%--First Look by States
The last six weeks of 2014 brought more than Thanksgiving and end-of-year holidays.
- Posted Oct. 29, 2014, by Richard Cauchi; links to The Commonwealth Fund's interactive map.
Health Marketplaces Open Enrollment Begins Nov. 15
With fall leaves painting the landscape, it’s time to think about the next open enrollment period to purchase health insurance under the Affordable Care Act.
- Posted Oct. 13, 2014, by Richard Cauchi; links to The Commonwealth Fund Survey
How Does U.S. Health Care Rate Internationally? Hint: Not Good
Are Americans getting the best bang for their health care buck?
- Posted Sep. 10, 2014, by Ashley Noble; links to The Commonwealth Fund "Aiming Higher" 2014 Survey
NCSL State Legislatures magazine
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).
- 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.
Legislative Summit, August 6-8, 2017, Boston, Mass.
Fixing Health Care: What’s Next? Deep Dive session
Legislative Summit, August 9, 2015, Seattle, Wash.
Beyond the Status Quo: Tackling Medicaid System Performance -
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
Deep 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
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
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
Health Providers and Workforce
Social Determinants of Health
NCSL acknowledges the generous support provided by a grant from The Commonwealth Fund.