State Policy Hub (3rd ed.)

April 30, 2019


Welcome to State Policy Hub. This edition features several states taking steps to improve prescription drug prices though state-based purchasing systems or state PBM contracts. Additionally, Washington has become the first state to pass a state-wide public insurance option as well as a public long-term care benefit. Republican states also debated different abortion bills.


 Governor Newsome and Los Angeles County Support Statewide Pharmaceutical Purchasing System

Tuesday, April 23

 Governor Gavin Newsome intends to lower the price of prescription drugs in California through a statewide purchasing program, leveraging public and private payer power. Los Angeles County agreed to join Gov. Newsome’s effort, in hopes that other local governments will join the coalition. Details of the purchasing system have yet to be announced.


Colorado Legislature Passes Public Option Study Legislation

Tuesday, April 23

The bill directs state agencies to explore public option plans that could compete in the Colorado Exchange market. The bill especially aims to provide a lower premium option for rural areas that currently offer one insurer in the individual market. State agencies are directed to provide a proposal by November and legislators are hopeful for 2021 enrollment in such a plan.


Florida Lawmakers Consider Medicaid Work Requirements

Wednesday, April 17

State officials estimate that 500,000 residents would be subject to the requirements. Florida’s proposal differs from other states’ work requirement programs in that it would not allow exemptions for parents. Parents with children under 3 months would be exempt, but parents with older children are expected to work twenty to thirty hours per week. Experts estimate that approximately 100,000 low-income parents could lose their Medicaid coverage under the new proposal.


New York Measles Outbreak Continues

Thursday, April 25

The CDC confirmed an additional 31 cases of measles in New York City, bringing the total to 390 cases since the outbreak began in October. Nationwide, the CDC has confirmed more than 700 cases of measles, which was considered to be eliminated in 2000. New York has implemented mandatory vaccinations and fines for those who refuse to vaccinate.


‘Triggered’ Abortion Bill Awaits Governor’s Signature

Tuesday, April 23

 The House and Senate advanced the bill that would allow for the prohibition of most abortions if Roe v. Wade were overturned by the Supreme Court. It is expected that Governor Bill Lee will sign the bill into law, given his repeated promises to support such a policy. Louisiana, Mississippi, North Dakota and South Dakota all have similar ‘trigger’ laws.

Tennessee Expected to Pass Medicaid Block Grant

Tuesday, April 30

The state Senate recently passed a bill that would fund their Medicaid program, TennCare, through a block grant. Republican lawmakers are supportive of the measure to increase flexibility in the program, while Democrat members worry about services that may be underfunded. After Governor Lee’s expected signature, the state would need to submit a waiver to CMS to approve the program.


Texas Senators Pass Surprise Medical Billing Legislation

Wednesday, April 17

The bill would allow for an arbitration process that removes the patient from the reimbursement negotiation. This replaces the current system which has seen an increase in surprise billing mediation and resulted in a backlog of requests. Patients are still responsible for routine cost-sharing and copays. The bill now moves to the State House for vote.

Texas House and Senate Pass Separate ‘Born Alive’ Bills

Friday, April 19

The bills would provide protection to infants born after a failed abortion attempt. Physicians could face felony charges and fines if they refuse to provide care to infants born in such circumstances.  Republican lawmakers support the bill in an attempt to rollback late abortion regulations recently passed in New York and Virginia. Democrat members argue the bill interferes with the physician patient relationship and further stigmatizes abortion.


North Carolina Governor Vetoes ‘Born Alive’ Bill

Thursday, April 18

Governor Roy Cooper vetoed the legislation that would have made it a felony for physicians to not treat infants that survive abortions. Governor Cooper stated that legislation already exists to protect the lives of infants and the bill creates “unnecessary interference” between physicians and patients.

Montana Legislature Reauthorizes Medicaid Expansion

Thursday, April 18

The bill would reauthorize the state’s Medicaid expansion program that currently covers 96,000 individuals and requires work and public service requirements for certain enrollees. Democratic State Senators were supportive of continuing coverage for the expansion population, without additional work requirements. The bill now moves to the Governor’s desk for approval.

Connecticut House Passes Measure to Protect Individuals with Preexisting Conditions

Thursday, April 18

The bill aims to protect individuals on short-term health insurance plans and ensure coverage of certain services. Opponents of the bill argue that covering individuals preexisting conditions will drive up premiums for municipal employees, but state official said the bill has no financial impact. The bill now heads to the Senate for a vote.

Illinois Proposes Bill to Stop High Insurance Price Increases

Tuesday, April 23

The bill would allow the Illinois Department of Insurance to reject proposed insurance price increases on plans for individuals and small businesses. Current practice allows the Department to negotiate with insurers, but the new proposal would allow for the denial of increases that are deemed unreasonable, excessive or unjustified. The bill has passed through the House and awaits a Senate vote.

Ohio Attorney General Proposes State Contract with Pharmacy Benefit Managers

Tuesday, April 23

Attorney General, Dave Yost, suggested that a centralized state contract with all pharmacy benefit managers (PBMs) would create transparency through the prescription drug supply chain. AG Yost believes PBMs have been overcharging the state, with Ohio’s Medicaid program paying $224 million to PBMs in 2017. The proposal also includes authority to review PBM contracts, payments, and purchases and to ban non-disclosure agreements with PBMs.

New Mexico Signs State Purchasing Program in to Law

Tuesday, April 23

The bill established a state Interagency Pharmaceutical Purchasing Council that would leverage public purchasing power to review and coordinate cost containing strategies throughout the drug supply chain. This would allow the state to develop their own formulary and negotiate prices.

Washington Passes Public Long-Term Care Insurance Program Bill

Wednesday, April 24

 The first of its kind bill would require residents to pay 0.5 percent of their wages in to the program beginning in in 2022, with the benefit expected to begin in 2025. The measure would support individuals who need assistance with three or more daily tasks, and would provide financial assistance to pay for in-home care or home modifications. The bill now heads to Governor Jay Inslee for signature.

Washington Legislature Approves First Public Option Bill

Sunday, April 28

Washington is set to offer a standardized health insurance plan on their federal insurance market exchange beginning in 2021 and add state-contracted public option plans that year as well. The bill require that primary care providers be paid 135 percent of Medicare rates while total provider reimbursements are capped at 160 percent of what Medicare would pay. Governor Jay Inslee is expected to sign the bill.


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