Sizing up state health policy landscape after 2016 elections
from the AAP Department of Community and Chapter Affairs and Quality Improvement
Chapters Views & News
Along with the presidential race, voters across the country made decisions last November
about who will lead state governments for the foreseeable future. Twelve governors,
more than 80% of state legislators and scores of other state level offices were on
As a result, Republicans will control both chambers of the legislature in 32 states
— an all-time high — while Democrats will control both chambers in 13 states. The
remainder will be split controlled or tied. Nebraska has a one-chamber, nonpartisan
legislature. Republicans hold potentially veto-proof legislative supermajorities in
17 states, and Democrats in five.
The current count for governors in 2017 is 33 Republicans, 16 Democrats and one independent.
Voters also made important choices on state ballot measures on a wide range of topics
important to child health and wellness.
California voters approved a measure requiring background checks for all ammunition
sales and a ban on large-capacity magazines. Background checks on all gun sales won
the favor of Nevada voters.
In Washington, voters decided to permit courts, upon petition by police or a family
member, to issue an order to prevent an individual from accessing firearms for a specified
time period if the person poses a risk of harm to himself/herself or others.
Increased court fees related to child sexual exploitation convictions with the proceeds
going to a fund for sexually exploited children was supported by the majority of voters
California, Maine, Massachusetts and Nevada voters legalized recreational marijuana,
and voters in Arkansas, Florida, Montana and North Dakota gave their approval to proposals
to legalize medical marijuana.
Arizona, Colorado and Maine will increase their minimum wages incrementally to $12
an hour by 2020, and Washington will increase to $13.50 an hour by the same year thanks
to the thumbs-up from voters.
Voters in Boulder, Colo.; Cook County, Ill.; and Albany, San Francisco and Oakland,
Calif., approved new taxes on sugar-sweetened beverages. The Boulder measure enacts
a 2 cent per-ounce tax on sugary drinks sold within the city, and the other localities
will implement a 1 cent per-ounce tax.
Californians supported a $2 per-pack increase on cigarettes, and equivalent increases
on other tobacco products, including electronic nicotine delivery systems (ENDS).
“The new year brings new opportunities for AAP chapters and members to connect with
new and returning state legislators and governors,” said J. Gary Wheeler, M.D., FAAP,
chair of the AAP Committee on State Government Affairs (COSGA). “Because our voice
is trusted and we share the common concerns of all children, we’re well-positioned
to have a positive impact on state health policy in 2017 and beyond.”
To help chapters with these efforts, COSGA developed the 2017 State Advocacy Outlook,
which is available at www.aap.org/stateadvocacyoutlook. The resource examines key AAP priorities, reflects opportunities and challenges
for chapters, and identifies state policy trends to help chapters craft advocacy agendas.
Key issues include:
Childhood immunization – implementing new AAP policy recommendations on nonmedical exemptions; supporting
vaccine delivery in the medical home.
Firearms research and data surveillance – supporting efforts for states to participate in the National Violent Death Reporting
System; using state child death review data to illustrate how gun violence disproportionally
Medicaid payment and payment/system reform – advocating for appropriate Medicaid payment; ensuring new payment models are optimized
Network adequacy and balance billing – ensuring that state regulation of health plans appropriately provides access to primary,
specialty and subspecialty care; addressing how payment for out-of-network care will
be adjudicated, with an emphasis on protecting families from surprise balance bills.
Poverty and child health – advocating for state policies to alleviate poverty, including minimum wages, paid
sick and family leave, and dependent care tax credits.
Prescription drug costs – advocating for caps on copays for prescription drugs or requiring price transparency
when prescription drug costs increase; urging establishment of legislative commissions
or state agencies to study prescription drug price increases, and requesting state
attorneys general to take action through new or existing authority.
Tobacco 21 – advocating for laws that raise the minimum purchase age of tobacco and ENDS products
Zika virus – assisting state-level efforts on disaster and emerging disease preparedness that
consider the needs of children; enhancing access to outpatient management and early
intervention services for babies testing positive for Zika or believed to be exposed
to the virus in utero.
Chapters and members can email the AAP State Government Affairs team at email@example.com for consultation, technical assistance, resources and support for their state advocacy