Sizing up state health policy landscape after 2016 elections

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 the ballot.

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.

Firearms

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.

Human trafficking

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 in Georgia.

Marijuana

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.

Minimum wage

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.

Sugar-sweetened beverages

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.

Tobacco taxes

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 affects children.
• Medicaid payment and payment/system reform – advocating for appropriate Medicaid payment; ensuring new payment models are optimized for pediatrics.
• 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 to 21.
• 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 stgov@aap.org for consultation, technical assistance, resources and support for their state advocacy work.