States Will Make More Health Policy Decisions in 2020

Health policy decisions will be impacted by the multi-year shifting of federal controls over select healthcare-related decision-making has emboldened state legislatures to act when Congress has been unable to do so.

As a result, laws requiring pharmacy benefit management registrations have been on the rise, while faster approvals that allow the broader use of prescription drugs (e.g., naloxone) are addressing fast-changing public health issues, such as the opioid crisis, in most states.

In addition, regulatory changes resulting from the Affordable Care Act (ACA) have also contributed to state-level engagement in healthcare change. Coupled with the current “healthcare for all” movement and select cases decided by the federal courts that support further ACA changes or elimination, less federal control over state matters seems likely.

States to Watch

Colorado and Washington are implementing public insurance options that could be a model for Democrats at the federal level.

Pennsylvania and New Jersey are taking over their Affordable Care Act marketplaces from the federal government.

California is embarking on an ambitious state-financed coverage expansion.

Idaho and other red states are promoting short-term insurance plans as an alternative to the Affordable Care Act.

Georgia is seeking ACA waiver plan to ditch the state’s marketplace, with consumers enrolling through insurers and web brokers, and a subsidy scheme allowing healthier consumers to choose skimpier plans that do not meet all ACA standards. 

Tennessee is seeking a form of per capita cap within Medicaid, with broad flexibility and favorable terms for the state.


Takeaway: States health policy decisions will affect millions of people.