More states showing interest in healthcare policy

Hospital leaders pay a great deal of attention to policy from lawmakers and regulators in Washington, but state legislatures have demonstrated a growing interest in passing laws related to healthcare.

Several advocates and analysts examined the growing activity of state lawmakers in a Jan. 29 panel with the Alliance for Health Policy.

State lawmakers are particularly interested in the price of prescription drugs. Since 2017, 49 states have enacted more than 200 laws to address drug prices, said Maureen Hensley-Quinn, MPA, senior program director of coverage, cost and value for the National Academy for State Health Policy. Every state has introduced legislation regarding prescription drug prices in the past five years.

“State leaders are trying desperately to balance access, quality and costs,” Hensley-Quinn said.

Since 2017, more than 100 laws have also focused on pharmacy benefit managers, the companies that manage drug benefits for insurers, large employers and other payers.

Colleen Becker, senior policy specialist for the National Conference of State Legislatures, said reforms aimed at pharmacy benefit managers are popular at the state level right now. “This is very much an area where we’ve seen bipartisan support,” Becker said.

State lawmakers have been passing measures to limit the co-pays for the costs of insulin. Becker said 19 states now have laws limiting the co-pays for a 30-day supply of insulin, typically ranging from $25 to $100.

Lawmakers at the state level have also been pushing measures to promote more transparency in prescription drug prices, Becker said. She said state legislatures are also showing more interest in state-run patient assistance programs, coverages of healthcare supplies and alternative payment models, based on outcomes or subscriptions.

Overall, analysts agreed state lawmakers are most anxious to curb the rising price of prescription drugs.

“Legislators are tired of the finger pointing,” Becker said. “They want to get down to the nuts and bolts and how to affect the cost of drug prices.”

While she said the National Conference of State Legislatures doesn’t typically engage in predictions for the year ahead, Becker pointed out that more than 6,000 state lawmakers across the nation will be running for reelection in the fall. With so many looking at new terms, that could affect action at the state level in different ways.

“It may deter some legislators from putting forth legislation or legislation that doesn’t have broad bipartisan support,” Becker said.

On the other hand, she said lawmakers who are trying to impress voters may be more motivated to sponsor novel or interesting ideas with public appeal.

States are busy responding to the COVID-19 pandemic and also preparing for a post-pandemic reality, said Stephanie Anthony, a senior advisor for Manatt Health, a consulting group.

Under the federal government’s public health emergency, states must keep people enrolled in Medicaid, the federal program designed to provide healthcare for those with lower incomes. When the emergency ends, states will have to weigh the eligibility of millions of people who are currently on Medicaid, Anthony said.

Some states have acted on their own to make some changes in healthcare policy as a result of the pandemic. Pennsylvania has expanded the scope of services eligible for telemedicine, including behavioral health, while Arkansas now allows pharmacy technicians to administer vaccines, including the COVID-19 vaccines.

Some states are also giving more attention to social factors that have an impact on health, Anthony said. California and North Carolina are increasing services and supports in areas such as meals, transportation access, and caregiver respite, among others.

While healthcare access and affordability have long been concerns among state legislatures, the advocates noted greater public pressure is spurring lawmakers to come up with solutions.

Citing states taking action to cap what consumers are paying for insulin as one example, Becker said, “We’re seeing constituents mobilizing in a way we haven’t before.”

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