Committee on Federal Government Affairs May 29-31, 2015 Division of State Government Affairs
Overview LEGISLATURES 50 state have regular sessions scheduled in 2015. There are 7,383 state legislators in the US. Republicans lead the legislatures in 30 states. Democrats lead in 11 states. 8 states have split partisan control. 1 state is nonpartisan.
Overview STATE BILL VOLUME 100,000+ bills introduced. Likely to replicate 2014 total of 180,000+ bills and 25% enactment rate.
Overview STATE BUDGETS All 50 governors have released their proposed budgets for FY 2016, which begins on July 1, 2015 for a majority of states. Funding issues highlighted by many governors included early childhood education; transportation, and workforce training.
Affordable Care Act MARKETPLACES For the 2015 enrollment period, 11.7 million consumers selected or were reenrolled in private insurance plans. 8.84 million enrollees used heathcare.gov, the federally run marketplace. 2.85 million enrollees used a state-based marketplace. Approximately 8% of these enrollees were children under the age of 18.
Affordable Care Act INSURANCE STATUS More than 16 million people have gained insurance coverage in the last 5 years under the Affordable Care Act (ACA). This includes 2.3 million young adults between ages 19-25 who were able to stay on their parents plans. The uninsured rate has dropped from 20.3% to 13.2% in that time. Current US uninsured rate is the lowest since 1997.
Affordable Care Act INSURANCE STATUS May 2015 Centers for Medicare and Medicaid Services (CMS) report: 70.5 million Medicaid/CHIP enrollees as of February 2015. 29.2 million of those enrollees are children. Medicaid/CHIP enrollment increased by 29.9% in states that expanded Medicaid vs a 8.01% increase in states that did not expand Medicaid.
Affordable Care Act MEDICAID EXPANSION Currently 29 states have expanded Medicaid under the ACA (MT needs HHS approval). 16 states are not expanding. 5 states are continuing the debate (AK, FL, NC, TN, UT). 6 states have had Medicaid waivers approved by CMS to expand using alternative plans (AR, IA, IN, MI, NH, PA). AAP chapters are involved in many expansion efforts with assistance from AAP.
Affordable Care Act MEDICAID PAYMENT In 2015, 15 states have continued Medicaid payment equity using state dollars (AL, CO, CT, DE, HI, IA, IN, ME, MD, MI, MS, NE, NV, NM, and SC). Several AAP chapters are currently working to achieve increased Medicaid payments with state dollars. The Division of State Government Affairs has developed resources to help chapters advocate for increased payment.
Affordable Care Act NETWORK ADEQUACY Reports have documented significant concerns with adequacy of marketplace network offerings. ACA standards are not stringent enough to prevent narrow networks, however HHS is currently looking at the issue. National Association of Insurance Commissioners (NAIC) is revising its network adequacy model act.
Affordable Care Act NETWORK ADEQUACY The AAP is participating in the NAIC subgroup working on the model act revision. The AAP has submitted several comment letters to NAIC regarding the draft model act. State Government Affairs staff continue to participate in weekly conference calls with NAIC on this issue.
Child Abuse and Neglect CHILD FATALITY/NEAR FATALITY 23 states and DC introduced legislation on child fatality/near fatality review, including: CT SB 310 Transfers responsibilities for conducting child fatality reviews to the Department of Children and Families to the Office of the Child Advocate. Requires the Office of the Child Advocate to submit an annual report on preventable child deaths to the legislature.
Child Abuse and Neglect INVESTIGATIONS 10 states introduced legislation on child abuse and neglect investigations and interviews, including: AL HB 48 Requires each county to develop protocols suspected child abuse and neglect investigations. VT SB 9 Requires the disclosure of child abuse reports and/or records to health care providers caring for the child and family and the mandated reporter if the mandated reporter is still working with the child.
Child Abuse and Neglect REPORTING REQUIREMENTS 35 states and DC have introduced legislation related to child abuse and neglect reporting requirements, including: KY SB 119 (Enacted) Requires the Department of Education to develop and maintain a list of evidence-based trainings on child abuse and neglect prevention, recognition, and reporting training. School staff must complete the trainings within 90 days of being hired and then every 2 years.
Child Passenger Safety Bills introduced: Require rear-facing infant seats until age 1 AR Require rear-facing child safety seats until age 2 CA, NJ, OK, SC, and TX Require booster seat until age 8 KY and NM Require rear seats until age 8 NY Require rear seats until age 13 SC
Child Passenger Safety Kentucky passed a law that requires children under 8 to ride in a booster seat. New Jersey enacted a law that will require rear-facing child passenger safety seats for children younger than 2 and weighing less than 30 lbs. An Oklahoma bill awaiting the governor s signature would require children to ride rearfacing until age 2 and would require booster seats until age 8.
E-Cigarettes AGE RESTRICTIONS Bills introduced: Prohibit sales to minors younger than 18 DC, MA, MI, MT, ND, NM, OR, PA, and TX Prohibit sales to minors younger than 21 CA, HI, and WA
E-Cigarettes AGE RESTRICTIONS Montana, New Mexico, and North Dakota all passed laws prohibiting minors younger than 18 from purchasing e-cigarettes.
E-Cigarettes CHILDPROOF PACKAGING Bills introduced: Require liquid nicotine products in CPSC-approved packaging AR, IN, MA, ME, MI, MO, MS, NC, ND, NH, NJ, NM, OH, RI, TN, TX, VA, and WA Require state agencies to create childproof packaging standards CA, NJ, PA, and WY Ban flavored liquid nicotine products NY and VT
E-Cigarettes CHILDPROOF PACKAGING Arkansas, Indiana, New Mexico, North Dakota, Tennessee, and Virginia enacted bills to require CPSC-approved childproof packaging on liquid nicotine products. Wyoming enacted legislation to require the state create and implement childproof packaging standards. A bill in Missouri requiring CPSCapproved childproof packaging on liquid nicotine is awaiting the governor s signature.
E-Cigarettes CLEAN INDOOR AIR ACTS Bills introduced: Include e-cigarettes in Clean Indoor Air Act CT, DE, KY, ME, MN, NV, N, TX, and WI Prohibit use on school or college campuses AR, CT, and TX Prohibit use in multiunit housing HI
E-Cigarettes TAXES Bills introduced: Tax e-cigarettes as tobacco products or create separate tax for the products AL, AR, AZ, HI, IA, LA, ME, MN, MT, NY, and OR
Firearms WOLLSCHLAEGER V FLORIDA In July 2014, a 3 judge panel of the 11 th Circuit Court of Appeals ruled in favor of the state of Florida, upholding a law restricting physician speech on firearm safety. A petition for rehearing of the Wollschlaeger v. Florida case by the full 11 th Circuit Court of Appeals is pending and the injunction against enforcing the 2011 law remains in place.
Firearms PHYSICIAN FIREARM SAFETY COUNSELING Bills to prohibit physicians from counseling patients about firearm safety have been introduced in 3 states (NC, ND, TX). North Dakota bill amended to remove the firearm counseling provision. North Carolina bill is pending. Texas bill died on the calendar.
Immunizations NONMEDICAL EXEMPTIONS TO SCHOOL ENTRY IMMUNIZATION REQUIREMENTS Bills to expand nonmedical exemption bills were defeated in MS, MT, and WV. Bills to curb or repeal the use of nonmedical exemptions are pending in CA, CT, DE, IL, ME, MN, NJ, NY, PA, VT. CA legislation sponsored by Senator Richard Pan, MD, FAAP to fully repeal all nonmedical exemptions has passed senate. VT legislation has passed both chambers of the legislature and is awaiting governor s signature.
Immunizations NONMEDICAL EXEMPTIONS TO SCHOOL ENTRY IMMUNIZATION REQUIREMENTS New polling from Truven/NPR: 90% of parents and nonparents agree that children attending public school should be required to receive all recommended vaccinations unless medically contraindicated. 2014 public opinion research shows that vaccine hesitancy isn t driven by scientific illiteracy; political ideologically.
LGBT Health and Wellness CONVERSION THERAPY Prior to 2015, 2 states (CA and NJ) and DC banned conversion therapy. In 2015, 21 states (AZ, CO, CT, FL, HI, IL, IA, MD, MA, MN, NV, NY, OH, PA, RI, TX, VA, WA, WI, WV, and VT) have introduced legislation to prohibit conversion therapy. This year, OR enacted legislation to prohibit conversion therapy. IL ban legislation has passed the house.
LGBT Health and Wellness RELIGIOUS FREEDOM ACTS 21 states have religious freedom restoration laws. Modeled after the Religious Freedom Restoration Act (Public Law 103-141) Government shall not substantially burden a person s exercise of religion even if the burden results from a rule of general applicability Originally intended to ensure that religious beliefs were protected by not burdening individuals for exercising their religious freedom. Originally applied to the federal government and state governments. Applicability to state law was overturned in 1997 by US Supreme Court. States began to enact their own religious freedom restoration laws.
LGBT Health and Wellness RELIGIOUS FREEDOM ACTS To date 17 states (AR, CO, GA, HI, IN, LA, MI, MT, NV, NC, OK, SC, SD, TX, UT, WV, and WY) have introduced legislation to create a religious freedom restoration law. Legislation has failed in 6 states (LA, MT, SD, UT, WV, and WY). 3 states (OK, SC, and TX) introduced legislation to amend their existing religious freedom restoration laws.
LGBT Health and Wellness RELIGIOUS FREEDOM ACTS 2 states (AR and IN) enacted religious freedom restoration laws. LA considered Marriage and Conscience Act Following defeat of legislation governor issued an executive order that fulfills the intent of the legislation to prohibit state action against a person acting in accordance with a religious belief that marriage is between one man and one woman.
Marijuana MEDICAL MARIJUANA Bills introduced: Legalize medical marijuana AL, FL, GA, IA, IN, KS, KY, MO, MS, NC, ND, NE, PA, SC, TN, TX, UT, and WV Legalize cannabis oil for the treatment of seizures GA, ID, KS, LA, OH, OK, TN, and VA
Marijuana MEDICAL MARIJUANA Georgia legalized low-thc cannabis oil for patients with certain chronic conditions. Oklahoma passed a law that allows cannabis oil to be administered to children with seizures during tightly controlled medical studies. Tennessee passed a bill that redefines 'marijuana' to exempt low-thc cannabis oil obtained legally in another state.
Marijuana MEDICAL MARIJUANA Virginia passed a law that allows cannabis oil to be recommended to treat epilepsy. Idaho s governor vetoed a bill that would have allowed the possession or use of cannabis oil.
Marijuana LEGALIZATION FOR RECREATIONAL USE Bills introduced: Legalize recreational marijuana AZ, CT, FL, GA, HI, MD, MA, MO, NV, NJ, NM, NY, PA, RI, TX, and VT
Marijuana BALLOT MEASURES Alaska, Oregon, and Washington, DC voters passed ballot initiatives to legalize marijuana in November 2014. States with proposed 2016 ballot measures include: AR, AZ, CA, FL, GA, ID, ME, MA, MI, MO, MS, MT, NM, NV, SD, and WY
Telehealth PAYMENT According to The Center for Connected Health Policy (CCHP): 46 states and DC provide for some form of Medicaid payment for telehealth services (IA, MA, NH, and RI do not). 22 states and DC require private insurance plans to cover telehealth services (AZ, CA, CO, GA, HI, KY, LA, ME, MD, MI, MO, MS, MT, NH, NM, NY, OK, OR, TN, TX, VA, and VT).
Telehealth PAYMENT In 2015, more than 100 bills have been introduced in 34 states regarding telehealth. 13 states have introduced bills that would require private insurance to pay for some telehealth services (CT, DE, IL, IN, IA, MA, MN, NC, NJ, NV, OH, PA, RI). 12 states have bills that would require Medicaid payment for telehealth (IA, KS, MA, ME, MO, NJ, NV, OH, PA, RI, TX, WA).
Telehealth ESTABLISHMENT OF RELATIONSHIP Establishment of the physician/patient relationship is emerging as an issue at the state level. 5 states have bills pending that would define the physician/patient relationship (DE, MS, NH, NJ, TX). This issue can also be addressed at the regulatory level.
Telehealth ADDITIONAL ISSUES Additional telehealth issues being addressed by state legislatures: Definition of telehealth/telemedicine. Telehealth practice standards. Medicaid coverage of telehealth for paramedics and EMTs. Coverage for behavioral health provided via telehealth. Medication management.
Tobacco AGE RESTRICTIONS Bills introduced: Require 21 year old purchase age for tobacco products. CA, HI, MA, NJ, NY, OR, RI, UT, VT, and WA Require 19 year old purchase age for tobacco products. IA and NJ
Tobacco AGE RESTRICTIONS Hawaii passed a law that requires all tobacco purchasers be 21 or older. Evanston, IL, Columbia, MO, and 5 cities in New Jersey enacted Tobacco 21 laws.
Tobacco FLAVORED TOBACCO Bills introduced: Prohibit the sale of flavored tobacco IL, MD, NY, OR, and WA
Tobacco USE AT BASEBALL STADIUMS Bill introduced: Prohibits all use of tobacco at baseball stadiums CA In addition to the state-level proposal, San Francisco enacted a tobacco-free ballparks ordinance.
Tobacco SMOKE-FREE ENVIRONMENTS Bills introduced: Prohibit smoking in all workplaces IN, KY, PA, and MS Prohibit smoking in cars with children GA, NJ, and NM Prohibit smoking marijuana in public places and cars OR Prohibit smoking in public parks and beaches NJ
Tobacco SMOKE-FREE ENVIRONMENTS New Jersey passed a law to prohibit smoking (including e- cigarettes) in public parks and beaches.
Tobacco TAXES Bills introduced: Proposed tobacco tax increase $1.00 or more/pack: AL, KY, LA, MD, MS, NY, ND, OH, OK, OR, RI, VA, VT, and WV Proposed tobacco tax increase less than $1.00/pack CA, KS, MO, NV, NH, PA, RI, WA, WV, and WY Proposed decrease in tobacco tax MI, NJ, and RI