As the 2024 election year unfolds, healthcare remains a priority for U.S. voters. Frustrated by gridlock at the national level, many are turning their attention to state governments, which are pursuing a variety of efforts to tackle pressing healthcare issues. Governors and state legislatures are exploring state-level solutions to healthcare issues and making policy choices that reflect the interests of their local constituencies. Beyond the publicized debates over reproductive rights and pharmaceutical pricing, many states are pursuing innovative strategies to improve healthcare access, quality, and affordability.
Public Health Workforce
Growth in both the proportion of the U.S. population over 65 and in the prevalence of chronic diseases has increased the need for healthcare professionals. Yet, as the COVID-19 pandemic has demonstrated, the healthcare sector is especially vulnerable to staffing shortages, and, as Applied Policy has previously discussed (here and here), ensuring an adequate and resilient healthcare workforce requires action on multiple fronts.
Many states find themselves actively competing for a limited pool of medical professionals. In one of the more conspicuous examples, New Mexico’s governor recently launched a campaign to recruit doctors from the neighboring state of Texas. The effort includes full-page advertisements in several of Texas’s leading newspapers and billboards touting the differences in the two states’ practice restrictions.
Other state efforts to address healthcare workforce shortages are less controversial, and the majority include financial incentives. Although growth in the price of education has slowed, educational costs remain a top concern for many Americans, as does student debt. Recognizing this, several states are attempting to build their healthcare workforce through loan forgiveness programs. These include California’s State Loan Repayment Program (SLRP), the Michigan State Loan Repayment Program (MSLRP), and Alaska’s Strengthening Healthcare Access Recruitment Program (SHARP). Undertaken to recruit and retain medical, dental, and mental health providers, loan forgiveness programs typically require participants to commit to working in a designated Health Professional Shortage Area (HPSA) for a minimum period.
Workforce Development Programs
The National Governors Association reports that strengthening healthcare workforces is a priority for its members. At the group’s Healthcare Workforce Summit last year, Colorado Governor Jared Polis observed, “When healthcare systems don’t have the workforce we need… everyone is impacted.”
Colorado is one of dozens of states hoping to strengthen its pipeline of “homegrown” ancillary healthcare workers through tuition assistance programs. Its Care Forward Colorado covers the tuition, fees, and course materials for students pursuing certification for such jobs as emergency medical technician, certified nursing assistant, and phlebotomy technician.
Under North Carolina’s Short-Term Workforce Development Grant program, qualifying residents pursuing education in health sciences can receive up to $750 in financial assistance. Wyoming’s WyHealthTrain offers students enrolled in eligible healthcare-related academic programs up to $10,000 in tuition assistance.
Licensing and Certification Reforms
Several states are reexamining licensing and certification requirements to streamline the process for healthcare workers to enter the field. Ohio recently became the thirteenth state to adopt the PA Licensure model legislation, which allows PAs (formerly known as physician assistants) to be licensed in multiple states. By modifying licensing requirements, states can make it easier for healthcare professionals from other states or countries to practice locally, thus expanding the available workforce.
Mental Health
According to the National Alliance on Mental Illness (NAMI), one in five adults in the United States experiences mental illness each year. In addition, suicide has become the second leading cause of death among individuals aged 10-34, underscoring the urgent need for effective interventions. In response, the Department of Health and Human Services’ National Strategy for Suicide Prevention emphasizes the importance of community-based prevention efforts as a primary strategy. State, local, and tribal governments increasingly focus on developing and implementing behavioral health programs that address mental health at the regional level.
Mental Health Services for Youth
With rates of anxiety and depression rising among children and adolescents, nearly three-quarters of states currently allocate funding for student mental health initiatives. As an example, Arizona’s Mitch Warnock Act (ARS 15-120) require all public school staff to be trained in suicide prevention. Under the state’s Jake’s Law, schools must have a policy for behavioral health referrals and a process for obtaining parental consent.
Exploring New Treatment Methods
In exploring unconventional treatment options for conditions such as PTSD and depression, some states are navigating legal gray areas. Oregon, for instance, has legalized the use of psilocybin, a psychedelic compound found in certain mushrooms, for therapeutic purposes. Colorado is currently establishing a framework for the licensing and regulation of the sale of mushrooms with psilocybin through its Natural Medicine Program. Despite these state-level initiatives, psilocybin remains classified as a Schedule I drug under the Federal Controlled Substances Act, indicating a high potential for abuse and “no accepted medical use.”
Additionally, while the Food and Drug Administration’s Psychopharmacologic Drugs Advisory Committee recently recommended against the approval of MDMA (3,4-methylenedioxymethamphetamine) as a prescription medicine, some states may yet pursue legislation to allow its therapeutic use within their borders. This reflects a growing interest in the potential benefits of psychedelics for mental health treatment despite federal policy.
Substance Misuse and Overdose Prevention
The rise in fatal drug overdoses has become a public health crisis in the United States. According to the Centers for Disease Control and Prevention (CDC), there were over 107,000 drug overdose deaths in the U.S. in 2021, a record high, driven mainly by opioids and synthetic drugs like fentanyl.
Harm Reduction Measures
Narcan, a nasal spray form of naloxone that can rapidly reverse opioid overdoses, is currently available in all 50 states and the District of Columbia. However, accessibility and distribution methods vary significantly. In some states, Narcan is dispensed through vending machines. In other states, purchasers must be trained in the drug’s use before a pharmacist dispenses it.
There is also wide variation in state approaches to syringe exchange programs, which have been shown to reduce the risk of transmission of blood-borne infections, including HIV and HCV, in intravenous drug users. While most states specifically authorize syringe exchange programs, at least a dozen are silent on the matter. Some states with existing programs have recently begun to reconsider them. The Idaho legislature repealed that state’s five-year syringe exchange program earlier this year after investigating its contractors.
Regulating High-Risk Substances
In addition to harm reduction and recovery support, states are implementing regulations on substances with high misuse potential. This includes monitoring prescription practices and establishing guidelines for the safe prescribing of opioids and other controlled substances. By addressing the root causes of substance misuse, states hope to prevent addiction and reduce the financial costs and overall burden of drug-related harm.
Data Systems Modernization and Privacy
As the healthcare landscape becomes increasingly digital, states prioritize efforts to modernize data systems and enhance privacy protections. Effective data management is critical for improving healthcare delivery, enabling research, and ensuring patient privacy. However, many states find themselves facing evolving privacy concerns with outdated systems.
Enhancing Privacy Protections
Several states are strengthening privacy protections for health data, and some are extending protections beyond what is traditionally considered private health information. For example, Washington’s My Health Data Act and Nevada’s SB 370 were adopted to protect the growing assortment of consumer health data. The Washington law includes data that “is linked or reasonably linkable to a consumer and identifies past, present or future physical or mental health status.” Journalists observed that this could extend to a restaurant’s notation of a patron’s food allergies.
Expanding Public Health Data Access
Even while taking steps to protect personal data, many states are expanding access to public health data to improve decision-making and public health outcomes. By making data more accessible to researchers, policymakers, and healthcare providers, states aim to enhance the understanding of health trends and inform targeted interventions. Initiatives include creating centralized data repositories and improving interoperability between health systems to facilitate data exchange.
Modernizing Data Collection Systems
States looking to improve the efficiency and accuracy of health data management are prioritizing modernizing data collection systems. Many states are investing in technology upgrades to replace outdated systems with more advanced and secure platforms. These upgrades aim to streamline data collection processes, reduce administrative burdens, and improve the quality of health data. Enhanced interoperability also allows for more comprehensive and real-time data analysis, supporting better patient care and public health responses.
Improving Interoperability and Efficiency
Interoperability enables different healthcare systems to communicate and share data effectively. States are implementing standards and protocols to ensure that electronic health records (EHRs) and other data systems can exchange information seamlessly. By improving interoperability, states aim to reduce duplicate testing, enhance care coordination, and improve patient outcomes. These efforts also support public health initiatives by providing more accurate and timely data to track and respond to health threats.
Optimizing Data Collection on Health Disparities
To effectively address health disparities, states optimize data collection efforts to understand the scope and nature of these challenges. By collecting and analyzing data on health outcomes across different demographic groups, states can identify disparities and target interventions more precisely. Initiatives include enhancing demographic data collection in health surveys and reports and collaborating with community organizations to gather qualitative insights from affected populations.
Improving Rural Healthcare Access
Rural communities often face significant barriers to accessing healthcare, including shortages of healthcare providers and facilities. Several states are investing in expanding telehealth services to improve healthcare access in rural areas. Alabama recently allocated $2 million to install telehealth stations in rural areas to expand Auburn University’s healthcare access model.
Healthcare Price Transparency
As healthcare costs continue to rise, states have recognized the potential of price transparency to empower consumers and promote competition among providers. Price transparency initiatives can make healthcare costs more predictable and understandable, enabling patients to make informed decisions about their care and encouraging providers to offer competitive pricing.
Utilizing All-Payer Claims Databases (APCDs)
All-Payer Claims Databases (APCDs) have become important tools in the effort to achieve price transparency. These comprehensive databases collect and aggregate healthcare claims data from all payers, including private insurers, Medicare, and Medicaid. By analyzing this data, states can provide insights into the actual costs of healthcare services and procedures, revealing price variations and trends across providers and regions. The Agency for Healthcare Research and Quality (AHRQ) supports states in realizing the value of APCDs for policymakers, researchers, and consumers seeking to understand and compare healthcare costs at the state level.
Promoting Consumer Access to Pricing Information
Several states, including California, Florida, Connecticut, and Maine, have passed or are considering legislation to improve consumer access to healthcare pricing information. This transparency legislation enables patients to compare costs and make informed choices about their care. For example, Massachusetts’s CompareCare allows patients to “check the average cost for common procedures.” Such initiatives aim to reduce surprise billing and increase patient engagement in healthcare decision-making.
Conclusion
State efforts to address healthcare issues underscore the importance of solutions that consider local needs and priorities. They can also have an impact that reaches beyond state borders. Data from state initiatives can ultimately inform national healthcare policy. In the end, the collective impact of these state-driven efforts could play an important role in shaping the future of healthcare across the country.