State Health Policy

State governments have the opportunity to improve health care coverage, access, and affordability. States can test and scale reforms that could serve as models for other states and provide a foundation for systemwide reforms at the federal level in the future.

The Center for American Progress regularly engages with state-level officials, including governors’ offices, health secretaries, departments of insurance, and state legislators, to design and advance policies in targeted areas. We provide research and analysis, policy development, technical assistance, and advocacy support to states. In addition, we monitor and evaluate innovative state reforms and disseminate insights and best practices.

State work

Below are examples of CAP’s previous work to support states in achieving their health policy goals.

In Pennsylvania, CAP worked on policies to lower costs and improve the quality of care across the statewide health care system. Working with the secretary of health, CAP developed a compendium of policy options, including global budgets for hospitals, that the state implemented for rural hospitals under a Center for Medicare and Medicaid Innovation model.

In Nevada, CAP worked to lower insulin costs for diabetics. CAP’s outreach and advocacy led to the introduction and enactment of legislation in 2017 that requires price transparency for insulin.

In New Jersey, CAP worked on lowering costs and improving quality for the state employee health benefits plan. CAP collaborated with the Governor’s Office and the secretary of human services; the latter was also the chair of the State Health Benefits Quality and Value Task Force. Analyzing claims data obtained from the state, CAP showed the variation in prices across counties for select procedures. CAP presented its findings and recommendations to the task force in May 2019. In 2022, CAP provided analysis to the New Jersey Governor’s Office on policy options to expand coverage to the state’s remaining uninsured population.

In New Mexico, CAP worked on lowering prescription drug costs for the state and its residents. CAP worked with the Office of the Governor and the Interagency Pharmaceuticals Purchasing Council, which was created to evaluate the state’s drug pricing policies. CAP conducted a comprehensive review of reforms across states, summarized lessons learned, and analyzed their applicability to New Mexico.

In North Carolina, CAP worked to improve retention and training among the direct care workforce. During the COVID-19 pandemic, CAP supported a shift in priorities to enhance safety and compensation for long-term care employees.

Publications

Health care costs and affordability:

• “How States Can Use Section 1332 Waivers To Improve Health Care Affordability and Access” by Natasha Murphy
• “Empowering State Attorneys General To Fight Health Care Consolidation” by Sam Hughes and Natasha Murphy
• “How State Health Care Cost Commissions Can Advance Affordability and Equity” by Nicole Rapfogel and Natasha Murphy
• “State Policies To Address Prescription Drug Affordability Across the Supply Chain” by Natasha Murphy
• “State Policies to Address Prescription Drug Prices” by Thomas Huelskoetter
• “Bold Ideas for State Action” by the Center for American Progress
• “Evaluating State Innovations to Reduce Health Care Costs” by Thomas Huelskoetter
• “State Options to Control Health Care Costs and Improve Quality” by Zeke Emanuel, Joshua Sharfstein, Topher Spiro, and Meghan O’Toole

Health coverage and access:

• “14 Years After the ACA’s Passage, Policymakers Should Build on Its Pillars of Affordable and Accessible Care” by Natasha Murphy and Andrea Ducas
• “An Urgent Opportunity to Close the Medicaid Coverage Gap” by Natasha Murphy (Governing)
• “How States Can Build Bridges by Smoothing Medicaid-to-Marketplace Coverage Transitions” by Natasha Murphy and Sarah Millender
• “Preventing Disruptions to Coverage and Care After the Public Health Emergency” by Natasha Murphy and Nicole Rapfogel
• “How States Can Expand Health Care Access in Rural Communities” by Thomas Waldrop and Emily Gee
• “Comment on Georgia Access Model Section 1332 Waiver” by Emily Gee and Natasha Murphy
• “Closing the Medicaid Coverage Gap Would Save 7,000 Lives Each Year” by Emily Gee and Nicole Rapfogel
• “Public Options Will Improve Health Equity Across the Country” by Nicole Rapfogel and Maura Calsyn
• “State Options for Making Wise Investments in the Direct Care Workforce” by Madeline Twomey
• “Expanding Medicaid in All States Would Save 14,000 Lives Per Year” by Rachel West
• “How States Are Combating Federal ACA Sabotage” by Aditya Krishnaswamy, Rhonda Rogombe, and Madeline Twomey
• “Medicaid and Home Visiting: Best Practices from States” by Rachel Herzfeldt-Kamprath, Maura Calsyn, and Thomas Huelskoetter
• “State Checklist for Expanding Medicaid to Cover Home Visiting“

Public health:

• “Preventing the Next Jackson-Like Water Crisis” by Marquisha Johns and Nicole Rapfogel (Route Fifty)
• “How State and Local Leaders Can Prepare for Future COVID-19 Surges” by Jill Rosenthal
• “How North Carolina Is Using Medicaid To Address Social Determinants of Health” by Nicole Rapfogel and Jill Rosenthal
• “School Air Filtration and Ventilation Strategies To Improve Health, Education, Equity, and Environmental Outcomes” by Jill Rosenthal, Elise Gout, Jamil Modaffari, and Tara Snover
• “COVID data lapses are just one symptom of our ailing public health system” by Jill Rosenthal (The Hill)