What are the Biggest Issues to Watch for in State Legislatures in 2020?

  

Many state legislative sessions have or will be launching soon. Although there is no shortage of issues, with 80 percent or 6,000 state legislative seats up for election across 46 states in November, there’s a desire to wrap up sessions and get out to campaign.  As such, agendas may be limited.

Commencement of the 2020 census in April with subsequent congressional/state legislative redistricting to follow in 2021 is prompting one defining theme in state capitals this year – election security and reform.  

In general, state economies are doing well with record low unemployment. However, annual budgets are always important; all but one State’s Constitution (Vermont) necessitates that the budget be balanced. Education and healthcare are almost always a state’s largest budget expenditures, so attention to issues within these two buckets are generally prevalent.  

Keeping the economy strong includes reducing barriers to employment and this has been particularly evident for those occupations requiring licensure. Occupational licensure reform efforts are still ubiquitous, including re-evaluation of select occupations and the continued need for licensure, expedited licensure particularly for military spouses, and a significant growth in health profession interstate compacts.

More than 40 states introduced scope of practice legislation during the 2019 legislative sessions. Fifty-four bills from 30 states were enacted into law related to behavioral health providers, physician assistants, nurse practitioners and oral health providers. More needs to be done to increase access to care by reducing barriers for qualified practitioners. ANA and state nurses’ associations continue to seek full practice authority for all four roles of Advanced Practice Registered Nurses (Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse Midwifes).

Closure of rural hospitals has led to an increased demand for telehealth services. Legislation and regulation are defining what constitutes as telehealth, which varies, as well as who can use technology, under what circumstances, and how payment issues are resolved. More than 30% of rural Americans do not have access to broadband at home, further complicating use of technology for access to services.

As we await the US Supreme Court’s ruling on the Affordable Care Act (ACA), states are still expanding Medicaid, some with the addition of work requirements, and there is an increased interest in block grants.  While Republicans dominate in both state legislative bodies as well as the Executive Branch, it is likely additional states will attempt to advance legislation to ban abortions. Other health related policy carry overs from 2019 include legalizing medicinal and / or recreational cannabis, with much of this having been done through ballot initiative due to reticent policy makers. Almost 900 bills were introduced in 2019 to address pharmaceuticals and their costs and continued efforts to curb the opioid epidemic, generally viewed as a non-partisan issue. Other public health issues expected to draw attention again include immunizations, gun violence prevention, and efforts to curb e-cigarettes / vaping. 

While it’s unclear how much will be accomplished, your engagement remains critical.  If you are a member of one of ANA’s state affiliates, you have access to intel. Many state nurses’ associations have a vehicle to communicate updates and grassroots alerts. Additionally, sign up for your elected official’s newsletter to follow discussions and debates. Email your state senators and representatives with questions and requests. Better yet, set up an appointment to meet when they are at home in the district. And be sure to get out and vote in November.

To follow ANA’s Federal agenda and locate resources, go to www.RNAction.org

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Author: Janet Haebler

Senior Associate Director for Policy & State Government Affairs, American Nurses Association (ANA) In this current role, Janet serves as a resource to the state nurses associations in their efforts to advance their legislative and regulatory agendas. Throughout her forty-seven years’ experience in nursing, Janet held numerous staff and leadership positions in a variety of settings: acute and long-term care, managed care, and academia. She has dedicated the past 17 years to the policy and advocacy arena; first at the state level, before joining ANA. While with the New York State Nurses’ Association, she was responsible for the Practice & Government Affairs program; during which time, Janet and her team celebrated such legislative successes as title “nurse” protection and safe patient handling & mobility. In addition to a number of other initiatives, her portfolio includes the number one issue for direct care nurses – safe staffing. Nine years ago, Janet launched the American Nurses Advocacy Institute, a year-long mentored program designed to develop nurse’s political competence. Janet completed her undergraduate degree in nursing at Russell Sage College in New York and master’s degree in nursing with a concentration in administration at Seton Hall University in New Jersey.

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