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States' big 2024 health plans: Workforce support and cheaper drugs

As state legislatures get back to work across the country, state policymakers are eying measures to bolster their burned-out health care workforces, make prescription drugs more affordable and reform their Medicaid programs.

Why it matters: Policymaking in Washington tends to slow down in a presidential election year, and the current Congress — so far the least productive in decades — has struggled to advance even bipartisan health measures.

  • States are expected to be far more active this year, as policymakers look to continue pandemic recovery efforts and address voter concerns over health care costs.

  • "Coming out of the pandemic, there has been just so many different challenges that have been exacerbated, I think, with more strain across the system," said Hemi Tewarson, executive director of the National Academy for State Health Policy.

  • But states' ambitions could be restrained by the expiration of federal pandemic aid that allowed their budgets to swell over the past few years.

Zoom in: Retaining and growing the health care workforce will be a state priority this year, Tewarson said. Providers have left the field in droves over the past couple of years on the heels of the pandemic.

  • At least 21 states last year considered legislation related to minimum nurse staffing levels, as nurses warned that their heavier workloads were putting patients in danger.

  • Several states, including Oregon, passed nurse staffing ratios in 2023, and other states may return to the issue this year. But the measures are usually controversial, pitting nurses unions against hospitals.

  • Tewarson also expects states to focus on growing the roles of community-based health workers like doulas, peer support workers and family caregivers, who can help fill gaps in care and make services more accessible.

  • Investing in and improving behavioral health will also top state policy agendas, as demand for mental health care surged coming out of the pandemic.

  • New York Gov. Kathy Hochul this week called for a major expansion of behavioral health services in the state, including 200 new inpatient beds and new mental health courts. In California, Gov. Gavin Newsom is rallying support for a March ballot measure that could create 10,000 new behavioral health beds and expand services for mental health and substance use disorders.

Drug prices will again be a big focus. Minnesota will launch its prescription drug affordability board this year, and Colorado's board could set its first price caps after identifying five costly medications last year.

  • Seven states advanced legislation to create similar boards last year, per Stat, and could revisit the topic this year.

  • The Food and Drug Administration's recent approval of Florida's plan to import some cheaper drugs from Canada could encourage states to take up similar measures, Tewarson said. Colorado has already submitted a plan to the FDA, and several other states have sought or plan to seek permission — though experts predict the impact of such proposals will be limited.

  • And as Congress weighs its own modest reforms to pharmacy benefits managers, states are expected to revisit legislation that could require them to disclose information about rebates or pass savings along to patients.

What we're watching: It could be an especially busy year for states seeking federal permission to alter their Medicaid programs, said Patricia Boozang, senior managing director at consultancy Manatt Health.

  • In presidential election years, states ideologically aligned with the current administration are more inclined to try to push through policies that a future administration is less likely to approve.

  • "Everybody becomes laser-focused on: I've got to get my waiver approval before the election," Boozang said.

  • Currently, 48 Medicaid waiver requests from states are awaiting federal review, and more could be filed throughout this year.

  • More than a dozen pending waivers would expand coverage to incarcerated people, per KFF. The coverage expansion is a Biden administration priority aimed at easing their transition out of the justice system.

  • Earlier this week, the Biden administration approved New York's $7.5 billion Medicaid waiver to improve primary care, better integrate behavioral health initiatives and reduce health inequities.

Reporter: Maya Goldman, author of Axios Vitals

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