State Health Policy Issues to Watch in 2020

January 08, 2020|4:23 p.m.| ASTHO Staff

The promise of a new year means that many state legislatures will soon reconvene, which also means a new (and not-so-new) set of health policy bills will start cropping up. To help navigate, ASTHO has a forthcoming "2020 state legislative prospectus" series that will highlight seven different priority policy areas states will address during this year’s legislative session. Each prospectus in the series provides a brief overview of the issue, the issue’s impact on health, and trends in state legislation to address the issue. This year, ASTHO developed prospectuses on e-cigarettes, HIV, influenza, maternal mortality and morbidity, neonatal abstinence syndrome (NAS), polyfluoroalkyl substances (PFAS), and rural health. Below is a summary of our first prospectus on policy initiatives to increase flu vaccination rates, as well as previews of the remaining six prospectus series topics to be featured and released in future ASTHO health policy updates.

Annual Flu Vaccinations: Vital to Public Health
The Centers for Disease Control and Prevention (CDC) estimates that each flu season, as many as 42.9 million Americans caught the flu, which also resulted in up to 20 million medical visits, as many as 647,000 hospitalizations, and between 36,400–61,200 deaths. Children under the age of five and adults aged 65 years and older are among the most vulnerable to serious illness or death from the flu. Public health surveillance captured an increase in vaccination rates among these vulnerable populations during the 2018-2019 flu season, and there were also lower rates of flu-associated illnesses this past season when compared to the 2017-2018 flu season.

While effectiveness varies, recent studies show vaccination reduces the risk of flu by 40 to 60 percent. Getting the annual flu vaccine not only reduces the risk of illness and death, but also lowers the risk of hospitalization and time away from school or work. For these and a variety of other public health-related reasons, the CDC recommends an annual flu vaccination for anyone over the age of six months.

State legislative trends for flu vaccinations include requirements for the education about seasonal flu risks among facilities frequented by the people most vulnerable to the flu (i.e. childcare and adult residential facilities). In 2020, ASTHO expects more states to adopt laws aimed at reducing the impact of flu among young children and older adults as well as new policies to allow pharmacists to administer flu vaccines to children, requirements for children attending childcare facilities to receive annual flu vaccinations, and requirements that employees of childcare and adult residential facilities receive annual flu vaccinations. Several states will consider bills to amend the age at which persons may receive the flu vaccine. A pre-filed bill in South Carolina would allow pharmacists to administer the flu vaccine to a person of any age—right now the age limit is 12 and older. Companion bills in Hawaii (HB900 and SB304) would authorize pharmacists to administer the flu vaccine to people as young as 11—Hawaii’s current age limit is 14.

Legislation that allows alternative providers within the immunization neighborhood (e.g., pharmacies, schools, workplace, and other clinical sites) can expand the places where vaccines are available and therefore increase access to vaccinations. By recognizing that not every person is reliably linked to a healthcare provider, these policies can allow for timely and consistent immunization services. For example, the Ohio legislature is considering a bill to authorize podiatrists to administer flu vaccines to individuals seven years or older. A New Hampshire bill would have authorized pharmacists or pharmacy interns to administer the influenza vaccine if they have received proper training.

Vaccination is one of the most cost-effective means of public health promotion and disease prevention. This work in increasing coverage rates, educating on the risks of the flu, and expanding the institutions and providers authorized to administer the vaccine requires cross-sector partnerships, resources, surveillance, and enforcement. State and territorial health agencies are well positioned to utilize their expertise, staff, funding, and partnerships to educate on and pursue appropriate policies and legislation that will increase or maintain flu vaccine coverage rates. ASTHO will continue to monitor state legislative efforts to ensure adequate flu vaccination coverage as the year progresses.

E-cigarettes and JUULs: Stopping a New Epidemic
2019 was a landmark year for tobacco legislation. States passed bills that increased the minimum sale age for tobacco products, regulated the sale of flavored tobacco products, and increased the price of tobacco products in statehouses across the country. This work was capped off with the federal government raising the age to buy tobacco products to 21 in December. ASTHO expects that states will continue to propose bills to prevent youth consumption of tobacco products, including e-cigarettes, in 2020. Other likely tobacco proposals include: the implementation of sales restrictions on tobacco products with specific nicotine concentrations; prohibitions on the bulk sale of e-cigarette products; the regulation of online sale and purchase of tobacco products and e-cigarettes; and the incorporation of e-cigarettes in the definition of tobacco products.

HIV: Ending the Epidemic with Evidence
In recent years, states have implemented evidence-based policies to prevent future HIV cases. These policies include improving access to treatment, notably pre-exposure prophylaxis (PrEP), the pill that prevents at-risk people from contracting HIV in the first place. States have also worked to establish programs to prevent the spread of infectious diseases, such as syringe service programs and establishing comprehensive sex education programs. In 2020, ASTHO expects states to increase access to these preventative treatments and services for minors, as well as amend criminal and public health statutes to decriminalize certain actions by people who are HIV-positive to reduce stigma and encourage testing, and expand routine testing and service programs to high-prevalence areas and high-risk populations.

Maternal Mortality and Morbidity: Preventing a Crisis
The United States continues to have one of the highest rates of maternal mortality in the developed world. To reverse this trend, state policymakers have started proposing legislation establishing Maternal Mortality Review Committees (MMRCs) and widening the scope of existing MMRCs, like including morbidity reviews. In 2020, ASTHO anticipates legislatures to include expanding the type of information available for review by MMRCs, improving screening and treatment for postpartum depression and substance use, and creating mental health advisory councils for interagency coordination and policy implementation.

Neonatal Abstinence Syndrome: Impact of an Epidemic
One of the many unfortunate outcomes of the opioid epidemic is an increase in cases of neonatal abstinence syndrome (NAS), when a baby is exposed to illicit and prescription drugs while in utero. In recent years states have started standardizing NAS screening and treatment for mothers and newborns, adding NAS to the list of notifiable conditions, and aligning NAS treatment interventions with child abuse and neglect laws. ASTHO anticipates that 2020 legislative trends will include the development of standardized NAS clinical definitions, guidelines to diagnose and treat NAS, license requirements for specialized NAS treatment facilities, and treatment programs addressing the mother-infant dyad.

Polyfluoroalkyl Substances (PFAS): Regulating Toxic Compounds
In 2019, state legislation took a variety of approaches to address PFAS contamination, including: assessment or monitoring the presence of PFAS and health effects; setting quality standards; restricting the use, sale, or distribution of PFAS; PFAS remediation and response activities; and calls for federal support. In 2020, ASTHO expects to see legislative trends around the use of PFAS chemicals in food and product packaging, the advancement of research to better understand the health effects of PFAS contamination, and calls for federal guidance to standardize assessments and set environmental limits.

Bringing Relief to Rural Health Care
In the last decade, 120 rural hospitals closed, and it will likely to continue to be an issue for rural communities in this new decade—though states have been working on legislation to stem the tide for the past several years. These laws have included creating tax incentives for rural hospital systems, establishing and providing technical assistance to rural hospitals, and increasing rural hospital Medicaid reimbursement rates. In 2020, ASTHO expects states to continue their efforts to protect rural health services by allowing tax credits for donations to rural hospitals, encouraging rural healthcare providers through loan repayment programs, and expanding healthcare provider scope of practice.