States are gearing up for their legislative sessions as the majority start this month. Forty-five states, plus Puerto Rico and the Virgin Islands, will go into legislative session this month. Indiana, New Hampshire, Pennsylvania, Rhode Island, and the District of Columbia hit the ground running by convening the first and second days in January. Only two states, Alabama and Louisiana, will look forward to convening in March and April. For exact convening and adjourning dates of all 2019 state legislative sessions, visit the National Conference of State Legislatures' Session Calendar.There are several trends that can be seen this year that may impact the outcome of topics covered in the 2019 sessions. Republicans lost total legislative control in four states, while Democrats gained control in one, equating to gains of around 300 seats. Historically, legislative bodies have been more split. This year only one state, Minnesota, has split control. In addition to a shift in political party control, state legislatures will see a record number of women will serve, approximately 2,107, making up 28.5% of all nationwide state legislatures. The number of women in state legislatures has increased by 3.2% from the 2018 session.
One topic expected to be included in several state legislative sessions is ACA-related Medicaid expansion. The District of Columbia and thirty six other states expanded their Medicaid programs. Idaho, Nebraska, Utah, and Maine all approved expansion via ballot initiative in November, though it has not yet been implemented, while seven additional states used an 1115 waiver. Fourteen states have not made decisions on expansion.
Surprise billing will also continue to be a hot-button issue in 2019 state legislature sessions, continuing over from 2018 when New Hampshire and North Dakota passed laws to protect patients. States will discuss this issue in reaction to the Congress proposed legislation, “Protecting Patients from Surprise Medical Bills Act.” More information on all topics expected to be in the upcoming 2019 sessions can be found on the NCSL website.
State legislators may be taking action to protect consumers in their states from future rulings in Texas v. United States. Four states have already passed legislation to implement an individual mandate in their state, and seven more are somewhere in the process of doing so. Congress and state legislatures are expected to pursue legislation to protect those with preexisting conditions and promote guaranteed issue. If the ACA is struck down after the appeals are heard in the higher courts, states will need to review any laws that were passed to align with the ACA to determine whether these laws are unconstitutional or may stand on their own without being preempted by any changes in the federal law.