Health Care Proposals in the 50 State of the State Speeches

In six of the last nine years, Public Opinion Strategies has analyzed the policy proposals put forth by every state’s governor in their annual State of the State speeches.  Overall, there were 580 policy proposals this year—370 from Republican governors, 196 from Democratic governors, and the remainder from an Independent.

Ten percent (10{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222}) of this year’s proposals focused on health care.  This is fewer than we have measured in the past:  In the five years preceding the passage of the Affordable Care Act, 16{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222} of the governors’ proposals were related to health care.  This drop comes largely from Democrats, who, before their party’s health care overhaul devoted 19{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222} of their policy prescriptions to health care, spent less than half that (9{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222}) on the topic this year.  Republicans devoted 11{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222} of their proposals to health care this year, which is roughly consistent with their pre-ACA average of 13{09f965da52dc6ab4c1643a77bd40d1f729d807040cd8db540234bb981a782222}.

The dominant focus across all the health care proposals was implementing the ACA, specifically Medicaid expansion.

  • Some governors were supportive:  “It’s the smart thing to do,” declared Missouri’s Jay Nixon, a Democrat.Democrat Jay Inslee of Washington explained, “Effectively implementing the Affordable Care Act will save us money… When we make our health care system more efficient, we lower the cost of doing business in our state.  The states that get this right will have a clear advantage in recruiting and retaining the jobs of tomorrow.”“Last month, I announced that Nevada would comply with the provisions of the Affordable Care Act as they related to the expansion of Medicaid services.  As a result, some 78,000 more Nevadans will now have coverage,” said Republican Brian Sandoval.
  • Others were begrudging.  “I didn’t support Obamacare.  But it’s the law of the land.  The election is over and the Supreme Court has ruled.  My job is not to play party politics, but to implement this law in a way that best serves New Mexico,” explained Republican Susana Martinez.
  • Still others remained steadfast in opposition:  “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion,” declared Republican Nikki Haley.“We have made it clear Texas will not expand Medicaid under the ACA…We won’t set up a state exchange…Texas will not drive millions more into an unsustainable system,” proclaimed Rick Perry.

In the aftermath of recent mass shootings that called attention to the interplay between mental health and public safety, governors gave significant consideration to mental health services, including proposing a renewed focus on mental health training, revamping their states’ mental health systems, and improving the protocol for reporting individuals who could pose a threat to themselves or to others.  Some governors emphasized redoubling efforts on suicide prevention and substance abuse programs.

Many governors of states with large rural populations called for adding slots in medical schools and residency programs, renovating medical training facilities, and incentivizing more health care providers to work in underserved communities.

You can read a full list of the governors’ health care proposals here.
Trend data from previous years can be found here.
A comprehensive list of all this year’s policy proposals can be found here.

Research assistance was provided by Martin Shull.

Public Opinion Strategies