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Idaho Governor Butch Otter has called a Special Session

Idaho Governor Butch Otter (R) has called a special session of the state’s legislature. During the session, which convenes Monday, May 18, the legislature will consider changes to the state’s child support program. The proposed bill, which was tabled shortly before the regular session adjourned, would amend existing laws relating to the Uniform Interstate Family Support Act (UISFA). State officials have stated that the passage of such legislation is imperative, as the state could potentially lose $16 million in federal funding for failing to maintain compliance with UIFSA. The full statement from the governor’s office can be read here.

Washington Governor Jay Inslee has called a Special Session

Washington Governor Jay Inslee has called a special session of the state legislature after lawmakers acknowledged this week that they would not reach a budget deal by the April 26 deadline. The session, which begins April 29, will last 30 days and will focus on continued negotiations over how the two-year budget will fund increases in public education spending that have been mandated by the state’s supreme court. The Democratic-controlled House supports creating new tax revenues while the Republican-controlled Senate is arguing that current tax revenues are sufficient. Washington’s fiscal year begins on July 1 and the state could face a government shutdown if no deal is reached by then. In addition to the budget, legislators are expected to consider a transportation package that would raise the state’s gasoline tax by nearly 12 cents per gallon to fund road and bridge projects.

Alaska Governor Bill Walker has called a Special Session

Alaska Governor Bill Walker has called a special session of the state legislature after lawmakers were only able to pass a temporary budget that will last until the fall. While the Democrats are minorities in both legislative chambers, they have been able to slow up the process because the Republican proposal would require a withdrawal from the constitutional budget reserve, a rainy day fund that requires a three-quarters vote in each chamber to access. Democrats are hoping to use this leverage to force concessions on Republican-supported education funding cuts. In addition to the budget, the legislature is expected to debate Medicaid expansion and a bill known as “Erin’s Law” that would establish sexual abuse prevention programs in schools .

Concierge Medicine Poses Problems for State Regulators

One of the main effects of the Affordable Care Act has been that it’s incited substantial changes to the health care system, among them the required inclusion of certain essential benefits, such as maternal care, newborn services and preventative care. In turn, these new mandated benefits have led to a spike in the use of primary care services and providers. According to a report by the UnitedHealth Center for Health Reform and Modernization, the ACA has created 25 million more annual primary care visits to already stressed primary care physicians. In response to the rising costs of health care and increased primary care physician workload, an alternative and privatized option for health care has developed over the past 20 years known as concierge medicine.

According to Concierge Medicine Today, an information repository and trade publication for the industry, concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or monthly retainer. In return, the patient receives enhanced and specialized care from physicians. Concierge physicians have many fewer patients than traditional practices: typically ranging in the hundreds as opposed to thousands that a physician may otherwise be responsible for. This allows physicians to ensure a deeper level of commitment to their patients in both time and availability. These plans can also boast specialty services such as telephone or email consultations, house calls, 24-hour access, next-day appointments, and more tailored preventative and wellness care for patients.

While there are varying models of concierge medicine services, the increasingly most popular is Direct Primary Care, or DPC, an emerging model that aims to provide a more affordable version of concierge medicine to a wider variety of patients. This model embraces a low, flat rate monthly fee for physician services, with monthly rates ranging between $50 and $100. Other concierge services in contrast range closer to $1,000 to $1,500 a month. In addition, unlike other concierge medicine services, DPC does not accept payment through a typical insurance policy; instead there is an upfront cost for services between patients and physicians without the barriers such as co-pays, deductibles or co-insurance fees.

Currently 42 states have DPC practices, ranging from as many as 10-13 practices in California to 1-3 practices in Maine. These sorts of practices have a growth rate of almost 25 percent a year. As a result of this rapid proliferation, states are having trouble finding an acceptable method of regulation for DPCs, often placing them under existing insurance regulations despite the fact that DPCs have explicit non-insurance policies.

Arizona, Louisiana, Michigan, Mississippi, Oregon, Utah, Washington and West Virginia are the only states thus far to have passed legislation explicitly stating DPC practices are not subject to insurance regulations. There is legislation currently pending in Florida, Idaho, Kansas, Missouri, Oklahoma and Texas to address this important distinction.

The Direct Primary Care Coalition has cited four key issues state legislation should address in attempting to regulate this new model of care: clarifying DPC as a healthcare service outside the scope of state insurance regulations, allowing healthcare consumers to purchase DPC options on health care exchanges, providing tax parity for DPC services and payments, and allowing Medicare and Medicaid beneficiaries to participate in DPC programs.

As states continue to explore options to reduce healthcare costs and expand primary care and employers are looking to comply with the ACA, DPC plans are increasingly becoming a preferred option. With pending legislation in six states and the increasing popularity of concierge medicine services, it is likely that states will continue to look at ways to bring these types of plans into the fold in upcoming legislative sessions.

A Twofold Approach to Federal Emission Standards

Greenhouse gas emissions have been a hot topic for states since the U.S. Environmental Protection Agency (EPA) released its controversial Clean Power Plan in June 2014. The plan, which aims to reduce carbon pollution from power plants by 30 percent by 2030, has been met with a variety of responses at the state level to either conform with or resist these standards. Under the rules, each state would be required to provide the EPA with its own plan for cutting emissions from power plants within its borders by June 2016. The rules are expected to be finalized and promulgated by the EPA by mid-summer.

The rules would also require each state to reduce its emissions based on a formula that divides the states total CO2 emissions from power plants in pounds by the total amount of megawatt hours the state’s plants generate in power. As such, these reductions can vary from state to state, with Vermont and the District of Columbia not required to reduce emissions at all; neither is home to an active power plant. Washington’s power generators would have to reduce their carbon emissions by nearly 72 percent, the largest reduction needed in the country. Arizona, where some of the most vehement opposition to the plan has originated, would have to reduce emissions by nearly 52 percent.

Opposition to these rules has been fierce at both the state and national level. Earlier this month, the pressure opposing them was markedly increased by U.S. Senate Majority Leader Mitch McConnell, R-Kentucky. In an op-ed to the Lexington Herald-Leader, Senator McConnell took the unprecedented step of urging states and state leaders to outright ignore the EPA rules, should they be finalized and take effect, calling them unfair and “probably illegal.”

Despite the fierce and vocal opposition to the plans – particularly in red states and those with economies heavily dependent on the energy sector – numerous states are opting to take a twofold approach to the pending rules, by passing a resolution stating opposition to the EPA action while also creating a plan to come into compliance with the rules should they take effect.

Alabama, Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, Nebraska, Oklahoma, Pennsylvania, West Virginia and Wyoming have all passed resolutions urging the EPA to respect the primacy of the state’s authority to regulate carbon dioxide performance standards or otherwise going on-the-record with their opposition to the plans, while resolutions are pending in several others.

In order to stay in compliance with the potential rules, Arkansas, Kansas, Kentucky, Louisiana, Missouri, Pennsylvania, Virginia, West Virginia and Wyoming have all passed bills that would authorize the creation of a state plan to cut emissions pursuant to the EPA’s proposed rules. Additionally, bills of this nature are pending in Alaska, Arizona, Colorado, Florida, Illinois, Indiana, Minnesota, Mississippi, Montana, Nebraska, Nevada, North Dakota, Oregon, South Carolina, South Dakota, Tennessee, Texas and Washington.

Looking forward through the 2016 legislative season, it is likely that the states which have not done so this will be in a rush to adopt legislation with the new emissions standards in mind, with the June 2016 deadline for a blueprint fast approaching. With only nine states having adopted bills to date, look for this to be a major issue next year.