States Step Up to Protect Healthcare Access Amid Federal Pressure
By Shaina Goodman, Vice President of Policy and Government Affairs at Community Catalyst and Erin Miller.
As state legislative sessions close and thoughts turn to 2027, this is a good time to take stock of some notable progress in state health policy. As federal health policy changes begin to reshape coverage and affordability and significant reductions in federal support for affordable coverage and care loom on the horizon, 2026 state legislative sessions became a critical testing ground for whether states would protect access to care — or allow new barriers to take hold.
So far this year we’ve worked alongside nearly 100 state and community partners — analyzing legislation, shaping strategy, and supporting advocacy to protect and expand access to care.
Wins (or good progress underway in ongoing state sessions):
Despite the challenging headwinds, healthcare advocates were able to secure important victories.
Protecting Affordable Coverage
Expanding and protecting coverage improves health outcomes, protects individual financial security, and strengthens communities.
- To support ongoing Marketplace coverage and affordability, Colorado passed a bill to sustain premium subsidies, continue coverage for undocumented residents, and improve transparency to allow more meaningful policy engagement from directly-impacted community members.
- Washington expanded access to its Medicaid-like program for undocumented residents and maintained funding for private coverage.
- New Mexico transferred additional funding to their health care affordability programs to fully mitigate coverage losses among lawfully residing immigrants and protecting families from steep premium increases.
- Successful defense must be celebrated too. Despite federal cuts, advocates have worked tirelessly to protect access to Medicaid. In several states, including Idaho, partners successfully defeated efforts to roll back Medicaid expansion.
Preventing Medical Debt
There was strong momentum across states to increase accountability across the health system and prevent medical debt. Medical debt reflects systemic affordability failures that compound health and economic inequity — and state policy can prevent that harm before it happens.
- A bill to improve access to hospital financial assistance has passed both chambers in Illinois. The bill requires a uniform financial assistance application across hospitals and that the approval of financial assistance be valid for a full year from the application date.
- In Pennsylvania, a bipartisan bill to enhance hospital financial assistance passed the House, while additional bills on healthcare mergers and price transparency remain under consideration.
- With the support of partners in Maine, the state passed a law to prohibit hospitals from establishing liens on primary residences or pursing wage garnishment for medical debt.
- Connecticut enacted protections from the predatory marketing of credit cards and other financing products in medical settings, including banning the marketing of these products when patients are receiving healthcare services or are under anesthesia, prohibiting healthcare providers from charging for services that haven’t yet been performed, and prohibiting providers from receiving financial compensation for marketing financial products.
Improving Access to Care through a More Diverse Healthcare Workforce
Coverage only works when there are enough providers, and a diversity of types of providers, so people can get the care they need.
- Current proposals in Illinois and Massachusetts would create new pathways for dental therapists — helping improve access to oral health care.
Raising Revenue to Support Healthcare
States are considering new revenue strategies to offset federal funding cuts. The ability of states to raise revenue to backfill federal funding have real implications for equity, workers, and access to care.
- Washington enacted a tax on high-income households to support public investments, including healthcare.
Near Misses
Advocates made substantial progress towards a people-centered healthcare agenda in many states, even if final passage of those policies has not yet been achieved. Initial progress indicates a real appetite for moving these policies forward in future sessions.
Protecting Medicaid and Ensuring Access to Affordable Coverage
While no state will be able to fully mitigate against the catastrophic harms of federal policy changes to Medicaid and other coverage programs, state decisions will determine the future of their health systems.
- In Nebraska, advocates pushed to limit Medicaid cost-sharing to the lowest level allowed under federal law and to allow managed care organizations to pay cost-sharing on the part of their enrollees. While the bill did not make it across the finish line, advocates continue to push creative strategies to limit the impact of Medicaid cuts.
- In Washington, a proposal to allow the Marketplace to actively manage plan offerings did not advance but reflects growing interest in this promising policy tool that is not impacted by changes to federal policy.
- A proposal in Connecticut would have established a health care affordability fund and moved the state towards establishing a Basic Health Plan and public option.
Expanding the Healthcare Workforce
- Florida also made progress towards establishing dental therapists — signaling a strong appetite for improving access to oral health care and creating a more diverse oral health workforce.
A Potential Revenue Source with Lots of Caution
To offset federal funding cuts, states are considering new revenue strategies that come with potential unintended consequences.
- Some states are exploring employer-based fees tied to Medicaid enrollment. Proposals failed in Washington and Colorado, but remain under consideration in other states. These policies raise concerns about increasing hiring discrimination against people who may be eligible for Medicaid, and increasing anti-Medicaid sentiment among large employers, and so need to be carefully evaluated and designed.
Setbacks
Despite our partners’ best efforts, there were some setbacks during their state sessions, especially as lawmakers look to reduce state spending on their Medicaid programs.
- In North Carolina, lawmakers passed legislation that requires strict work reporting requirements and maximum cost-sharing, raising concerns about coverage loss and affordability.
Looking Ahead
Despite a challenging political environment, this year we saw community-driven state advocacy to protect coverage, reduce costs and advance equity — giving advocates policies to build on in future years. Looking ahead, the wins and setbacks of this year will provide critical insight into our collective agenda going forward. Advocates can learn from both the substantive successes and the campaign tactics of their counterparts in other states as they seek to blunt the impact of harmful federal policies and advance an agenda centering affordability, accessibility, and accountability.
LEARN MORE
We will be actively working with state partners to build on the successes of this year and develop strategies to overcome the setbacks.
We are so grateful to support the critical work state and community advocates are doing across the country. With federal uncertainty continuing, these state-level efforts — and the partnerships behind them — will remain essential to building a health system that works for everyone.