State Policy Network

SPN Healthcare Working Group

Healthcare Working Group Mission

SPN’s Healthcare Working Group provides a platform where state think tanks collaborate on ideas for advancing state-level healthcare reforms, share best practices, and serve as a voice for states in DC and across the 50-state Network.

Resources for States

Healthcare Toolkit: Ten Reforms State Lawmakers Can Implement Now

Imagine a world in which you can visit with your doctor using your iPhone, or only take 10 minutes out of your day to drive to a specialist, or actually spend a full hour with your doctor. This is possible through the state-level reforms and action steps outlined in State Policy Network’s state-focused healthcare toolkit: Ten Reforms State Lawmakers Can Implement Now by Naomi Lopez Bauman of the Goldwater Institute. Bauman is one of several state think tank healthcare experts who have participated in SPN’s Healthcare Solutions Working Group.  

Unlike the Affordable Care Act, these healthcare reforms are not “one size fits all.” Instead, they may be tailored to each state—and they are already working. Think tanks in Tennessee, Oklahoma, Ohio, and Wyoming have educated their state populations on these reforms, many of which have passed. From telemedicine to direct primary care to repealing certificate of need laws, the toolkit provides an action plan for state-level reforms. 

Download the Toolkit

Medicaid Waiver Toolkit

This toolkit outlines twenty reforms that states can pursue to overcome Washington’s bureaucratic red tape. By taking advantage of opportunities that already exist and demanding even greater flexibility through the process, states can innovate with more affordable, accessible, market- driven healthcare solutions whether or not Washington passes reforms dismantling the Affordable Care Act. The reforms envision a Medicaid program that has resources to help the truly needy and has transitioned healthy adults into the workforce where they can live better.

Download the Toolkit

50 States, 50 Stories: The Impact of the Affordable Care Act

With the passage of the ACA, Congress promised Americans that they would be able to keep the plans and doctors they like while paying less for health insurance and healthcare overall. Seven years later, many Americans have fewer choices when it comes to health decisions and are paying more for care and insurance. These stories from around the country highlight state and local challenges and represent the need for a state-based approach that unleashes innovation in healthcare based upon the needs of citizens.

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Market Research: What Americans Think about the State of Healthcare

Despite the sweeping reforms of Obamacare, healthcare costs and access remain concerns among Americans. Policymakers on both sides are suggesting reforms that range from a fully government-run system to more targeted reforms that alleviate specific concerns such as prescription drug pricing and improving access through direct primary care.

State Policy Network conducted a national survey and conjoint experiment with over 1,500 registered voters to understand the most and least appealing aspects of healthcare reforms in the current policy debate. The objective was to identify which reform features draw the most support or opposition to healthcare reform packages.

Sweeping liberal healthcare reform packages included summaries of the proposals currently being touted in policy debate, projected costs, payment plans, effects on taxation, and projected outcomes. The research demonstrates that support for liberal plans drops precipitously as Americans understand the likely impacts on access to healthcare, rationing, and wait times. Although not a strong driver of opinions, support for liberal plans decreases as the cost increase past $1 trillion, resulting in tax uncertainty and large tax increases for every American.

Conservative reform packages tend to focus on targeted areas of healthcare delivery that are designed to increase access, improve health, and lower costs. Researchers tested the impact of reform features such as certificate of need reforms, direct primary care, drug pricing, essential health benefits, health savings accounts, portability, tax benefits, and price transparency. Americans respond strongly to reform packages that promise greater pricing transparency when it comes to hospitals, doctors, and drugs. When discussing access and costs, the research shows Americans favor reform packages that allow portability of health insurance across state lines, lower drug prices, and promote direct primary care.

The research finds that Americans are most concerned about the likely negative effects Medicaid expansion will have on healthcare access and quality. Additionally, the survey found participants were concerned about the effects of a growing Medicaid budget on other government spending on essential services and education.


The research demonstrates that Americans are moved most not by details, but by specific descriptions of results – how reform packages will improve or harm access to quality healthcare, increase or decrease personal control and general transparency, or affect other priorities in state policies.

Discussions about healthcare reforms should focus on setting a positive vision of specific improvements in how people experience healthcare, in contrast with negative alternatives, by focusing on two key components:

Access & Quality

  • Voters care most about whether a reform package is likely to improve or harm their healthcare system experiences.
  • Describe the effects of good reforms like direct primary care and regulatory changes, not the details—good reforms will expand options and access to quality healthcare.
  • Describe the effects of bad reforms like Medicare for All/Some, not the details—bad reforms will decrease access to and the quality of healthcare, with increased wait times and government rationing of care.

Control & Costs

  • Voters are hungry for more transparency and personal control in healthcare.
  • Frame reforms as a way to drive price transparency—regulatory and tax reforms are the mechanisms to achieve these goals, but the details don’t matter to most people.
  • Emphasize personal control rather than just increased choice—insurance portability, direct primary care options, drug pricing reform are mechanisms to reach that goal.

Download the Market Research