State Update: Medicaid Expansion, Rural Hospitals, & Sick Leave Laws

These are just a few highlights of topics at the national and state levels that may have a significant impact on the cancer community.

National News:

  • Trouble for Rural Hospitals:Dozens of rural hospitals have already closed nationwide this decade. A new report finds that an estimated 430 rural hospitals – roughly 1 in 5 – are in danger of closing, which not only impacts access to care, but also impacts the economic livelihood of the communities where those hospitals are located. Two-thirds of states have at least five rural hospitals at high financial risk of closing, partly as a result of uncompensated care for individuals who are uninsured. The top 10 states with the highest percentage of endangered rural hospitals: Connecticut, Alabama, Mississippi, Georgia, Alaska, Maine, West Virginia, Arkansas, Florida and New Hampshire. Some argue that expanding Medicaid coverage for individuals who are currently uninsured would improve the fiscal health of these rural hospitals, to allow them to stay open.
  • Medical Marijuana Cases:While many states have passed laws to legalize the use of medical or even recreational marijuana, it is still illegal under federal law. That poses some challenges for individuals diagnosed with cancer, who would like to use marijuana to manage their treatment side effects. One of those challenges is navigating their employment rights. Because someone can test positive for marijuana use long after usage, if an employer drug tests and has a zero-tolerance policy, an employee could be let go for using medical marijuana. There have been some recent court cases which have ruled in favor of employers (CA, CO, OR, WA) and some for employees (RI, MA, CT), partly because of differences in state medical marijuana laws. Nine states specifically ban employment discrimination against medical marijuana users, who could continue to face difficulties in getting or keeping jobs in other states. This is a rapidly changing area of law, as states pass additional statutes, new cases are filed, and bills are proposed in Congress to undo marijuana's classification as a controlled substance with no medicinal value. Because of this uncertain landscape, some employers have dropped marijuana from the drug tests they require of employees, because it excludes too many potential workers.
  • States Stop Cities from Passing Sick Leave Laws: Since San Francisco approved the first paid sick leave ordinance in 2006, paid sick day requirements have passed in 35 cities or counties and 11 states. But some states are opposed to these local protections, because they make it difficult for employers to comply with the rules if they have employees in different cities. To date, 22 states have passed laws that forbid local paid sick leave ordinances: AR, WI, LA, TM, MS, KS, IN, FL, OK, AL, OR, MO, MI, OH, NC, SC, RI, KY, IA, AR, NJ, and MD (in order of passage).

New Mexico:

New Mexico may become the eighth state to adopt a death with dignity law. The New Mexico state legislature is considering HB 90/SB 153, the Elizabeth Whitfield End of Life Options Act, which allows a terminally ill, mentally capable adult the option to request, obtain and take medication to die peacefully in their sleep, if their suffering becomes unbearable.


The Kansas Farm Bureau is proposing to allow farmers and ranchers to purchase health insurance that does not comply with the consumer protections in the Affordable Care Act (ACA or Obamacare).  As we have discussed in previous blogs, this poses a danger for consumers who are unaware that they no longer have access to those protections, including pre-existing condition exclusion protections. These plans are also allowed to exclude coverage for certain categories of care, including chemotherapy or prescription drugs. They are attractive because they have lower monthly premiums, but consumers often learn too late, that these plans do not offer comprehensive coverage.

North Carolina:

State legislators are considering proposals to move forward with Medicaid expansion in North Carolina. In the meantime, Medicaid in North Carolina is moving to a managed care system, away from a fee-for-service model. And advocates will be watching to ensure that this move does not negatively impact people with serious medical conditions.


Advocacy groups in Florida are working on a campaign to get Medicaid expansion on the ballot in 2020. If voters in Florida approve Medicaid expansion, as many as 700,000 Florida residents could get access to health insurance coverage.

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