*Dermody A. The t wo biggest issues facing 32 states in 2017. CQRollCall.
com. Available at: cqrollcall.com/statetrackers/the-two-biggest-issues-
facing-32-states-in-2017/. Accessed March 2, 2017.
are affecting state health care programs and patient
access to care.
At the close of the 2016 legislative session, the
Mississippi legislature passed a budget bill that swept
funds from state programs with dedicated financing
and redirected the monies into the state’s general revenue fund. The Mississippi Trauma Care System was
one of many state programs affected by the act. While
state officials have indicated that the trauma system
will be funded at the same level through the state’s
Department of Health annual budget, the rerouted
fees earmarked for the trauma system will continue
to go into the state’s general revenue fund. Critics
have noted that the Department of Health’s budget
will not be reduced or increased. Adding the funding
for the state trauma system is likely to pull funding
from other health programs funded by the Department of Health.
Some states are considering policies to improve their
revenues through increased or new taxes on products
and services. Some tax increases, such as an increase on
tobacco, can have a positive impact on health outcomes.
More than a dozen states, including Arizona, Connecticut, Indiana, Kansas, Montana, New Jersey, New
Mexico, New York, Ohio, Oregon, Rhode Island,
Virginia, Vermont, and Wyoming, have proposals to
increase the sales tax on tobacco products or add electronic cigarettes (vapor) to existing tobacco tax laws.
Conversely, tax policy can have a potentially negative
impact on access to care, such as a proposal in Ohio to
tax cosmetic surgery.
In Ohio, Gov. John Kasich (R) supports a tax reform
proposal that would add cosmetic procedures to the
state’s sales tax. The proposal also seeks to increase
the sales tax rate to 6. 25 percent. The governor’s state
budget estimates that the cosmetic surgery tax will
generate up to $25 million annually. New Jersey imple-
mented a similar tax in 2004. New Jersey eventually
repealed the tax because it did not collect the projected
amount of revenue and instead cost the state money
to administer the tax, while patients went out of state
for cosmetic and reconstructive procedures. The ACS
highlights New Jersey’s experience with this issue to
discourage other states from considering a similar tax.
While state budget challenges may affect health
care services, opportunities still exist to advocate for
increased funding of state programs. The Georgia
Society of the ACS, at its 2017 state lobby day in February
with the Georgia Trauma Foundation, advocated for
$1 million from the state’s Super Speeder Law fund to
install bleeding control kits in all public schools. To
support their lobby day efforts, the Georgia Society
conducted a bleeding control simulation for legislators, staff, and others in the state capitol building, and
secured passage of a resolution in the House and Senate
declaring February 7 as Trauma Awareness Day at the
Priority legislative activities
Despite political uncertainty and fiscal challenges,
the regular order of business has not stopped in the
state legislatures. Several ACS state legislative priorities remain active, including the following: limiting
scope-of-practice expansion initiatives by nonphysician
providers; clarifying the definition of surgery; and supporting legislation on distracted driving, motorcycle
safety, cancer prevention, and tanning bed use.
Scope of practice
Working closely with other surgical specialty associations, the ACS has been engaged in advocacy efforts
in several states to stop legislation that would expand
the scope of practice for optometrists. Alaska, Florida, Georgia, Iowa, North Carolina, Maryland, and
Nebraska have introduced bills that would expand
optometrists’ scope of practice to allow them to perform surgical procedures. The ACS Florida Chapter,
the Georgia Society, and the North Carolina Chapter
engaged in campaigns to encourage their legislators
to oppose the legislation. As a result of the Georgia