State policy experts have named healthcare reform as one of the top issues that state lawmakers should expect to face in 2011.
Healthcare came in fourth in a list of 11 top issues released Tuesday by the National Conference of State Legislatures. The rankings were based on a survey of NCSL policy experts, the executive committee and standing committees.
The survey said a sluggish economy would be the major factor controlling states' agendas in 2011.
The top three priorities named by experts are balancing state budgets, reforming and providing state pension plans and providing jobs.
William Pound, executive director of the NCSL, said money is the starting and stopping point for virtually every state program and service. "We are expecting that budget cuts will again be deep, controversial and painful," he said.
According to the survey, lawmakers will face challenges in understanding and implementing new healthcare reform laws that affect states. These healthcare policy concerns will be augmented by changes in state leadership, worries about affordable coverage and a lengthy list of policy options and decisions they face under the Affordable Care Act.
The NCSL said eight states so far are using state law to avoid enforcing mandatory features of the ACA, while others are considering a retreat from its costly Medicaid features.
In descending order, the other top 11 state legislative issues the experts named for 2011 are redesigning higher education, redrawing district lines, lowering unemployment and funding benefits, passing state laws on illegal immigration violations, improving education, enforcing immigration laws and maintaining transportation and infrastructure.
Medical malpractice and liability was also named as a top issue, but was not among the top 11, according to the NCSL.
In December 2009, the Congressional Budget Office estimated that changes to medical liability laws nationally would reduce the federal budget deficit by about $54 billion between 2010 and 2019.
NCSL leaders said medical liability and malpractice was "largely left out" of recent federal healthcare reform, but the ACA does authorize demonstration projects by states.
NCSL policy experts said the "Top 11 List" is not reflective of every issue that states will grapple with during the upcoming year, but it does reflect an overview of some of the top issues expected to cross state lines and be dominant themes next year in state legislative sessions.