Capitol Ideas | 2019 | Special Deluxe Issue 2/3/4 | CSG National Task Forces by The Council of State Governments

2019 ISSUE 2/3/4

SPECIAL DELUXE ISSUE CSG NATIONAL TASK FORCES HEALTHY STATES THE FUTURE OF WORK THE CSG CENTER OF INNOVATION

CSG Healthy States National Task Force Co-Chair Sen. Bo Watson | Tennessee

Thank you!

CSG’S 2019 LEADERSHIP CIRCLE

To learn more about CSG’s Associates Program and Leadership Circle, please contact Maggie Mick, Chief Advancement Officer | The Council of State Governments | ph 859.244.8113 | mmick@csg.org Margaret Ridley, Corporate Relations Manager | The Council of State Governments | ph 859.244.8116 | mridley@csg.org

Issue 2/3/4 CSG NATIONAL TASK FORCES ON THE COVER Tennessee state Sen. Bo Watson serves as co-chair of the CSG Healthy States National Task force along with Delaware state Sen. Bryan Townsend. Watson is the chair of the Tennessee Senate Finance Ways and Means Committee. Photo Courtesy of Lawson Whitaker

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A MESSAGE FROM CSG’S EXECUTIVE DIRECTOR/CEO

HEALTHY STATES NATIONAL TASK FORCE

THE FUTURE OF WORK NATIONAL TASK FORCE

CSG CENTER OF INNOVATION

The state officials serving on CSG’s two national task forces—Healthy States and The Future of Work— will dig deep into health and workforce issues and innovations during the next biennium to determine best practices and share state successes with their peers.

The Healthy States Task Force is divided into four subcommittees: What’s Next? Leveraging Innovation; State Health Systems and Return on Investment; Capacity, Preparedness and Resiliency; and Interventions to Save Lives.

The Future of Work Task Force is divided into four subcommittees: The Workforce of Tomorrow; Smart Government; What’s Next? Embracing the Future; and Equity and Inclusion.

The CSG Center of Innovation is an initiative that leverages external funding to provide education, convenings and technical assistance to the states on focused policy topics.

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FEATURES

SPOTLIGHT: CSG National Task Forces

10 A Message from CSG Executive Director/CEO 46 THE WORKFORCE OF TOMORROW David Adkins The state officials serving on CSG’s two national task forces—Healthy States and The Future of Work—will dig deep into health and workforce issues and innovations during the next biennium to determine best practices in these areas and share state successes with their peers.

16 WHAT’S NEXT? LEVERAGING INNOVATION The What’s Next? Leveraging Innovation Subcommittee is examining how telemedicine can improve access to care, how states can support advances in the use of artificial intelligence in clinical diagnostic and research settings, and occupational licensure and health care data management through electronic health records, among other topics.

22 STATE HEALTH SYSTEMS AND RETURN ON INVESTMENT The State Health Systems and Return on Investment Subcommittee is looking at where health care funds come from and how funds are spent, especially in regard to overcoming obstacles, health promotion and harm reduction.

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28 CAPACITY, PREPAREDNESS AND RESILIENCY

The Capacity, Preparedness and Resiliency Subcommittee is studying how states can prevent and mitigate natural disasters, public health crises and other emergencies that arise through better planning, preparedness and intergovernmental communication.

34 INTERVENTIONS TO SAVE LIVES The Interventions to Save Lives Subcommittee is exploring innovative state practices, programs and health interventions that drive cost savings, reduce adverse health outcomes and improve quality of life for constituents.

The Workforce of Tomorrow Subcommittee is examining how states can re-evaluate the links between education and careers to meet the demands of the future workforce.

52 SMART GOVERNMENT The Smart Government Subcommittee is exploring new perspectives on state governance and the delivery of state services that enhance the performance of state systems.

58 WHAT’S NEXT? EMBRACING THE FUTURE The What’s Next? Embracing the Future Subcommittee is exploring how governments, the private sector, communities and individuals can prepare for a future where everyone can live, work and grow in one’s community; benefit from emerging technology; and be successful in an evolving economy.

64 EQUITY AND INCLUSION The Equity and Inclusion Subcommittee is exploring how states can promote and encourage equal opportunity and diversity in the new economy.

71 THE CSG CENTER OF INNOVATION The CSG Center of Innovation is an initiative that leverages external funding to provide education, convenings and technical assistance to the states on focused policy topics.

WHAT’S HAPPENING AT CSG

THEY TWEETED IT | task forces

REGIONAL ROUNDUP | east

REGIONAL ROUNDUP | south

REGIONAL ROUNDUP | midwest

REGIONAL ROUNDUP | west

CSG 2019 POLICY ACADEMY SCHEDULE

publisher DAVID ADKINS

dadkins@csg.org

editor-in-chief KELLEY ARNOLD

contributing NATALIE BURIKHANOV

writers CSG Policy Analyst nburikhanov@csg.org

contributing SEAN SLONE writers CSG Senior Policy Analyst continued sslone@csg.org

karnold@csg.org

CLAY FANNIN

BRANDY WHISMAN

managing editor BLAIR HESS

CSG Policy Analyst cfannin@csg.org

CSG Policy Analyst bwhisman@csg.org

bhess@csg.org

SYDNEY GEIGER associate editors SHAWNTAYE HOPKINS CSG Research Associate capitolideas@csg.org

sydney.geiger@csg.org

LISA MCKINNEY

JESSICA KIRBY

lmckinney@csg.org

technical editor CHRIS PRYOR

CAPITOL IDEAS, ISSN 2152-8489, ISSUE 2/3/4, Vol. 62, No. 2—Published by The Council of State Governments, 1776 Avenue of the States, Lexington, KY 40511-8536. Opinions expressed in this magazine do not necessarily reflect the policies of The Council of State Governments nor the views of the editorial staff. Readers’ comments are welcome. Subscription rates: in the U.S., $42 per year. Single issues are available at $7 per copy. POSTMASTER: Send address changes to Capitol Ideas, Sales Department, The Council of State Governments, 1776 Avenue of the States, Lexington, KY 40511-8536. Periodicals postage paid at Lexington, Ky., and additional mailing offices.

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Sen. Lou D’Allesandro NEW HAMPSHIRE CSG National Chair

Senate President Rep. Ryan Mackenzie Joseph B. Scarnati, III PENNSYLVANIA PENNSYLVANIA CSG East Co-Chair

CSG EXECUTIVE DIRECTOR/CEO dadkins@csg.org

Wendell M. Hannaford CSG EAST DIRECTOR whannaford@csg.org

Sen. Elgie R. Sims Jr. ILLINOIS CSG Midwest Chair

House Speaker Tim Moore NORTH CAROLINA CSG South Chair

Rep. Kimberly Dudik MONTANA CSG West Chair

Michael H. McCabe

Colleen Cousineau

Edgar Ruiz

CSG MIDWEST DIRECTOR mmccabe@csg.org

CSG SOUTH DIRECTOR fitzgerald@csg.org

CSG WEST DIRECTOR eruiz@csg.org

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David Adkins

CSG East Co-Chair

30 SFI-01681

what’s happening at csg

WHAT'S HAPPENING AT CSG?

2019 Medicaid Policy Academy to be Held in October

The CSG 2019 National Conference will be held in San Juan, Puerto Rico, Dec. 4–7. The conference will feature sessions tailored to state officials on workforce innovation, interstate compacts, health policy and more. It will also include full-day Policy Academies that will take an in-depth look at 5G technology, the energy landscape in the states and marijuana policy. Join your fellow state officials from across the country for this exceptional educational and networking opportunity. Register at csg.org/2019nationalconference.

On Oct. 9–11, CSG members will gather in Washington, D.C., for the CSG Medicaid 101 Policy Academy to learn more about Medicaid and how states can improve health outcomes for enrollees. The Medicaid 101 Policy Academy will provide attendees with an opportunity to meet with federal government officials and other Medicaid experts to develop a deeper understanding of program rules and requirements. During the three-day program, attendees will participate in lectures, interactive panels and round table discussions on topics including the Children’s Health Insurance Program, or CHIP, interbranch relations, return on investment programs and social determinants of health.

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CSG Hosts Occupational Licensing Policy Learning Seminars States are increasingly examining licensing criteria to ensure that existing and new licensing requirements are not overly broad, burdensome or restrictive, and that they do not create unnecessary barriers to labor market entry. Many states are also improving the portability and reciprocity provisions for selected occupations across state lines. CSG hosted one-day seminars on occupational licensing policy for members of CSG’s Western, Southern and Eastern regions. Programming explored best practices from other states, policy to aid disproportionately affected populations, and licensure reciprocity mechanisms such as interstate compacts. Participants became familiar with occupational licensing policy in their own state as well.

Registration Open for the CSG 2019 National Conference

CSG 2019 Toll Class Completes Fellowship The members of the Henry Toll Fellowship class of 2019, who hail from 33 states and represent all three branches of state government, convened Aug. 23–27 in Lexington, Kentucky, for one of the nation’s premier leadership development programs for state government officials. Every year, CSG brings 48 rising state leaders together at CSG Headquarters for an intensive six-day, five-night “leadership boot camp” designed to stimulate personal assessment and growth, while providing professional relationship-building opportunities with colleagues from across the country. Plan to attend the 2019 Toll Fellow graduation ceremony at the CSG National Conference in San Juan, Puerto Rico, in December. For more information on the Toll Fellowship, visit csg.org/leadershipdevelopment.

CSG Justice Center Releases a Report on Probation and Parole A new report from the CSG Justice Center, Confined and Costly: How Supervision Violations are Filling Prisons and Burdening Budgets, reveals the startling extent to which probation and parole violations contribute to states’ high prison admissions and populations, as well as the subsequent cost to taxpayers. Until now, national data regarding the impact of probation violations on prison populations have been unavailable, resulting in a lopsided focus on parole. The CSG Justice Center recently engaged corrections and community supervision leaders in 50 states to develop the first complete picture of how probation and parole violations make up states’ prison populations. To view the report, visit csgjusticecenter.org/confinedandcostly.

they tweeted it

They Tweeted It RepHolliSullivan @RepSullivanHD78 • Jun 21 Look at this team! Productive engaging start to our Smart Government Committee. I am honored to Co-Chair this group of colleagues from Nebraska, South Dakota, Microsoft, Kansas, Massachusetts, Maryland, Colorado, Rhode Island and Washington #IndianaLeads #lovemyjob @CSGovts

Heather Carter AZ @HeatherCarterAZ • May 17 Honored to be a part of the @CSGovts “Future of Work Task Force.” I can’t wait to dive into the research as part of the “Workforce of Tomorrow” subcommittee. #CSGFutureofwork http://www.csg.org

Bo Watson @SenBoWatson • Jun 18 Day 1 of the #csghealthstates task force mtg @CSGovts. Some of the best state legislative health policy thinkers from across the US here for 2 yr project. Looking for solutions. Proud to co-Chair with @BryanTownsendDE @TimesFreePress @wdefnews12 @newschannelnine @WRCB @tnsenate

Shevrin Jones @ShevrinJones • Jun 19 What a pleasure it is to serve on the #HealthyStates @CSGovts National Task Force with Senator @Gayle_Harrell—looking forward to bringing home some great bi-partisan legislation for Florida.

Sen. Carolyn McGinn @SenatorMcGinn • Jun 21 Listening, learning and discussing The Future of Work for our country. @CSGovts

Sen. Bryan Townsend @BryanTownsendDE • Jun 18 A key question at @CSGovts #csghealthystates conference, during presentation on Adverse Childhood Experiences Policymakers can have an impact; we can and must do better. #ACES “How does one perform reverse alchemy, going from a normal newborn with almost unlimited potential, to a diseased, depressed adult? How does one turn gold into lead?” -Vincent Felitti, MD

Carmelo Ríos @Carmelorios • Jun 18 During this forum we discussed the problems of access to healthcare and the challenges we face in Puerto Rico. #csghealthystates

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John Tilley @TilleyKY • Jun 20 Excited to attend @CSGovts Future of Work Task Force & offer a criminal justice perspective on our workforce challenges. Strong reentry not only benefits public safety, but also our economy & workforce. Thx to @kydavidgivens, @SenatorJimmy & many others for their efforts! @CSGJC

Michael O. Moore @SenMikeMoore • May 7 As technology continues to advance, so will the needs of our workforce & our employers. I’m eager to participate as part of @CSGovts ‘Future of Work Task Force’ to explore policy options that would address the shifting needs of our labor market. #csgfutureofwork #mapoli

regional roundup

The East CT • DE • MA • MD • ME • NH • NJ • NY • PA • RI • VT • NB • NS • ON • PE • PR • QC • VI FENTANYL

RELOCATION INCENTIVE

Fatal overdoses from fentanyl, a synthetic opioid, declined in the first three months of 2019 in Maryland, reported The Baltimore Sun. The overall overdose decline was just under 15% to 577 total deaths, with fewer overdoses recorded in 15 counties and Baltimore City, according to data from the state Department of Health and the Opioid Operational Command Center.

On Jan. 1, Vermont began reimbursing people up to $10,000 if they move to the state to take remote jobs, reported VTDigger. Next year, the program will reimburse workers up to $5,000- $7,500 in parts of the state that have a difficult time recruiting workers. So far, 33 people have moved to Vermont to take jobs through the remote worker program, said Vermont state Sen. Alison Clarkson.

INTERNET PRIVACY

GAMBLING

Maine Gov. Janet Mills signed a bill requiring internet service providers to adhere to strict consumer privacy protections, reported the Portland Press Herald. The law, which goes into effect on July 1, 2020, requires internet providers to ask permission before they sell or share customers’ data to a third party. The law also applies to telecommunications companies that provide internet access through cellular networks.

In a decision by Commonwealth Court, Pennsylvania casinos lost their bid to prohibit online lottery games, which compete with casino gambling. However, the casino owners’ lawsuit will continue, according to The Associated Press. Lottery officials argued their online games comply with the state law that authorized them, while the casino owners argue that some of the games violate the law because they are too similar to slot machines and casino gambling.

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CAT DECLAWING

The New York Legislature passed legislation to ban the declawing of cats. Signed into law in July, by Gov. Andrew Cuomo, New York became the first state to ban the practice. The bill would fine veterinarians $1,000 for performing a declawing operation, reported The Associated Press. Animal welfare advocates and some veterinarians consider the practice cruel and unnecessary.

For more on CSG East, visit capitolideas.csg.org and www.csg-erc.org.

Connecticut Expands Family and Medical Leave Law Connecticut Gov. Ned Lamont in June signed one of the nation’s most extensive family and medical leave laws, according to the Harford Courant. “It’s about time,” Lamont said at a news conference. “[This bill] means you can now take the time you need to care for a sick child, to care for a new child and do what you’ve got to do, and you don’t need to choose between a job and someone you love.” The new law will allow Connecticut workers up to 12 weeks of paid leave to care for a newborn, a newly adopted or foster child, a seriously ill relative or a close associate who is the equivalent of a family member. Employees with their own serious health conditions or who are serving as a marrow or organ donor will also be eligible. The law applies to organizations with one or more employees. The program will be paid for by a 0.5% payroll tax levied on all employees.

regional roundup

The South AL • AR • FL • GA • KY • LA • MO • MS • NC • OK • SC • TN • TX • VA • WV TECH INCENTIVES

INFRASTRUCTURE FUNDING

The recently passed Alabama Incentives Modernization Act creates new incentives for tech companies in the state, adds to incentives already available for rural counties with populations of 50,000 or less and expands benefits for opportunity zones, reported The Birmingham Business Journal. According to the legislation, the addition of only five new jobs will be required for technology companies to be eligible for Jobs Act credits.

Louisiana’s largest infrastructure bill in 30 years was approved by the Legislature during the 2019 session, according to The Advocate. Nearly $700 million in funding will be available for 10 projects statewide after legislators overhauled how the state spends settlement dollars from the 2010 Deepwater Horizon Gulf oil spill. Louisiana has an estimated $14 billion backlog of road, bridge and other transportation work that needs to be completed.

DRUG IMPORTATION

Virginia Offers Student Loan Repayment Incentive The Virginia Tobacco Region Revitalization Commission is overhauling its student loan repayment program to incentivize skilled professionals to settle in one of 40 localities in Southwest and Southside Virginia, The Roanoke Times reported. Although student loan repayment options will be available to applicants from Virginia and nationally, the tobacco commission will give preference to those who were born and raised in the region and are interested in returning after completing their degree programs. The initiative, known as the Talent Attraction Program, will provide $24,000 over two years to recent college graduates willing to live in the region and work in highdemand jobs. To qualify, participants also will have to become civically engaged, for example volunteering for Habitat for Humanity or joining a local government board.

OCCUPATIONAL LICENSING Texas’ licensing boards no longer will be permitted to suspend workers’ occupational licenses if they default on their student loans, The Texas Tribune reported, after Gov. Greg Abbott signed legislation banning the practice. Thousands of people in the state were at risk of losing their licenses in 2017 due to student loan default. Supporters of the legislation argue that it becomes even more difficult for borrowers to repay their student loans if their professional licenses are revoked or suspended.

TRAINING VETERANS A new program launched in Kentucky to train veterans with experience in aviation or power plant mechanics to receive Federal Aviation Administration certified credentials, reported The Associated Press. The initiative, called Veterans Accelerated Learning for Licensed Occupations, offers certifications for veterans to address critical workforce shortages by condensing an 18-month certification process into one semester.

For more on CSG South, visit capitolideas.csg.org and www.slcatlanta.org.

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For jobs in the health care industry, the potential incentives are significantly higher. The tobacco commission is partnering with the Virginia Department of Health to expand a program that currently provides up to $140,000 over four years to work in underserved areas. With state and federal funding and a match from health care employers, the Department of Health’s program supported approximately 33% of eligible applicants this year. The tobacco commission plans to increase funding for the program to support additional eligible applicants in the future.

Florida Gov. Ron DeSantis signed legislation in June creating a drug importation program in the state, according to The Associated Press. The legislation establishes a framework for importing drugs from Canada and elsewhere, with the hope of reducing prescription drug costs for consumers. Opponents of drug importation warn the program will be difficult and costly to oversee and regulate, and potentially could lead to counterfeit, contaminated or ineffective drugs.

regional roundup

The Midwest IA • IL • IN • KS • MI • MN • ND • NE • OH • SD • WI • AB • MB • ON • SK MARIJUANA POSSESSION

GOVERNOR’S PODCAST

North Dakota Gov. Doug Burgum signed a bill into law eliminating jail time for possession of small amounts of marijuana, reported Valley News Live. House Bill 1050 makes possession of up to a half ounce of marijuana by adults 21 and older punishable by a maximum fine of $1,000. Prior to the legislation, the offense was classified as a misdemeanor with a punishment of up to 30 days in jail in addition to a fine.

Nebraska Gov. Pete Ricketts launched a podcast in June as a means for the governor’s office connect with residents. The podcast will feature conversations with lawmakers, sports coaches and others about topics of public interest, reported The Associated Press. The inaugural episode’s guest is U.S. Sen. Deb Fischer, who spoke with the governor about current debates in Congress and her time in the Nebraska Legislature.

REDUCING POLLUTION

DRIVERLESS VEHICLE TRACK

Illinois Gov. J.B. Pritzker in June signed legislation to reduce ethylene oxide pollution, which is known to cause cancer, in the state. The law requires Medline Industries, Sterigenics and other sterilization facilities to prevent ethylene oxide leaks into surrounding neighborhoods. The law also requires the companies to dramatically reduce pollution emitted through smokestacks, according to the Chicago Tribune.

Ohio opened a state-funded facility for testing driverless vehicles as part of an expansion of the state’s Transportation Research Center, reported Cleveland. com. The Smart Mobility Advanced Research Test, or SMART, Center features a six-lane, high-speed “smart” intersection that companies and researchers can use to test smart vehicles. The facility cost $45 million—$25 million was provided by Ohio State University, and the rest comes from the state’s JobsOhio program and the Ohio Department of Transportation.

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TRANSGENDER BIRTH CERTIFICATES

The Kansas Department of Health and Environment entered into a consent judgment in a federal lawsuit to allow people to legally change their gender in their birth records by submitting a sworn statement of gender identity, reported The Wichita Eagle. Applicants to change their gender designation will also be required to provide a driver’s license or passport with their new identity, or an affidavit from a doctor attesting to their gender identity.

For more on CSG Midwest, visit: capitolideas.csg.org and www.csgmidwest.org.

Minnesota Enacts Policy to Protect Elderly Residents Minnesota Gov. Tim Walz signed into law a package of policies to protect elder and vulnerable adults in assisted living facilities. The legislation requires assisted living facilities to be licensed, ensures the rights of residents, and allows residents and their families to record in their rooms to protect occupants from abuse, reported the Duluth News Tribune. “No Minnesotan or their family should have to worry about their safety when putting their trust in an assisted living facility,” Walz said in a statement. “Reports of elder abuse in Minnesota are tragic and unacceptable. This law will create longoverdue protections to help ensure every resident of an assisted living facility is cared for and safe.” The legislation also protects elders from loss of housing or retaliation if they report abuse or neglect. Prior to the passage of the law, Minnesota was the only state that didn’t require the licensing of assisted living facilities. The new law’s licensing system is set to be online in August 2021.

regional roundup

The west AK • AZ • CA • CO • HI • ID • MT • NM • NV • OR • UT • WA • WY • AB • AS • BC • CNMI • GU DEMOCRACY VOUCHERS The Washington Supreme Court upheld Seattle’s “democracy vouchers” program, which allows residents to give taxpayer money to political candidates, according to The Associated Press. Voters receive four $25 vouchers, funded by a property tax, they can give to city council or city attorney candidates. Critics said the program could effectively force residents to support candidates they don’t agree with. The court ruled that because any candidate can qualify for funds, the program is politically neutral.

MOBILE HOMES

California Sets New Standards for Worker Classification The California Assembly passed a bill in May that would create more stringent requirements for companies to classify workers as independent contractors, as many workers in the gig economy are, instead of employees, reported Vox. Employees are entitled to labor protections and benefits—such as unemployment insurance, health care subsidies, paid parental leave, overtime pay and workers’ compensation—that are not required for independent contractors. “Big businesses shouldn’t be able to pass their costs onto taxpayers while depriving workers of the labor law protections they are rightfully entitled to,” Assemblywoman Lorena González wrote on Twitter.

COAL PLANT CLOSURE New Mexico regulators in July planned a course of action to close of the state’s largest utility, Public Service Co. of New Mexico, which applied to close its San Juan Generating Station. The plan outlines financing the closure and providing benefits and training to the coal plants’ workers. It also includes

PROSTITUTION CONVICTIONS Hawaii Gov. David Ige signed legislation that removes the requirement that a person be a victim of sex trafficking to erase a prostitution conviction. The state will remove prostitution convictions for people who don’t obtain additional convictions for three years, according to The Associated Press. Hawaii is the first state to remove the requirement. Advocates say victims often can’t reveal or prove they’ve been trafficked because of fear of retaliation or dependence on their trafficker.

HOLOCAUST EDUCATION A law signed by Oregon Gov. Kate Brown in July requires the Holocaust and genocide to be taught to age-appropriate students in Oregon schools, starting in the 2020 school year. Oregon high school sophomore Claire Sarnowski contacted legislators about creating the law, which was supported by the Oregon Jewish Museum Center for Holocaust Education, reported KATU.

For more on CSG West, visit: capitolideas.csg.org and www.csgwest.org.

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The bill expands on the 2018 California Supreme Court decision in Dynamex Operations West, Inc. v. Superior Court of Los Angeles, which set standards for worker classification. The ruling and the bill require businesses to use the “ABC test” to determine if a worker is an employee or an independent contractor. To hire someone as an independent contractor, businesses have to show that the worker (a) is free from the company’s control, (b) is doing work that isn’t central to the company’s business, and (c) has an independent business in that industry.

Colorado Gov. Jared Polis signed a bill to expand regulatory protections for residents of mobile home parks. Polis said the bill will be particularly helpful in Boulder County, where highprofile disputes between mobile home park owners and residents have required city council intervention, according to Boulder’s Daily Camera. House Bill 1309 will be an enforcement mechanism for regulations outlined in the 1985 Mobile Home Parks Act.

options for replacing the lost power. The plant closing marks the beginning of the end of coal-powered energy in the state, reported The Associated Press.

csg national task forces

Bringing People of Purpose Together For more than 85 years, The Council of State Governments has convened public servants who strive to solve complex problems in order to make their communities, states and the world a better place for everyone. The state officials serving on the two CSG national task forcesâ&#x20AC;&#x201D;Healthy States and The Future of Workâ&#x20AC;&#x201D;are continuing this tradition by digging deep into health and workforce issues and innovations to determine best practices in these areas and share state successes with their peers.

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In June 2019, the national task forces began the work that will continue over the next two years and culminate with a report at our CSG 2020 National Conference that provides a national framework for all state officials.

We have created an inclusive, nonpartisan space where state officials selected for their knowledge and work in health care- and workforce-related issues can work together across geography and political ideology to focus on data and build a consensus about how to move forward in solving problems that all states face. America spends more money on health care than any other industrialized nation. But when it comes to outcomes, America isnâ&#x20AC;&#x2122;t at the top of the heap. There is work to be done, and the insights of the Healthy States National Task Force will help states reduce costs and improve outcomes because regardless of political background, every person desires health and wants to live in a healthy state.

A message from CSG Executive Director/ CEO David Adkins

In addition, we all want to live in a state where economic prosperity is possible and everyone can know the dignity and value that work brings. This is an issue that CSG has researched for many years, but now The Future of Work National Task Force participants are taking a fresh look at workforce issues to figure out how to grow economies and succeed globally. On behalf of CSG staff and our national leadership team, I want to thank the state officials who are stepping out of their comfort zones and setting aside judgement to learn from each other and ultimately prepare a report that identifies challenges but, most importantly, celebrates successes. CSG has remained a relevant tool for the states because of the public servants who guide our organization by asking tough questions and then seeking shareable solutions. As you read through this special edition of Capitol Ideas, introducing the national task forces and their members, remember that our states and our democracy work better when we collaborate with colleagues who come from a different state or have a different political perspective. This journey over the next two years and the dialogue happening is just as important as the finished product, which will reflect the hard work and passions of a diverse group of public servants and provide states and our nation with fuel to continue moving toward excellence.

healthy states

CSG Healthy States National Task Force Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Health Care Spending and Outcomes by Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 CSG Healthy States National Task Force Co-Chairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

What's Next? Leveraging Innovation Subcommittee . . . . . . . . . . . 16

Telemedicine, 5G, Electronic Health Records. . 16 Small Cell Legislation . . . . . . . . . . . . . . . . . . . . . . 18 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Social Factors and Health Care Costs. . . . . . . . . 22 What Determines Health? . . . . . . . . . . . . . . . . . . 24 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Addressing Emerging Health Threats and Responses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Measles Outbreaks on the Rise. . . . . . . . . . . . . . 30 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Interventions to Save Lives Subcommittee . . . . . . . . . . . . . . . . . . . . . . . . 34

Innovative Solutions to Pressing Preventive Health Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 School-Based Interventions for Child Health. . . 36 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

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State Health Systems Return on Investment Subcommittee . . . . . . . . . . . 22

Capacity, Preparedness and Resiliency (CPR) Subcommittee. . . . . . . . . . . . . . . . 28

csg national task forces

Introducing the CSG Healthy States National Task Force In June, members of the CSG Healthy States National Task Force met for the first time to learn from experts on various health care-related projects and issues and to set goals for the work that will occur through 2019 and 2020. “The topic is as complicated and fraught with uncertainties and policy complexities and political pitfalls as it is critical from a fiscal, economic, business and moral perspective,” said Delaware state Sen. Bryan Townsend, who serves as co-chair of the task force with Tennessee state Sen. Bo Watson. The Healthy States Task Force is divided into four subcommittees: What’s Next? Leveraging Innovation; State Health Systems and Return on Investment; Capacity, Preparedness and Resiliency; and Interventions to Save Lives.

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The What’s Next? Leveraging Innovation Subcommittee is examining how innovations such as artificial intelligence and electronic health records will impact health care in the years to come and how state governments can use innovations to reduce costs and improve access.

The State Health Systems and Return on Investment Subcommittee is looking at where health care funds come from and how funds are spent, especially in regard to overcoming obstacles, health promotion and harm reduction. The Capacity, Preparedness and Resiliency Subcommittee is examining how states can prevent and mitigate natural disasters, public health crises and other emergencies that arise through better planning, preparedness and intergovernmental communication. Finally, the Interventions to Save Lives Subcommittee is exploring innovative state practices, programs and health interventions that drive cost savings, reduce adverse health outcomes and improve quality of life for constituents.

In addition to the task force co-chairs, each subcommittee has two co-chairs from different political parties and 10 members. You will be introduced to this diverse group throughout the following section of this special edition of Capitol Ideas. “This is important work,” Watson said. “This is a very heavy lift. Each of the subcommittees—you can look at any single issue in a subcommittee and spend a week, a month, a year, just on that one piece of subject matter.” The following pages also will explore policy issues studied by the subcommittees, including health care spending, Medicaid/Medicare, telemedicine, infectious disease outbreaks and vaccination policies. Members of the task force have two years to survey best practices and innovative state initiatives around these topics and will meet during planned task force meetings, some of which will be held at annual CSG National Conferences. “Two years is the least it’s going to take to tackle all of this, but we think it can be done,” Townsend said at the meeting in June. The task force will ultimately produce a report that will serve as a national framework for all states. “The way that health impacts all of us in different ways and different times… and the idea of having kids get off to a great start in life because we know what happens if they don’t—that’s what drives my passion for the topic,” Townsend said. The task force co-chairs encouraged members of the group to learn from each other and various speakers and gain inspiration and new ways of looking at familiar problems. “You are here—and were selected to be here—for a reason and it’s because of the skill set that you have around this subject,” Watson said.

healthy states

Health Care Spending and Outcomes by Country Today, states spend nearly 1 of every 3 dollars

on their Medicaid programs alone As a nation, Americans now spend over $11,000 per person per year on health care. In 2016, spending on health care in the United States was 16.9% of GDP, with annual spending topping $3 trillion. National health spending is projected to grow at an average rate of 5.5% per year for the next decade and is projected to reach $6 trillion by 2027.

And yet, health care outcomes in America lag far behind other industrialized nations. For the third consecutive year, life expectancy in the U. S. has declined. State health systems are continually under pressure to maintain quality of care while simultaneously identifying savings.

Infant Mortality Rate

Health Expenditure (2015)

per capita in US Dollars CANADA $4,507 FRANCE $4,026 GERMANY $4,592 ITALY $2,700 JAPAN $3,733 NORWAY $7,464

UNITED KINGDOM $4,356 UNITED STATES $9,536

percentage of gross domestic product (GDP)

(DEATHS/1,000 LIVE BIRTHS) 2017

4.5 3.2 3.4 3.3

Canada France Germany Italy

2.0 2.5 4.3 5.8

Japan

10.4%

11.1%

11.2%

Norway

Canada

France

Germany

Italy

10.9%

10%

9.9%

16.8%

Japan

Norway

U.K.

U.S.

United Kingdom United States

Source: The World Factbook, CIA https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Cancer, age-standardized death rates (15+) PER 100,000 POPULATION (2016) Country

Female

171 132.4

years

81.0

years

82.8

Canada

France

Germany

Italy

84.2

82.5 years

81.4

years

78.5

143.1

years

133.9

Japan

Norway

U.K.

U.S.

FRANCE

219.3 126.1

GERMANY

198.9 131

ITALY

191.7 120.5

JAPAN

187.2 101.6

NORWAY

178.6 131.6

UNITED KINGDOM

189.7

UNITED STATES

178.3

Source: World Health Organization

Life expectancy at birth (2016) 82.8

82.9

years

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CANADA

Male

csg national task forces

CSG Healthy States National Task Force Co-Chairs

What issues are you excited to focus on as part of the CSG Healthy States Task Force? I am most interested in learning from effective efforts to promote health and wellness by focusing on primary care, and successful efforts to address racial disparities in maternal and child health outcomes.

Delaware

How can states best meet the challenges presented by the current health care system?

B rya n

How can states leverage the opportunities offered by the revolutionary changes occurring in this sector?

State Senator

Townsend ISSUE 2/3/4 2019 | CAPITOL IDEAS

Chair, Delaware Health and Social Services Committee

The way that health impacts all of us in different ways and different times … and the idea of having kids get off to a great start in life because we know what happens if they don’t—that’s what drives my passion for the topic.”

In the current climate, states can best meet challenges by making use of federal flexibility, prioritization of state-level innovation, and by focusing on regional and scalable efforts rather than federal ones.

Revolutionary changes include the ability to collect and analyze data, as well as telemedicine. States can embrace the chance to deploy technology to reach more citizens at a lower cost and help keep them well, and to deploy data-analytic measures to identify and correct outliers in health outcomes—for example, hospitals that have higher-than-average maternal deaths—and to target people for whom medical intervention is most likely to make the greatest difference.

State health systems are continually under pressure to maintain quality of care while simultaneously identifying savings. What are some of the initiatives that your state has implemented to address this? Delaware is engaged in conversations about how to direct more resources toward primary care. We also have been an early adopter of telemedicine frameworks, and we have enhanced our focus on mental and behavioral health as part of achieving overall wellness in a more cost-efficient and fiscally-sustainable way.

healthy states

What issues are you excited to focus on as part of the CSG Healthy States Task Force? It is the collaborative process that the task force will undertake that is exciting to me. The task force is composed of some great problem solvers in their respective states. Through the collaborative effort, I believe the task force can bring forward practical ideas that can have a positive impact on quality, access, cost and community health status.

Tennessee State Senator

Watson Chair, Tennessee Senate Finance Ways and Means Committee

How can states best meet the challenges presented by the current health care system? States, not the federal government, are in the best position to begin to recreate the health care delivery model and to address population health at a local level. States need to demand flexibility in the Medicaid system so they can innovate new delivery systems, and states need to institute policies that encourage healthier lifestyles.

How can states leverage the opportunities offered by the revolutionary changes occurring in this sector? By allowing disruption to occur in the market. Look, we are watching technology and innovation disrupt markets from transportation to hospitality. Health care should be no different. States can leverage their combined experience to identify and create new systems and processes that can significantly change how we access and deliver health care services and how communities improve their health status.

Through the collaborative effort, I believe the task force can bring forward practical ideas that can have a positive impact on quality, access, cost and community health status."

This is the great conundrum of the American health care system. To my mind, no other economic system operates this way, when the consumer (patient) is removed from the transaction via third-party payers. In Tennessee, we are experimenting with patient-centered strategies to determine if there is a way, via legislation, that allows the consumer to have a say in the purchase of their health care servicesâ&#x20AC;&#x201D;often termed right-to-shop. We are also trying new delivery models for providers like episodes of care and payment for quality not quantity.

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csg national task forces

CSG Healthy States N a t i o n a l Ta s k F o r c e W H AT ' S N E X T ? LEVERAGING I N N O VAT I O N SUBCOMMITTEE

Telemedicine, 5G Electronic Health Records on the Agenda by Sean Slone New Mexico state Rep. Liz Thomson, a licensed physical therapist who is co-chairing the CSG Healthy States Subcommittee on Leveraging Innovation, knows well the importance of one technological innovation in health care—telemedicine—to serving the far-flung corners of her state.

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“New Mexico is a very rural state, the fifth largest, with about 17 people per square mile,” she said. “There are several counties in the state that are considered frontier. We have a shortage of most, if not all, medical providers. We have the oldest average age of physicians in the nation. All of the above make it difficult to provide adequate health care services throughout the state, making telehealth a helpful, and even necessary, part of our overall health care system.”

New Mexico has been recognized in recent years as a leading state on telemedicine by the American Telemedicine Association. The state enacted a parity law in 2013 that created parity for telemedicine services under private insurance, Medicaid and state employee health plans. Through the New Mexico Telehealth Alliance, the state offers technical and program support to ensure coordinated services via telemedicine across the state. The state also funds Project ECHO (Extension for Community Healthcare Outcomes) through the University of New Mexico, which hosts virtual clinics with experts from remote sites. But for Thomson, when it comes to telemedicine, the issue is personal as well.

“I have a 28-year-old son with severe autism and intermittent explosive disorder,” she said. “When he was young, services in New Mexico, even in the big city of Albuquerque, were minimal with essentially no access to applied behavioral analysis, the major evidence-based intervention in autism spectrum disorders. There are many more services available now but getting them into more rural areas continues to present major challenges, and telehealth is used to address some of these issues.” But the expansion of telemedicine faces challenges around the country. “Telemedicine capabilities are only as good and effective as the broadband capabilities that currently exist in rural communities,” said Kentucky state Sen. Stephen Meredith, a retired rural hospital CEO who is the subcommittee’s other co-chair. “And, unfortunately, the broadband capabilities in rural communities leave much to be desired. We cannot possibly take advantage of these wonderful and sometimes miraculous capabilities until we are willing to invest in the infrastructure to make high-speed internet available to every community in America.” The transition to fifth generation cellular networks, known as 5G, is expected to enable advances in telemedicine such as virtual reality and augmented reality applications. As of earlier this year, 22 state legislatures have enacted small cell legislation to streamline state and local regulations to encourage industry deployment of 5G infrastructure. One of those states is Illinois, where subcommittee member and state Rep. Tom Demmer is the director of innovation and strategy at a hospital in Dixon.

healthy states

“The new 5G network will greatly improve data speeds and will unlock the potential for new types of interaction between patients in their home and providers in a hospital or clinic,” said Demmer. “Legislation that paved the way for 5G implementation is just the first step toward a more connected future.” Among the other topics, the Leveraging Innovation Subcommittee is examining: how states can support advances in the use of artificial intelligence in clinical diagnostic and research settings, and occupational licensure and health care data management through electronic health records, or EHRs.

We cannot possibly take advantage of these wonderful and sometimes miraculous capabilities until we are willing to invest in the infrastructure to make high-speed internet available to every community in America.” Kentucky state Sen. Stephen Meredith

Kaiser and Fortune also found that instead of streamlining medicine, federal efforts to push EHRs forward had “created a host of largely unacknowledged patient safety risks.” “As a hospital CEO of a rural hospital, I was against the federal mandate for EHRs from the very beginning,” said Meredith. “By forcing the mandate, it has caused health care providers to invest massive amounts of capital and man-hours without a comparable return on investment. In rural communities, in particular, this mandate has slowed the productivity of providers as much as 20% to 30%. And, this came at a time when demand for health care exploded because of the Affordable Care Act. It has resulted in lower operating margins thus creating a financial death spiral that is preventing rural health care providers from obtaining the newest and latest health care advances because of the required investment in information technology.” Another subcommittee member, Sen. Carmelo Rios of Puerto Rico, has concerns as well. “It has dehumanized the process, making it easier to pay more attention to billing, the time spent and finding the correct code to give a patient,” he said.

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Eighty-five percent of office-based physicians and 90% of hospitals in the United States currently use EHRs, Forbes magazine reported last year. A federal mandate enacted under the Affordable Care Act went into effect in 2014. But despite the long-held promise of EHRs to make medicine safer, bring higher-quality care, empower patients, create greater portability and save money, many are concerned they haven’t

fulfilled that promise. Fortune magazine and Kaiser Health News reported in March that “the nation’s thousands of EHRs largely remain a sprawling, disconnected network.” Moreover, the report said, the federal mandate “has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it.”

csg national task forces

Small Cell Legislation What is 5G?

Small Cell Legislation Enacted Small Cell Legislation Introduced in 2019

5G, or 5th Generation,

wireless networks are the next generation of internet connectivity. 5G is expected to be much faster than existing networks, have the capacity to handle heavier loads of data and be more reliable. Source: “Mobile 5G and Small Cell 2019 Legislation,” National Conference of State Legislatures, Feb. 15, 2019.

What Will 5G Mean for Health Care? 5G is expected to have implications for the handling of patient data and for telemedicine. It’s expected to allow for:

ISSUE 2/3/4 2019 | CAPITOL IDEAS

continuous monitoring of patients

remote diagnosis and imaging

use of virtual reality and augmented reality

What is Small Cell Legislation? Deploying 5G requires new infrastructure called small cells

which generate less power, collect and transmit signals in a short range from one another

and are required to be located on other infrastructure

With legislation, states have sought to streamline RIGHTS -OFWAY PERMITTING

SITING AND APPLICATION FEES APPLICATION TIMELINES

APPEALS

to make it easier for wireless companies to deploy the small cell 5G infrastructure on an expedited basis.

healthy states

Private Insurance Telemedicine Parity States with the highest grades for private insurance telemedicine parity States with the Highest Grades States with the Lowest Grades

Source: American Telemedicine Association. â&#x20AC;&#x153;State Telemedicine Gaps Analysis: Coverage & Reimbursement,â&#x20AC;? February 2017.

States with the highest grades for provide statewide coverage and have no

provider, technology or

patient setting restrictions.

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private insurance telemedicine parity

csg national task forces

What's Next? Leveraging Innovation Subcommittee Key Issues and Resources Artificial Intelligence

The MIT Technology Review in February took a look at how AI is transforming the task of finding new drugs (“AI is reinventing the way we invent”). The New York Times examined how AI is being used by physicians to diagnose illness and disease (“A.I. Shows Promise Assisting Physicians,” Feb. 11, 2019). Healthcare IT News highlighted a recent study that showed that the way machine learning works may be at odds with clinical outcomes unless carefully controlled for (“AI in health care— not so fast? Study outlines challenges, dangers for machine learning,” Jan. 16, 2019). A former health care CEO outlined the promise and potential of AI in medicine in a piece for Forbes (“Artificial Intelligence in Healthcare: Separating Reality from Hype,” March 13, 2018). For more information, visit technologyreview.com.

Telemedicine/Telehealth

The American Telemedicine Association offers assessments of every state’s telemedicine policies in a 2017 report (“State Telemedicine Gaps Analysis: Coverage & Reimbursement,” February 2017). Professional services firm Manatt conducted its own survey of state policies in a 2018 report (“State Telehealth Laws and Medicaid Policies: 50-State Survey Findings,” July 10, 2018). For more information visit, americantelemed.org.

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David Teece of UC Berkeley noted in a 2017 research report how 5G wireless networks will allow for the continuous monitoring of patients, remote diagnosis, and imaging and the personalization of health care (“5G Mobile: Impact on the Health Care Sector,” Oct. 26, 2017). The Center for Technology Innovation at Brookings looked at the benefits of 5G for medical imaging, diagnostics, data analytics and treatment in a 2016 report (“How 5G technology enables the health internet of things,” July 2016). For more information, visit berkeley.edu.

Occupational Licensure & Scope of Practice Guidelines

The Brookings Institution in 2018 pointed to recent research showing the potential benefits of reforming licensing rules in the health care sector and loosening scope of practice limitations on nonphysician providers (“Improving health care through occupational licensing reform,” Aug. 28, 2018). For more information, visit brookings.edu.

Health Care Data Management

A joint investigation by Fortune and Kaiser Health News examines the problems with electronic health records (“Death by a Thousand Clicks: Where Electronic Health Records Went Wrong,” March 18, 2019). Healthcare IT News discussed how blockchain could be used to improve electronic health record systems (“Blockchain use case: Electronic health records,” Dec. 14, 2018). A recent piece for The Verge looked at why it may be time to update the 1996 Health Insurance Portability and Accountability Act (“Why It’s Time to Rethink the Laws That Keep Our Health Data Private,” Jan. 29, 2019). For more information visit, khn.org/news/death-by-a-thousand-clicks.

healthy states

leveraging innovation subcommittee roster CO-CHAIR

CO-CHAIR

New Mexico

Kentucky

Representative Liz Thomson

Senator Stephen Meredith

Representative Nicole Macri Washington

Representative Ruth Briggs King Delaware

Representative Rena Moran Minnesota

Senator Lou Dâ&#x20AC;&#x2122;Allesandro New Hampshire

Senator Carmelo Rios Puerto Rico

Representative Tom Demmer Illinois

Senator George Young Oklahoma

Representative Shevrin Jones Florida

Representative Rick Youngblood Idaho

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Senator Elaine Bowers Kansas

csg national task forces

Article

CSG Healthy States N a t i o n a l Ta s k F o r c e S T A T E H E A LT H S Y S T E M S AND RETURN ON INVESTMENT SUBCOMMITTEE

The Connection between Social Factors & Health Care Costs by Brandy Whisman

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In the past, states have used policy to manage health care costs by lowering reimbursement rates to providers, eliminating services and/or eligibility groups, or adding requirements like 1115 waivers with a work requirement. However, investing in programs that address health-related social issues may net a return on investment and lower overall health care costs.

According to estimates by the Centers for Medicare and Medicaid Services, or CMS, approximately 74 million people were enrolled in Medicaid in 2017. While Medicaid and CHIP, the Children’s Health Insurance Program, are the biggest health care cost driver for states, prison system health care, active state employee health insurance and retired state employee health insurance contribute to the overall cost as well. As states continue to struggle with the burden of health care costs, growing evidence indicates that failure to address health-related social needs, like inadequate housing or food insecurity, may increase the risk of developing chronic conditions, reduce the ability to manage these conditions and lead to avoidable health care costs. Several studies have examined the role of social determinants—genetics; health care; and social, environmental and behavioral factors—in promoting health. Surprisingly, these studies found that nonmedical factors play

A system of care coordinators or navigators who help to not just coordinate medical care but also connect to social services is a critical component of effectively addressing social determinants.” New Mexico state Rep. Deborah Armstrong

a much larger role than medical factors in overall health. Similar findings have been reproduced when analyzing specific diseases, including chronic conditions that are commonly thought to be largely genetic. As both a practicing physician with 35 years of experience and a legislator with five years of experience, West Virginia Delegate Matthew Rohrbach knows quite a bit about the real-world side of health care access and delivery. “The problem of substance abuse is one of the main problems in public health at this time,” he said. “I personally hope this is the area where I can focus my committee work. Practicing in and representing a very rural state also gives me an insight into the barriers of care that this unique population suffers from.”

healthy states

Simply understanding the health care system can be overwhelming for patients and create a barrier to accessing needed services. New Mexico state Rep. Deborah Armstrong has worked extensively in the health care field and recognizes the importance of coordination of care when navigating the health care system.

But, lack of communication and coordinated care between providers, health care organizations and social services presents one of the biggest barriers to addressing unmet social health issues and reducing costs. Health care providers often lack the information to refer individuals to issue-specific resources. A recent study in Boston involving eight community health care centers showed that giving health care providers a list of local community resources and screening for basic needs during well-child visits led to increased provider referrals, higher patient enroll-

Organizations and service providers can also become siloed, failing to take into account the views of key stakeholders—patients, health care providers, policymakers and social service providers. Dr. Courtney Phillips, executive commissioner of Texas Health and Human Services, spent 12 years with the Louisiana Department of Health and Hospitals in a variety of roles, giving her valuable insight into the intersection of health services and stakeholders. “As a leading state health entity, it is imperative we invite varying perspectives to have a seat at the table,” she said. “This provides the opportunity for all system stakeholders to share their views on the barriers facing the social determinants of health improvements, as well as the opportunities to address communication between social service and health care providers. The invitation to the table, coupled with the recognition that each stakeholder has a different but valued view, is a critical first step.”

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“A system of care coordinators or navigators who help to not just coordinate medical care but also connect to social services is a critical component of effectively addressing social determinants,” she said. “For high-risk or highneed patients, just navigating the health care system is hard enough, but also connecting to appropriate social services makes it even more complicated. This is not just a matter of better communication or referrals. It must be intentional and focused navigational assistance in order to be effective.”

ment in support services, and more enrollments in child care services. A similar study conducted in Indianapolis at Eskenazi Health found that referring patients to wraparound services was associated with a reduction in the number of hospitalizations and emergency room visits. This resulted in an estimated annual savings of $1.4 million in avoided hospital visits.

csg national task forces

What Determines Health? Would you be shocked to learn that health care does not have the biggest impact on your overall health? Surprisingly, nonmedical factors play a much larger role than medical factors in overall health. Increasing evidence shows that social determinants play a significant role in general health, access to care and adherence to care plans.

The Social Determinants of Health are the conditions

in which people are born, grow, live, work and age that shape health. ECONOMIC STABILITY

NEIGHBORHOOD & PHYSICAL ENVIRONMENT

EDUCATION

FOOD

Employment

Housing

Literacy

Hunger

Income

Transportation

Language

Expenses

Safety

Debt

Parks

Early Childhood Education

Access to Healthy Options

Medical Bills

Playgrounds

Support

Walkability

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Zip Code/ Geography

COMMUNITY & SOCIAL CONTEXT

HEALTH CARE SYSTEM

Social Integration

Health Coverage

Support Systems

Provider Availability

Vocational Training

Community Engagement

Higher Education

Discrimination

Provider Linguistic & Cultural Competency

Stress

Quality of Care

Health Outcomes

MORTALITY

MORBIDITY

LIFE EXPECTANCY

HEALTH CARE EXPENDITURES

HEALTH STATUS

Source: Henry J. Kaiser Family Foundation, https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.

FUNCTIONAL LIMITATIONS

healthy states

The Impact of Different Factors on Health and Well Being and the Risk of Premature Death

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views on the barriers facing the social determinants of health improvements, as well as the opportunities for addressing communication between social service and health care providers. The invitation to the table, coupled with the recognition that each stakeholder has a different but valued view, is a critical first step.” D r . C o u rt n e y P h i l l i p s , e x e c u t i v e c o m m i s s i o n e r o f T e x a s H e a l t h a n d H u m a n S e r v i c es

Graph Source: Henry J. Kaiser Family Foundation, https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. Schroeder, SA (2007), We Can Do Better— Improving the Health of the American People, NEJM, 357:1221–8.

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As a leading state health entity, it is imperative we invite varying perspectives to have a seat at the table. This provides the opportunity for all system stakeholders to share their

csg national task forces

State Health Systems and Return on Investment Key Issues and Resources Center for Health Care Strategies

The Center for Health Care Strategies, or CHCS, has been advancing health care initiatives for low-income populations since 1995. As a nonpartisan organization, CHCS facilitates collaborative exchanges and peer learning among a diverse range of health care stakeholders to improve access, integrate fragmented services, reduce avoidable expenditures and link payment with quality. CHCS offers webinars, articles and studies about social determinants of health. Visit chcs.org for more information.

Institute for Medicaid Innovation

The Institute for Medicaid Innovation, or IMI, examines what works well in the Medicaid program, identifies areas for improvement, and shares innovative initiatives and solutions that address critical issues. IMI collects data on high-risk care coordination, value-based payment, pharmacy, behavioral health, womenâ&#x20AC;&#x2122;s health, child and adolescent health, longterm services and supports, and social determinants of health through its annual Medicaid managed care survey. Visit medicaidinnovation.org for more information.

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The Pew Charitable Trusts

The nonpartisan Pew Research Center informs the public about social issues, attitudes and trends shaping the world. The State Health Care Spending Project, an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, helps policymakers understand state health care costs, cost changes over time and which policies are most effective for containing costs while maintaining or improving health outcomes. Visit pewresearch.org for more information.

The Commonwealth Fund

The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality and greater efficiency, particularly for societyâ&#x20AC;&#x2122;s most vulnerable, including low-income people, the uninsured and people of color. The Commonwealth Fund provides a return on investment calculator to assess the risk/benefit of implementing social services for high needs, high cost patients. Visit commonwealthfund.org for more information.

Peterson-Kaiser Health System Tracker

The Peterson-Kaiser Health System Tracker provides an objective resource for journalists, policymakers and other stakeholders to understand trends in U.S. health care spending, health outcomes and system efficiency. A partnership of Peterson Center on Healthcare and the Kaiser Family Foundation, the Peterson-Kaiser Health System Tracker also illustrates how the U.S. is performing relative to other countries and how different parts of the system are performing relative to one another. Visit healthsystemtracker.org for more information.

healthy states

State Health Systems & ROI subcommittee roster CO-CHAIR

CO-CHAIR

Pennsylvania

South Dakota

Representative Pam DeLissio

Representative Kevin Jensen

Senator Ferrell Haile Tennessee

Senator John Bizon Michigan

Representative Pattie McCoy Vermont

Representative Ed Clere Indiana

Exec. Commissioner Courtney Phillips Texas

Representative Karla Drenner Georgia

Assemblywoman Nancy Pinkin New Jersey

Representative Debra Gibbs Mississippi

Delegate Matthew Rohrbach West Virginia

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Representative Deborah Armstrong New Mexico

csg national task forces

Article

CSG Healthy States N a t i o n a l Ta s k F o r c e C A PA C I T Y, P R E PA R E D N E S S A N D RESILIENCY (CPR) SUBCOMMITTEE

Addressing emerging Health Threats & Responses by Brandy Whisman

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The United States has faced a number of tests of its health system’s preparedness, including tornado outbreaks in the Midwest, infectious disease emergencies like the H1N1 influenza pandemic and measles outbreak, the opioid crisis, the rise of e-cigarettes and vaping, and extreme weather events such as Superstorm Sandy and Hurricane Katrina. Members of the Capacity, Preparedness and Resiliency, or CPR, Subcommittee gathered in June to discuss these and other emerging health threats.

Several subcommittee members shared programs that their states are employing in an effort to respond quickly to health threats and disasters.

Corps training, a program to equip New York participants with the ability to prepare for, respond to and recover from emergencies and disasters. Each participant receives a disaster preparedness kit that contains essential items to assist in the aftermath of a disaster. Hawaii state Rep. John Mizuno, who serves on the subcommittee, experienced his state’s response to potential emergencies firsthand in January 2018 when Hawaii residents received an emergency alert text message stating, “Ballistic missile threat inbound to Hawaii. Seek immediate shelter. This is not a drill.” Social media lit up with the news, causing panic. Roughly 38 minutes later, the message was retracted via the Wireless Emergency Alert system. This experience helped Hawaii officials and service providers examine their state responsiveness and emergency protocols.

“Kansas is well equipped to handle threats posed either by infectious disease or natural disaster,” said Kansas state Rep. Susan Concannon, co-chair of the CPR Subcommittee. “Our combined civilian and military personnel prepare in an all hazards approach of preparedness, mitigation, response and recovery. Matters of jurisdiction are made clear. Plans for communication are in place as well as agreements with bordering states.”

“Because Hawaii was under a false ballistic missile attack, this helped our state ascertain our lack of adequate responsiveness should the missile attack be real,” Mizuno said. “This helped our state place protocols to ensure proper procedures are in place should or when a disaster, natural or manmade, occurs in our state.”

New York Assemblywoman Tremaine Wright, who co-chairs the subcommittee with Concannon, knows the importance of being prepared for a disaster or emergency. She is one of the organizers of the Citizen Preparedness

Idaho Brig. Gen. Brad Richy, who serves on the subcommittee, stressed the importance of functional health care infrastructure in responding to health crises.

healthy states

“As we know, health care infrastructure is a focal point for the community during a response,” he said. “Ensuring this critical infrastructure is operational through an event is paramount. Whether that requires building codes, CMS rules for power generation, priority fuel service, pharmaceutical redundancy, plans to support staff … hospitals must be prepared to weather the storm. Secondly, we must ensure we can decompress these facilities. This requires planning within the community, and potentially with neighboring communities. It’s important to understand that while hospitals may be nonprofit, if they can’t sustain operations and have trouble evacuating, that becomes a local government issue.”

“Funding is at a level of stability, which has historically been sufficient, but a higher-level disaster would require outside resources,” Concannon said. Mizuno said that as an island state, Hawaii lacks adequate shelter for citizens in the event of a hurricane. Additionally, the state has flood zones and needs adequate transportation in the case of a flood to transport people to a safe zone. While every disaster serves as a learning experience, and much work remains to be done, in the intervening years since Hurricane Katrina there

Idaho Brig. Gen. Brad Richy has been demonstrable improvements in the nation’s ability to handle health threats and maintain responsive, high-functioning health care and public health systems. Even with all the progress made, threats to American health security are on the rise and could hit U.S. communities at any time. The responsibility for preparing for potential threats and keeping people safe doesn’t fall on any one official or institution but on diverse government agencies, health care organizations, public health officials, nonprofit organizations, business leaders and community members. Effective communication and coordination among all these stakeholders will be key to effectively responding to health emergencies.

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Several subcommittee members identified potential sources of future concern for states including funding, shelter capacity and transportation in the event of a disaster.

Health care infrastructure is a focal point for the community during a response. Ensuring this critical infrastructure is operational through an event is paramount. … hospitals must be prepared to weather the storm.”

csg national task forces

Case Study: Measles Outbreaks on the Rise The number of measles cases in the U.S. has jumped to the highest level in a quarter century. As of May 24, the CDC has reported 940 cases of measles.

940

26 States Reported Cases to CDC Colors refer to vaccine coverage map

Arizona California Colorado

667

Connecticut Florida Georgia

372 220 63 2010

55 2011

2012

Indiana

188

187

Illinois

120

Iowa Kentucky

2013

2014

2015

2016

2017

2018

2019

Maine M a ry l a n d

Source: Centers for Disease Control and Prevention.

Massachuset ts

Measles is so contagious that

if one person has it,

ISSUE 2/3/4 2019 | CAPITOL IDEAS

out of 10

Herd Immunity

of all ages near this person

will also become

Missouri

Provides the Main

Nevada

ProTection

New Hampshire

But

unvaccinated people

Michigan

90%â&#x20AC;&#x201C;95% of the Population must be Vaccinated

New Jersey New Mexico New York Oklahoma Oregon P e n n s y lv a n i a Tennessee

to avoid Harboring

Texas

Pockets of the Virus

Washington

healthy states

The staggering number

of measles cases

300%

in the U.S. is part of a

global uptick

Democratic Republic of the Congo

Philippines Thailand Myanmar Chad Kazakhstan

in the

first three months

of this year compared to the Same

period last year

1,414 2,179 1,802 5,662 2,020 382 2,131 79 2,862 18 3,414

January to April 2019 January to April 2018

Nigeria

3,813 4,379

India

Source: World Health Organization. | *Democratic Republic of Congo

7,246 28,531

Ukraine Madagascar

COUNTRIES WITH THE MOST CONFIRMED MEASLES CASES

25,319 8,747 46,187 27

Vaccination

Coverage Rate

Measles, Mumps and Rubella (MMR) Vaccine among Children 19–35 Months by State, 2017

92.4 –93.7% 91.4 –92.3% 89.4 –91.3% 82.5– 89.3% Source: Centers for Disease Control and Prevention, 2017.

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93.8–98.3%

csg national task forces

Capacity, Preparedness and Resiliency (CPR) Key Issues and Resources Centers for Disease Control and Prevention

The CDC is the leading national public health institute of the U.S. The CDC’s Healthcare Preparedness and Response website features health care preparedness tools and resources to help communities plan for public health emergencies. The CDC, along with researchers from the Johns Hopkins Center for Health Security, has developed a checklist that outlines action steps for medical and public health officials to assess and strengthen the resilience of their community’s health sector to high-consequence infectious disease, or HCID, events. The full report, Health Sector Resilience Checklist for High Consequence Infectious Diseases—Informed by the Domestic U.S. Ebola Response (2017) offers several recommendations to various stakeholders, including elected officials, for building and maintaining health sector resilience in their community. For more information, visit cdc.gov.

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Johns Hopkins Bloomberg School of Public Health

The Johns Hopkins Bloomberg School of Public Health has several experts focused on health care preparedness for catastrophic events and health sector resilience. Dr. Eric Toner collaborated with the CDC on a 2017 study, A Community Checklist for Health Sector Resilience Informed by Hurricane Sandy, examining the impact of Hurricane Sandy on the health sectors of affected areas. Dr. Amesh Adalja is an infectious diseases and critical care expert and has produced several studies looking at the spread of infectious diseases and health sector emergency preparedness. Recently, the school’s Center for Health Security produced a report, A Framework for Healthcare Disaster Resilience: A View to the Future (2018), which found that, while U.S. health care organizations are “reasonably well prepared for relatively small” events such as tornadoes and local disease outbreaks, they are less ready to respond to large-scale ones such as hurricanes and mass-casualty shootings and bombings. For more information, visit jhsph.edu.

National Academy for State Health Policy

The National Academy for State Health Policy, or NASHP, is a Washington, D.C.-based nonpartisan organization that identifies policy best practices in health care access and delivery across states. Many of its reports and briefs focus on the opioid crisis and tackling the emergence of infectious diseases. For instance, a new report highlights “Cross-agency approaches to substance use disorder prevention and treatment” (March 2019) while NASHP’s “State Immunization Services and Policies Resources” website showcases effective state efforts to increase immunization among specific populations. For more information, visit nashp.org.

National Health Security Preparedness Index

The National Health Security Preparedness Index, or NHSPI, is an annual assessment of the nation’s day-to-day community preparedness for managing health emergencies. The Preparedness Index analyzes more than 140 measures—such as hazard planning in public schools, monitoring food and water safety, wireless 9-1-1 capabilities, flu vaccination rates, and numbers of paramedics and hospitals—to calculate a composite score that provides the most comprehensive picture of health security and preparedness available. NHSPI was originally developed by the U.S. Centers for Disease Control and Prevention. Responsibility for the index transferred to the Robert Wood Johnson Foundation in January 2015. For more information, visit nhspi.org.

Pew Charitable Trusts

The Washington, D.C.-based nonprofit public policy organization conducts original research and works with experts in the field to help policymakers understand health care costs, access and delivery. Pew has conducted extensive research on the opioid crisis and effective state strategies to address it. Some of its latest publications include Innovative approaches can help improve availability of opioid use disorder treatment (November 2018), How health care payers can help stem the opioid crisis (December 2018), and Opioid use disorder: Challenges and opportunities in rural communities (February 2019). For more information, visit pewtrusts.org.

healthy states

Capacity, Preparedness and Resiliency subcommittee roster CO-CHAIR

CO-CHAIR

Kansas

New York

Representative Susan Concannon

ASSEMBLYWOMAN TREMAINE WRIGHT

Representative John Mizuno Hawaii

Representative Mat Erpelding Idaho

Representative Kimberly Moser Kentucky

Senator Rhonda Fields Colorado

Brigadier General Brad Richy Idaho

Senator Gayle Harrell Florida

Commissioner Vicki Schmidt Kansas

Senator Randall Head Indiana

Representative Denise Tepler Maine

Representative Shelby Maldonado Rhode Island

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Representative Chad Caldwell Oklahoma

csg national task forces

CSG Healthy States Ta s k F o r c e INTERVENTIONS TO SAVE LIVES SUBCOMMITTEE

ISSUE 2/3/4 2019 | CAPITOL IDEAS

Innovative Solutions to Pressing Preventive Health Needs

by Natalie Burikhanov

a subcommittee co-chair. To illustrate the pressing need for solutions, he shares his experience garnering broad support for mental health legislation.

As a part of the CSG Healthy States National Task Force, the Interventions to Save Lives Subcommittee is exploring a variety of solutions to challenges in preventive health services, access to care and adverse health outcomes. The subcommittee members are examining promising health interventions that can be models for impactful and cost-effective state-led policy in the areas of mental health, vaccine confidence, social determinants of health and telemedicine.

“I wasn’t sure how my colleagues would react to the first suicide prevention bill that I sponsored,” he said. “It was extremely encouraging to see the bill pass on a nearly unanimous vote and then to have many of my colleagues come to me in private to express support for the legislation. Polices that improve mental health, and prevent suicide, are some of the most bipartisan policy issues that civic leaders can focus on.”

Crafting effective public health policy at a time when health care spending is rising and U.S. life expectancy is declining can seem daunting. Solutions to meet today’s health needs will require states to reimagine traditional investments, embrace innovative programming, and prioritize preventive care and impactful care management. Subcommittee members recognized early on in their two-year project that mental health would be one of their priority areas. In the U.S., around 1 in 5 adults has a mental health issue, and over half of those individuals do not receive services for their conditions, according to an estimate by international professional services network and consulting firm Deloitte. “We need not be afraid of trying to save lives and improve the prospects of people suffering from a mental health condition through bold and innovative policy proposals,” said Utah state Rep. Steven Eliason, who serves as

For many subcommittee members, today’s mental health policy involves increasing awareness, addressing needs in the mental health field, and reaching those at increased risk or with significant barriers to preventive and treatment services. “We must keep working to remove the stigma around mental health and to reduce the barriers to care. This means creating more access to highly-trained and qualified providers, finding space for patients to get the care they need, and looking at the wellness of the whole person,” said Ohio state Rep. Brigid Kelly, who also serves as a subcommittee co-chair. When it comes to tackling obstacles to mental health care, Illinois state Sen. Laura Fine points to work in her home state as examples for the subcommittee to consider. “This session, I passed legislation to create a collaborative care model so family physicians in communities where psychiatrists are scarce can

healthy states

collaborate with a psychiatrist to treat their patients and decide the best course of action for treatment,” Fine said. She also drew attention to efforts to increase resources on college campuses and to meet the behavioral health needs of first responders. Members are focusing on mental health solutions that are targeted toward children and youth. Because of the unique barriers to mental health care that youth face, schools are increasingly viewed as important players for mental health care, services and suicide prevention.

We must keep working to remove the stigma around mental health and to reduce the barriers to care. This means creating more access to highly trained and qualified providers, finding space for patients to get the care they need, and looking at the wellness of the whole person.” Ohio state Rep. Brigid Kelly

For some subcommittee members, schools serve as access points for other areas the subcommittee is exploring. In addition to mental health support, schools have the potential to coordinate essential health interventions and preventive care for students and surrounding communities. “School-based health centers make it easy for families to get early care before something becomes more complicated and thus more expensive. Schools are the center of any community or neighborhood, so it makes sense to use them as a resource for health care for those who otherwise would not have this access,” said subcommittee member and Nebraska state Sen. Sara Howard. Kelly said she’s seen firsthand the role schools can play in preventative care and treatment. “The Community Learning Center model, where medical and behavioral health services are available in schools for students, their families and members of the community, has been a great success in our area,” she said. “For example, kids can learn better when they can see the board after they have access to an eye exam and a pair of glasses.”

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“One of the most effective and promising initiatives I have seen in Utah schools is school districts that do voluntary mental health student screenings with subsequent referrals to treatment as needed,” Eliason

said. “These can be done at very little cost and have been opted into by parents at a very high rate. States need to encourage such initiatives, and back them up with funding, so students with unmet needs can receive services that will help them at an early state when intervention is typically most beneficial.”

csg national task forces

School-Based Interventions for Child Health Addressing Mental Health

Encouraging Dental Care THE CDC ENCOURAGES

Half of children W I T H T R E ATA B L E M E N TA L H E A LT H CONDITIONS DO NOT RECEIVE S P E C I A L I Z E D T R E AT M E N T.

school-based dental sealant programs F O R A C C E S S I B L E A N D C O S TEFFECTIVE ORAL CARE FOR CHILDREN.

If the

7 million children

who are low-income in the U.S. utilized school sealant programs,

ISSUE 2/3/4 2019 | CAPITOL IDEAS

of school-based health clinics provide access to a mental health specialist.

Schools provide a unique opportunity to identify and treat mental health conditions by serving students where they already are.â&#x20AC;? â&#x20AC;&#x201D;National Alliance on Mental Illness Sources: American Academy of Family Physicians; School-Based Health Alliance

3 million cavities and $300 million

in dental costs would be saved.

Over five years, participation in a school-based dental sealant program leads to a 60% reduction in tooth decay. Sources: Centers for Disease Control and Prevention; The Pew Charitable Trusts

healthy states

Meeting Nutrition Needs Around 21.6 million children participate in free and reduced meals programs.

18% O F CHI L D R EN CO ME F RO M HO U S EHO LDS THAT A R E F O O D I NS EC U RE .

School meal programs lower obesity rates by 17%.

Schools & Immunizations The 2019 measles outbreak is now the largest outbreak in the United States since the disease was declared eliminated in 2000, and legislators are revisiting schoolbased vaccine requirements. So far in 2019, over 130 bills have been filed in more than 30 states related to vaccines.

Sources: No Kid Hungry; United States Department of Agriculture, Food Research and Action Center

According to a 2009 study, vaccination programs in schools and daycares saw an increased vaccination rate of 47%.

Only medical Religious Religious and philosophical

Sources: The Community Preventive Services Task Force, The Community Guide, www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

ISSUE 2/3/4 2019 | CAPITOL IDEAS

Exemptions Allowed

csg national task forces

Interventions to Save Lives Key Issues and Resources American Academy of Pediatrics

American Academy of Pediatrics is an organization of pediatricians committed to the optimal physical, mental, and social health and well-being of all infants, children, adolescents and young adults. State advocacy areas of focus include bullying prevention, childhood immunizations, essential health benefits, medical marijuana, raising the tobacco purchase age to 21, and telehealth care payments. For more information visit aap.org.

American Academy of Pediatric Dentistry

American Academy of Pediatric Dentistry is the leading national advocate dedicated exclusively to children’s oral health. Its focus areas include oral health in primary care, the dental workforce and children’s health data. For more information visit aapd.org.

American Foundation for Suicide Prevention

American Foundation for Suicide Prevention is an organization that raises awareness, funds scientific research, and provides resources and aid to those affected by suicide. Its work includes finding better ways to prevent suicide, creating a culture that is smart about mental health and bringing hope to those affected by suicide. For more information visit afsp.org.

ISSUE 2/3/4 2019 | CAPITOL IDEAS

Centers for Disease Control and Prevention

The CDC is the nation’s health protection agency that saves lives and protects people from health, safety and security threats. Its areas of focus include adolescent and school health, food safety, smoking and tobacco use, vaccines and immunizations, oral health, and environmental health. Relevant reports for the Interventions to Save Lives Subcommittee: Disparities in Oral Health and Social Determinants of Health: Know What Affects Health. For more information visit cdc.gov.

Deloitte Center for Health Solutions

Deloitte Center for Health Solutions is a source for a fresh perspective in health care that looks deeper at the biggest industry issues and provides cutting-edge research. Its focus areas include the patient experience, analytics, the future of health and emerging technologies. Relevant reports for the Interventions to Save Lives Subcommittee: Addressing the Social Determinants of Health for Medicare and Medicaid Enrollees; Want to Improve the Health of Medicare/ Medicaid Members? Meet Their Socioeconomic Needs; and When Building a Virtual Health Portfolio, Behavioral Health Might Be the Perfect Place to Start. For more information visit deloitte.com/centerforhealthsolutions.

National Alliance on Mental Illness

National Alliance on Mental Illness is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. Its areas of focus include access to treatment, family education and support, juvenile justice, mental health in schools, and parity for mental health coverage. For more information visit nami.org.

Pew Research Center

Pew Research Center is a nonpartisan organization that informs the public about the issues, attitudes and trends shaping the world. It is a subsidiary of The Pew Charitable Trusts, which is an independent, nonprofit, nongovernmental organization that is improving public policy, informing the public and stimulating civic life. Their areas of focus include dental campaigns, health information technology, teens and youth, and poverty. Relevant reports for the Interventions to Save Lives Subcommittee: Many Recommended Teaching Mental Health in Schools. Now States Will Require It and The Concerns and Challenges of Being a U.S. Teen: What the Data Show. For more information visit pewresearch.org.

healthy states

Interventions to Save Lives Subcommittee Roster CO-CHAIR

CO-CHAIR

Utah

Ohio

Representative Steve Eliason

Representative Brigid Kelly

Senator Troy Carter Louisiana

Senator Laura Fine Illinois

Senator Gayle Goldin Rhode Island

Senator Sara Howard Nebraska

Senator Joan Lovely Massachusetts

Representative Suzie Pollock Missouri

Representative Josh Revak Alaska

Policy Director Heather Smith Wisconsin

Representative Jonathan Steinberg Connecticut

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Representative John Allen Arizona

csg national task forces

CSG Healthy States N a t i o n a l Ta s k F o r c e Pa r t n e r s

LEAD PARTNERS

OUR CHILDREN ARE OUR FUTURE - LET’S PROTECT THEM by Nanette Cocero, Global President, Pfizer Vaccines As a global health community, there is so much to be proud of when it comes to protecting lives through immunization. The most recent statistics on global child immunization, from 2017, show that the highest-ever number of children were immunized that year—116.2 million. Yet, in 2019, it often feels like we are moving in the wrong direction.

ISSUE 2/3/4 2019 | CAPITOL IDEAS

I’m very aware of the recent warning from two United Nations agency heads that we are currently facing a global measles crisis. Cases of measles were up by 300% globally in the first three months of 2019 compared to the same period of 2018. That’s a shocking rise in a potentially deadly disease for which effective vaccines have been in use for many years. In fact, over the last two years the world has seen multiple outbreaks of various other vaccine-preventable diseases, including diphtheria.

Vaccines are one of the greatest public health advances of all time, resulting in the control, elimination or near-elimination of numerous infectious diseases that were once pervasive and often fatal, including smallpox and polio. And the benefits of vaccination can often extend far beyond the prevention of specific diseases in individuals: prevention through vaccines has helped generations of children and their families to avoid often-deadly diseases and develop, grow and contribute to their communities, societies and economies. And yet the value of vaccines can be overlooked.

Individuals recommended for vaccination should not miss out on getting the immunizations they need. But people are missing out. There are still nearly 20 million unvaccinated and under-vaccinated children in the world today, according to the World Health Organization. Perhaps the success of modern vaccination programs has allowed us to forget the devastating impact of many childhood infectious diseases. As a leading vaccines innovator, Pfizer also recognizes that we have a responsibility to continue to invest in researching and developing vaccines against diseases where there is significant unmet medical need. Our scientists are currently developing novel vaccines targeting diseases across all life stages, from viruses commonly affecting newborn babies to conditions more often seen in older populations, such as hospital-acquired infections and cancer. These efforts represent our shared responsibility as part of the global health community. But just as important, I believe we have an ongoing individual responsibility to respond to the 2019 World Immunization Week rallying cry of ‘Protected Together: Vaccines Work!’ We all can share our experiences of getting vaccinated with others, challenge misinformation and advocate for everyone in our communities to receive the vaccinations recommended for them. This is the message I commit to amplifying with my colleagues, children, friends and family, going forward.

PARTNERS

the future of work

CSG future of work National Task Force Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 The Gig Economy. . . . . . . . . . . . . . . . . . . . . . . . . . 43 Future of Work National Task Force Co-Chairs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

The Workforce of Tomorrow Subcommittee . . . . . . . . . . . . . . . . . . . . . . . . 46

Redefining Education, Preparing for the Skills Transitions Ahead. . . . . . . . . . . . . . . . . . . . . . . . . . 46 Work-Based Learning Policies in the States. . . . 48 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Modernizing State Systems and Improve Public Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Meeting The Needs of Future Public Servants. . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

AI, Automation Drive New Industries. . . . . . . . . 58 The State of Artificial Intelligence and Automation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Equity and Inclusion Subcommittee . . . . . . . . . . . . . . . . . . . . . . . . 64

Everyone Deserves an Equal Chance to Participate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Economic Inequity. . . . . . . . . . . . . . . . . . . . . . . . . 66 Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Roster. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

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Smart Government Subcommittee . . . 52

What's Next? Embracing the Future Subcommittee. . . . . . . . . . . . . . . . 58

csg national task forces

Introducing the CSG future of work National Task Force Members of CSG’s The Future of Work National Task Force met for the first time in June to hear experts and policymakers speak about workforce issues and to set goals for the work they will take on through 2019 and 2020. Kansas state Sen. Carolyn McGinn, who serves as co-chair of the task force with Colorado state Sen. Nancy Todd, opened the meeting with discussion about the past, present and future of the workforce —from the various trades of immigrants to the impact of generations entering the workforce now. She recalled being a kid watching The Jetsons and not believing the show would ever become a reality. “Now, when we think about autonomous cars, we’re getting pretty close to that,” McGinn said. “So, we’ve gone a long way in technology.”

ISSUE 2/3/4 2019 | CAPITOL IDEAS

The Future of Work Task Force is divided into four subcommittees: The Workforce of Tomorrow; Smart Government; What’s Next? Embracing the Future; and Equity and Inclusion.

The Workforce of Tomorrow Subcommittee is examining how states can re-evaluate the links between education and careers to meet the demands of the future workforce. The Smart Government Subcommittee is exploring new perspectives on state governance and the delivery of state services that enhance the performance of state systems. The What’s Next? Embracing the Future Subcommittee is examining how governments, the private sector, communities and individuals can prepare for a future where everyone can live, work and grow in one’s community; benefit from emerging technology; and be successful in an evolving economy. Finally, the Equity

and Inclusion Subcommittee is exploring how states can promote and encourage equal opportunity and diversity in the new economy. “The topic that we are looking at today with workforce, I can’t help but go back and say, ‘Where does it all begin?’,” Todd said. “And it all begins in the classroom. It all begins with what we are doing in preparing our children for the future.” In addition to the task force co-chairs, each subcommittee has two co-chairs from different political parties and 10 members. You will be introduced to this diverse group throughout the following section of this special edition of Capitol Ideas. The following pages also delve into issues such as the gig economy, automation and artificial intelligence, and work-based learning. Members of the task force have two years to survey best practices and innovative state initiatives and will meet during planned task force meetings, some of which will be held at annual CSG National Conferences. The group will ultimately produce a report that will serve as a national framework for all states. Todd offered this advice to members of the task force as they prepared to meet in their subcommittees for the first time: “Listen to each other. Think about different perspectives. ‘My way or the highway’ will never work in a good, collaborative setting.”

the future of work

THE GIG ECONOMY The development of the gig economy is changing in the way both

57%

want to earn more money/ supplement income

32%

want to be their own boss

Reasons for working in the

46%

employers and employees view work. The gig economy is a labor market in which short-term contracts or freelance work are prevalent, either instead of or in addition to traditional full-time

35%

economy

19%

want another source of income while looking for work

About 57.3 million people, or more than 35% of the U.S. workforce,

want greater worklife flexibility

are now freelancers, according to an estimate by Upworkâ&#x20AC;&#x2122;s Freelancing in America. State governments have been responding to this new movement in the workforce by updating employment definitions, creating new worker protections and writing economic

32%

on-demand

want to create and control their own schedule

employment.

development legislation.

want to try something new

Hourly earnings

of on-demand workers ranged from

21%

want to make up for financial hardship

$5 $34

$61 $26

with an average of COMPARED TO ABOUT

The median income generated by

on-demand work

$2,500 was about

annually.

for all payroll workers.

Source: Dispatches From the New Economy: The On Demand Workforce, Intuit, February 2017.

41%

of on-demand workers either have a full- or part-time job in addition to their gig work.

24%

On average, 24% of household income is generated by on-demand work.

26%

Source: Dispatches From the New Economy: The On Demand Workforce, Intuit, February 2017.

of on-demand workers did not get medical treatment in the past year because they could not afford it.

Non-employer Business Growth by Industry 2003â&#x20AC;&#x201C;2013 A nonemployer is a self-employed individual operating a very small, unincorporated business with no paid employees. Other services*

of on-demand workers said their top challenge was getting enough work.

62%

55%

of contingent workers would prefer a permanent job

2 in 5 contingent workers

Professional, scientific and technical services Health care and social assistance Real estate and rental and leasing Arts, entertainment and recreation

work less than 35 hours per week, compared with fewer than 1 in 5 noncontingent workers

Transportation and warehousing * This industry sector includes repair and maintenance; personal and laundry services; and religious, grantmaking, civic, professional and similar organizations.

Source: The Bureau of Labor Statistics, May 2017.

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Administrative, support, waste management and remediation services

csg national task forces

Future of work National task force co-chairs What most concerns you about the future of work? Bridging the generation gap in the workforce. With the improvements in technology, the generation gap is larger than it has ever been. I also see this as an opportunity to make changes in how we keep our economy thriving.

What role can state government play in ensuring that the transition to the future is successful? Making sure the education system can quickly adapt to the changing economy and the job skills needed by the future workforce. Technical colleges need to be a larger part of the discussion and traditional fouryear research institutions need to look back and figure out what their next 100 years are going to look like and not lean on what prepared us in the past. Also, trying to figure out a financial mechanism that doesnâ&#x20AC;&#x2122;t put students in so much debt that makes it hard to build their future.

Kansas

State Senator

carolyn mcginn ISSUE 2/3/4 2019 | CAPITOL IDEAS

Chair, Kansas Ways and Means Committee

Why is it important for states to get a handle now on the future of work? States are always going to have a limited amount of resources for a number of needs. States used to compete with other states to draw the most talented to grow their economies and now we are competing globally. Without a handle on the future and a clear path to get there, states will struggle to compete in the global market.

How has your state addressed some of the issues involved in this policy area? In 2015, I was part of a team to increase engineering enrollment in Kansas for four-year institutions after years of decreases in enrollment in this field. The goal was to fill positions needed in our manufacturing industries, primarily aviation and agriculture. A public-private partnership allowed for a matching dollar investment to provide cutting-edge facilities. One of our regent universities coordinated with a local technical college to provide four-year degree programs after getting a technical degree, without losing hours. Technical scholarships were also given to increase enrollment.

Do you feel like your state has a good handle on these issues?

Without a handle on the future and a clear path to get there, states will struggle to compete in the global market.â&#x20AC;?

Kansas has adapted in the area of manufacturing, along with encouraging students to look at engineering. We have a good workforce in Kansas, but often with new technology, retraining is necessary. The state has invested dollars related to the aviation industry that also have a long-term impact in other areas of manufacturing. Can we do more? Absolutely, particularly in providing a culture that will appeal to young people entering the workforce and an environment for people with disabilities to join and stay in the workforce.

the future of work

What most concerns you about the future of work? I believe the lack of looking at new and undiscovered work for the future is my greatest concern. Broad and flexible approaches to problem solving are key to exploring new jobs that are yet to be created.

What role can state government play in ensuring that the transition to the future is successful?

colorado State Senator

n a n cy

todd Chair, Colorado Education Committee

Why is it important for states to get a handle now on the future of work? Because many jobs of the future are yet undefined, it is imperative that states take on leadership for the direction of how work may look by providing more nontraditional learning opportunities to create a preparedness for innovation and creativity.

How has your state addressed some of the issues involved in this policy area? In Colorado, we are increasing career technical learning opportunities and school-to-work internships and creating more partnerships with business and the technology sector. The continual re-evaluation of what needs are not being met is an open exploration through the K-12 system, community colleges and post-secondary learning opportunities. Providing credit for work experience is another incentive for alternative learning opportunities.

Do you feel like your state has a good handle on these issues? I believe Colorado is on the road to preparing citizens for the many work opportunities and alternatives, which will lead to an atmosphere of readiness for innovation and undiscovered career pathways. Providing for flexibility in our schools and smoother transitions is welcome in Colorado and incentivizing an entrepreneurial spirit is alive and well in the Centennial State.

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State government can be helpful in ensuring successful transition to the future by incentivizing innovation in approaches to learning."

State government can be helpful in ensuring successful transition to the future by incentivizing innovation in approaches to learning. Providing alternative job training, creative problem solving in the workplace, and more flexibility can benefit education that may take a nontraditional pathway.

csg national task forces

C S G Th e Fu t u re o f Wo r k N a t i o n a l Ta s k F o r c e WORKFORCE OF TOMORROW SUBCOMMITTEE

Redefining Education, Preparing for the Skills Transitions Ahead by Sean Slone The members of the Workforce of Tomorrow Subcommittee have already done plenty of thinking about how automation, artificial intelligence and other factors are changing the kinds of skills in demand by employers and how education at all levels may need to evolve in the years ahead as a result.

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For Wisconsin state Rep. Joan Ballweg, a former first grade teacher, it’s about getting the environment right from the very beginning.

“The student experience should be inviting, helping kids become lifelong learners,” she said. “This is crucial in preparing kids for higher education, entering the workforce, and being resilient and adaptable employees in our ever-changing economies. We need to make sure all children develop the soft skills that ensure they can communicate effectively and be reliable in showing up and delivering work.” Kentucky state Sen. David Givens said the way we prepare teachers to train the future workforce will be key. “Some experts estimate that around 85% of the jobs that today's learners will be doing in 2030 haven't been invented yet,” he said. “State governments should focus on dynamic teacher preparation systems that develop top-tier talent. Tomorrow's teachers should be well-rewarded for engaging students in blended learning environments that combine physical classroom experiences with virtual education delivery models.”

Finding effective ways to bridge the gap between schools and the business community is essential in ensuring students possess the skills needed to succeed, according to Massachusetts state Sen. Michael Moore. “Apprenticeships give students a leg-up with pursuing their future careers by providing students with the opportunity to apply the theories that they are taught in a classroom setting,” he said. “Apprenticeships also help expedite the acquisition of skills necessary to succeed in the workforce and can be tailored to fit the needs of high-demand fields.” A panel of experts convened a couple of years ago by the Pew Research Center suggested that workers of the future will need to learn to cultivate creativity, collaboration, abstract and systems thinking, complex communications, and the ability to thrive in diverse environments. Similarly, in a 2011 report for the University of Phoenix Research Institute, the Institute for the Future defined 10 skills for the future workforce: sense-making, social intelligence, novel and adaptive thinking, cross cultural competency, computational thinking, new media literacy, transdisciplinarity (literacy in and ability to understand concepts across multiple disciplines), design mindset, cognitive load management (the ability to discriminate and filter information for importance), and virtual collaboration. Experts believe the cultivation of these 21st century skills, capabilities and attributes all call for the advancement of practical, experiential learning via mentoring and apprenticeship programs.

the future of work

Many of the subcommittee members point to recent significant legislation and initiatives in their states to advance apprenticeships and address the many challenges the future of work is expected to bring. New York Assemblyman Walter Mosley, who is serving as one of the subcommittee’s co-chairs, said his state’s recently enacted budget included increased funding for workforce development that will expand the number and types of apprenticeships available in emerging, jobs-rich fields like clean energy, life sciences, computer science and advanced technologies.

“I am honored and proud to represent a district that is diverse, dynamic and a long-standing leader in technology,” said Slatter, who represents part of the city of Redmond, where Microsoft has its headquarters. “To compete on the world stage, our innovative tech employers will continue to need access to the best and the brightest from America and around the world.” But it’s not technology alone that is driving the changes impacting the workforce. Economic trends that see Americans driving for ride-hailing and food delivery companies or working other part-time jobs that may not offer the kinds of benefits to which workers have become accustomed make it important for policymakers to consider how the workforce of the

Massachusetts state Sen. Michael Moore future will be able to maintain careers and livelihoods and whether social safety net programs will need to be strengthened to assist them. “The gig economy is not sustainable,” said Wisconsin state Rep. Gary Hebl. “If corporations were willing to turn their profits or immense tax breaks into livable wages, or affordable work benefits like insurance, paid time off, or parental leave, I think the economy would be much stronger and the American people much happier.” The subcommittee members also recognize that when it comes to the issues driving the workforce of the future, the work is never-ending—for everyone involved. “Workers will have to be willing to constantly update their skills or even totally retool them, as technology continues to require new skills and makes others obsolete,” said Tennessee state Rep. Patsy Hazlewood. “And government and industry will have to work together to make sure those learning opportunities are available and accessible.”

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Washington state Rep. Vandana Slatter highlighted a workforce education investment bill enacted this year in her state that will raise almost $1 billion over four years from a surcharge on companies like Amazon and Microsoft that employ highly skilled workers and use that money to offer free or reduced college tuition as well as more apprenticeships.

Apprenticeships give students a leg-up with pursuing their future careers by providing students with the opportunity to apply the theories that they are taught in a classroom setting.”

csg national task forces

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Work-Based Learning Policies in the States

WORK-BASED LEARNING EXPANSION INITIATIVES These states direct resources for state staff or other organizations to support the growth of work-based learning.

SECONDARY STUDENT WORK-BASED LEARNING: PRE-APPRENTICESHIP OR YOUTH APPRENTICESHIP These states have policies supporting pre-apprenticeships or youth apprenticeships.

EMPLOYER WORK-BASED LEARNING SUBSIDY: GRANT OR REIMBURSEMENT These states provide a grant or reimbursement to employers for workbased learning programs.

SECONDARY STUDENT WORK-BASED LEARNING: OTHER These states have another type of policy to require or fund work experiences for secondary students that include work-based learning.

EMPLOYER WORK-BASED LEARNING SUBSIDY: TAX CREDIT These states provide a tax credit to employers for work-based learning programs.

SUBSIDIZED POSTSECONDARY INSTRUCTION FOR APPRENTICES These states have a policy subsidizing postsecondary classroom instruction for apprenticeships.

Source: “Work-Based Learning Policy 50 State Scan,” National Skills Coalition, April 2017.

the future of work

in 2016

7 states passed 11 new apprenticeship laws.

in 2017

14 states passed 20 new apprenticeship laws.

in 2018

19 states passed 29 new apprenticeship laws.

Source: National Conference of State Legislatures

How Apprenticeships Work step 1 Company registers apprenticeship program with either the U.S. Department of Labor or a state labor agency, which ensure the program meets national quality standards.

step 2

step 3 Apprentice receives a job and an industry-recognized credential based on passing an assessment. Source: â&#x20AC;&#x153;States Increasingly Look to Apprentices to Bolster Their Workforce,â&#x20AC;? Governing, March 14, 2018.

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Participants get paid by employer while they receive training at work and in an educational setting (college classroom, trade school).

csg national task forces

The Workforce of Tomorrow Subcommittee Key Issues and Resources Axios

The three-year-old news and information website founded by former Politico executives frequently highlights stories with a technology, business or science angle, including many that touch on automation, the future of work, skills transition and education. Recent features have included Rebooting high school (March 29), Walmart’s robot army (April 17), Experts weigh taxing robots to pay for the jobs they take (April 15), The problem with automation (April 10) and Humans must learn to tackle what robots can’t (April 4). For more information, visit axios.com.

Brookings Institution

The Washington, D.C.-based nonprofit public policy organization has highlighted how 21st century emerging technologies such as artificial intelligence and advanced robotics are poised to transform modern society. Their work includes the ongoing series A Blueprint for the Future of AI, analyzing the new challenges and potential policy solutions suggested by these technologies. In January, the series examined Why We Need to Rethink Education in the Artificial Intelligence Age (January 31). The Metropolitan Policy Program at Brookings was responsible for the January report Automation and Artificial Intelligence: How Machines are Affecting People and Places. For more information, visit brookings.edu.

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Consultancies: Accenture, Deloitte, McKinsey & Company

Accenture, the global management consulting and professional services firm, examines future work insights in reports such as The Big Disconnect: AI, Leaders and the Workforce (July 12, 2018), which found that investment in artificial intelligence is not being matched by investment in reskilling. Deloitte, the multinational professional services network, focuses on human capital trends in publications such as Forces of Change: The Future of Work (Nov. 9, 2017), which pointed to a need to reimagine lifelong education and reassess legal and regulatory policies as two implications for policymakers. McKinsey & Company, the New York-based management consulting firm, has an extensive library of future of work publications including Skill Shift: Automation and the Future of the Workforce (May 2018) and Jobs Lost, Jobs Gained: Workforce Transitions in a Time of Automation (December 2017). For more information about Accenture, visit accenture.com. For more information about Deloitte, deloitte.com. For more information about McKinsey & Company, mckinsey.com.

National Skills Coalition

The Washington, D.C.-based coalition’s website includes such reports as Work-Based Learning Policy 50-State Scan (April 2017) and Broadening the Apprenticeship Pipeline (August 2018). The group’s initiatives include the State Workforce and Education Alignment Project, or SWEAP. For more information, visit nationalskillscoalition.org.

XQ Institute

Led by a former education adviser to President Barack Obama, this network of educators and others has been working since 2015 on ways to rethink and redesign the American high school. Their work includes the report High School & the Future of Work: A Guide for State Policymakers (Fall 2018). For more information, visit xqsuperschool.org.

Other Perspectives

• In an Aug. 31, 2018, article for The American Prospect, It’s Not the ‘Future of Work,’ It’s the Future of Workers That’s in Doubt, three workers’ advocates suggested that an echo chamber of future of work promoters, including consultancies, financial institutions, thought-leader organizations and the business press, may be creating a distorted paradigm and overstating the threat of technological change. For more information about The American Prospect, visit prospect.org. • Economists Daron Acemoglu of MIT and Pascual Restrepo of Boston University, authors of Automation and New Tasks: How Technology Displaces and Reinstates Labor (Journal of Economic Perspectives, March 5, 2019), suggest that “The effects of automation are counterbalanced by the creation of new tasks in which labor has a comparative advantage. The introduction of new tasks changes the task content of production in favor of labor because of a reinstatement effect, and always raises the labor share and labor demand.” For more information visit aeaweb.org/ journals/jep.

the future of work

The Workforce of Tomorrow Subcommittee Roster CO-CHAIR

CO-CHAIR

Maine

New York

Senator Lisa Keim

Assemblyman Walter Mosley

Senator Heather Carter Arizona

Senator David Givens Kentucky

Representative Patsy Hazlewood Tennessee

Representative Gary Hebl Wisconsin

Representative Ryan Mackenzie Pennsylvania

Senator Mark Messmer Indiana

Senator Michael Moore Massachusetts

Representative Vandana Slatter Washington

Secretary John Tilley Kentucky

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Representative Joan Ballweg Wisconsin

csg national task forces

C S G Th e Fu t u re o f Wo r k N a t i o n a l Ta s k F o r c e SMART GOVERNMENT SUBCOMMITTEE

modernizing state systems AND improving public services by Natalie Burikhanov Technology has propelled industry and services toward unprecedented levels of engagement and efficiency, and governments are uniquely positioned to leverage the benefits and tools of the new economy. Terms like blockchain technology, the cloud and the Internet of Things, or IoT, have entered the public sector lexicon as constituents expect curated, expedient and accessible government interactions. As a result, public officials are reevaluating traditional systems to drive return on investment and improve delivery of services. In a world that is increasingly digitized and connected, governments are learning the importance of being “smart.”

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For Massachusetts state Sen. Marc Pacheco, harnessing technology for government services isn’t anything new.

“But the pace of technological evolution is faster today than ever before, and the potential benefits of these advances have become more significant,” Pacheco said. As co-chair of the CSG Future of Work Smart Government Subcommittee, Pacheco sees the value in finding contemporary solutions to traditional government problems. “A modern public sector provides more efficient and more effective public services using technological advances to improve the lives of the citizens we serve,” he said.

With the help of technology, government entities are able to deliver tailored and data-informed services while also improving how government work is done. Updating to modernized state systems is a key way that states are maximizing system efficiency and user engagement while adapting to changes in technology and user behavior. Shared dashboards, artificial intelligence and collaborative platforms are being used by government entities across the country to streamline cross-agency programmatic reporting and effectively deliver social services. When partnered with AI technology, shared databases can run analytics on inputted data while freeing up human skills and employee time for problem-solving, innovation and complex interpretation. Recent reports from Governing and Deloitte have highlighted how law enforcement agencies are utilizing big data and AI to break up silos, analyze similar crime scene profiles from across departments and, in some cases, reduce manual labor by law enforcement by 98% at 70% lower costs. Improvements and investments in the technology infrastructure of the public sector can unlock efficiency and delivery in ways that seemed unimaginable decades ago. For example, cloud-managed transportation systems have allowed jurisdictions to coalesce public transportation use into smartphone apps; IoT has led to more easily managed roadways and energy-efficient government buildings; and coordinated emergency management applications have the potential to streamline mass communication in the event of earthquakes or tsunamis.

the future of work

As the Smart Government Subcommittee explores state-driven roadmaps for modern government, its members are keenly aware that there isn’t a set template for states to follow. “Given technology and data are key to driving results, it’s important that every government solution be tailored to an actual problem that needs to be solved,” said Indiana state Rep. Holli Sullivan, who serves as a cochair of the subcommittee. To maximize return on investments, Sullivan said, public officials should look toward customized investments rather than a “one-size-fits-all” approach. “In other words, for one city it may be about improving existing infrastructure whereas in another, the focus may be on reducing traffic congestion,” she said.

Given technology and data are key to driving results, it’s important that every government solution be tailored to an actual problem that needs to be solved.” Indiana state Rep. Holli Sullivan

“Washington was the second state in the nation to move all vote by mail, and in 2018, the state paid for postage for all return ballots. This year, the Legislature provided postage funds for all local and state elections in 2019-20. This July, we will implement automatic voter registration, Election Day registration, and 16- and 17-year-old preregistration when youth get their driver’s license or state identification card,” he said. “In Washington, we have no lines for waiting for the opportunity to cast a ballot.” Subcommittee members also understand that building a government for the future is about more than improving state systems and public services. It will also involve an invested and passionate modern workforce. However, governments are struggling to attract and retain a new generation of public servants. The workforce of the future seeks dynamic and purpose-driven work in a flexible, collaborative and talent-led environment, and public entities are evolving their work spaces and benefits to bring in and support new workers. A modern public sector leverages the innovation of the private sector to maximize the power of its systems, service delivery and workforce. By exploring initiatives that could serve as models for statewide application, subcommittee members hope to provide roadmaps for smart government.

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For some states, being “smart” doesn’t have to mean big tech investments – service delivery of the future can include bringing government closer to constituents by looking at bureaucratic barriers. In Washington, state Sen. Sam Hunt highlights how increasing voter turnout was the

right priority for his state, and Washington has become a national leader because of its forward-thinking but relatively low-tech investments.

csg national task forces

meeting the needs of future public servants The workforce of the future values mobility, flexibility and technology, but they are also drawn to mission-driven work, robust benefits and collaborative work environments. Governments are in a unique position to attract a new generation of workers that seek to positively impact their communities without sacrificing work-life balance and stable benefits. But governments are struggling to do so.

As state government

job advertisements

11% increased by

from 2013-2017,

Work

Problem

Workforce

Problem For every employee

who leaves,

of state and local

government employees

indicated that

outdated information technology infrastructure

Source: Gallup

Solutions

industries surveyed.

Create talent-led

Source: The Workforce Institute at Kronos Incorporated

Solutions ISSUE 2/3/4 2019 | CAPITOL IDEAS

of that person’s

annual salary.

complicated their work –

the highest of all

150% it costs businesses

Incorporate

artificial intelligence

automation and

into state systems, and curate

work to skills

rather than to tasks.

and

collaborative teams,

as well as opportunities for

reskilling

and continued learning.

Workplace

Problem

40% of workers reported

applications

24% decreased by

significant

Governments

stress.

focusing on modernizing

job-related Source: Deloitte Insights

Solutions Integrate

flexible,

team-based work,

as well as

work environments

that promote overall

employee health and

well-being.

can fix this trend by

󴑴he work, 󴑴he workforce and

󴑴he workplace

to meet the needs of

󴑦uture public servants. Source: National Association of State Chief Administrators

the future of work

riding on the cloud States and cities, such as Oregon and Los Angeles, are increasingly utilizing cloud technology to streamline services like public transportation. These innovative practices not only modernize state systems, but they also improve end-user experience. By using cloud platforms, governments can integrate transportation options and account services into easy-to-use apps, payment options and devices. With cloud-enabled technology, a citizen can use any of the bus, rail, bikeshare or charging station options in a public transportation system, as well as a variety of payment formats, through one central app or account that can be easily accessed. The goal of these programs is to increase public transportation use and improve the customer experienceâ&#x20AC;&#x201D;all without complicating the governmentâ&#x20AC;&#x2122;s IT system.

With cloud-enabled technology,

a citizen can use any of the bus, rail, bikeshare or charging station options in a public transportation system...

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csg national task forces

smart government Subcommittee Key Issues and Resources Center for Digital Government

The Center for Digital Government is a national research and advisory institute on information technology policies and best practices in state and local government. Its focus areas include analytics, network and connectivity, civic technology, government experience, smart cities, and the workforce. Relevant report for the Smart Government Subcommittee: Take a Fresh Look at Hybrid IT Environments. For more information, visit govtech.com.

Deloitte Center for Government Insights

Deloitte Center for Government Insights produces groundbreaking research to help government solve its most complex problems. Its focus areas include analytics, the Internet of Things, digital government transformation, health and human services, government workforce, future of government, customer experience, and cybersecurity in government. Relevant reports for the Smart Government Subcommittee: The Future of Work in Government: Navigating a Shifting Talent Landscape, Investigative Analytics: Leveraging Data for Law Enforcement Insights, and Integrated Multi-Cloud Management for the Federal Government. For more information, visit deloitte.com.

Center for State & Local Government Excellence

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The Center for State & Local Government Excellence is a nonpartisan, nonprofit organization that conducts research and promotes state and local government to attract and retain talented public servants. Its focus areas include retirement, health and wellness, and the workforce. For more information, visit slge.org.

Future of Work(ers) at the Ford Foundation

The Future of Work(ers) at the Ford Foundation is a research initiative of the Ford Foundation Center for Social Justice that seeks to ensure that there is a meaningful future of work that places workers and their well-being at the center. For more information, visit fordfoundation.org.

Mercer

Mercer is the worldâ&#x20AC;&#x2122;s largest human resources consulting firm that uses analytics and insights as catalysts for change. Workforce and careers are one of its focus areas with emphasis on talent strategy and mobility, human resources transformation, and workforce rewards. Relevant report for the Smart Government Subcommittee: Global Talent Trends 2019. For more information, visit mercer.com.

The Workforce Institute at Kronos Incorporated

The Workforce Institute at Kronos Incorporated is a think tank that empowers organizations with practical ideas for optimizing the 21st century workplace. Its focus areas include employee engagement, multigenerational workforce, the future of work, work and life, workforce development, and artificial intelligence. Relevant reports for the Smart Government Subcommittee: Engaging Opportunity and The Rise of the Responsive Employee Experience. For more information, visit workforceinstitute.org.

the future of work

smart government Subcommittee roster CO-CHAIR

CO-CHAIR

Massachusetts

Indiana

Representative Holli Sullivan

Representative Marvin Abney Rhode Island

Senator Matt Hansen Nebraska

Senator Stuart Adams Utah

Secretary Marcia Hultman South Dakota

Representative Becky Beard Montana

Senator Sam Hunt Washington

Senator Wesley Bishop Louisiana

Representative Stephen Ross North Carolina

Delegate Mark Chang Maryland

Senator Amy Sinclair Iowa

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Senator Marc Pacheco

csg national task forces

C S G Th e Fu t u re o f Wo r k N a t i o n a l Ta s k F o r c e W H AT ' S N E X T ? EMBRACING THE FUTURE SUBCOMMITTEE

AI, Automation Drive New Industries

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by Devashree Saha

able environments, and creative content are unlikely to be as affected by automation in the near future. However, as automation rapidly evolves, state leaders will need to develop strategies to maximize the benefits for and minimize the risks to their constituents.

Automation is shaping how we interact with the world around us. The integration of robotics and artificial intelligence into everyday life raises important policy questions. Future progress is expected to be even more explosive and experts, as well as policymakers, anticipate that these technologies will transform work and the labor market.

Kansas state Rep. Tom Phillips, who serves as a member of the What’s Next? Embracing the Future Subcommittee, views automation as a welcome change.

The current prevailing opinion is that robotics and AI will replace tasks and not people. According to McKinsey Global Institute, roughly half of the tasks that employees engage in could be automated, but less than 5% of jobs can be fully automated.

“Our nation and states have experienced economic transformations driven by technology before,” he said. “I look at these economic and technology shifts as a positive change. These periods of disruption and change result in new industries and jobs and advancement in quality of life.”

When assessing workforce needs of the future, it's important to recognize that some jobs and tasks cannot be performed by automation or robotics. The McKinsey Global Institute pointed out that some jobs will be less susceptible than others. Jobs involving customer service, unpredict-

But these disruptions can cause unintended consequences that can have a real impact on communities. “To be sure, there are also negative consequences when industries are forced to adapt or decline,” Phillips said. “These market impacts create real

Our nation and states have experienced economic transformations driven by technology before. I look at these economic and technology shifts as a positive change. These periods of disruption and change result in new industries and jobs and advancement in quality of life.” Kansas state Rep. Tom Phillips

the future of work

hardships on individuals, households and communities, which is why government must find solutions to help people and communities adapt.” It’s no secret that artificial intelligence, robotics and automation cause feelings of apprehension and concern among many American workers. According to the Pew Research Center, approximately 72% of workers express worry over the future of work. Education and workforce development will be key priorities for states as they prepare to meet the needs of future employers.

As jobs and tasks are automated, workers will need to develop new skills to adapt to the changing labor market. Policymakers will need to encourage innovation and investment in technology, while supporting education and training “Technology and workforce evolution always render some jobs and occupations obsolete while creating previously unimaginable careers,” said North Dakota state Rep. Corey Mock, a member of the What’s Next? Embracing the Future Subcommittee. “And while jobs lost are usually re-

Nevada Assemblywoman Ellen Spiegel, who also serves on the subcommittee, pointed out the importance of investing in workforce development to help anticipate the needs of the future. “Policymakers have an opportunity to make strategic investments in workforce development,” she said. “Each state can inventory current jobs by categories and by skillsets, assess workforce development needs, and help create or enhance programs to ensure those needs are met.” Phillips agreed that state leaders should create strategies to ensure that communities are able to adapt to change. “Policymakers need to ensure economic transformation being driven by emerging technologies is viewed favorably for creating new jobs and growing the economy,” he said. “State leadership needs to ensure workers and local communities embrace economic change. State leaders must partner with rural regions and communities to create a new vision for how they adapt to the significant economic, demographic and technological changes disrupting their economy, delivery of local health care, education, professional services and retail.”

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Some of those fears are valid. Automation and robots have wiped out many jobs over the last few decades, especially in manufacturing. In one of the first attempts to quantify the impact of industrial robots, research by Daron Acemoglu and his colleagues at the Massachusetts Institute of Technology, based on data from 1990 to 2007, found that for every robot on the factory floor, almost six jobs are lost.

placed with new opportunities, those working in now-unnecessary fields rarely have the training to benefit directly. Policymakers should support industry and technology evolution, but balance that with continuing education for today’s workforce.”

csg national task forces

The State of Artificial Intelligence and Automation Potential for automation

(volume of tasks within the job that are susceptible for automation)

AI-driven automation is coming, but it will not be the end of work. An estimated 25% of occupations in the U.S. are at high risk from the dangers of automation.

Total Investment and Number of Deals Among AI Companies by Year AI is being commercialized at a dizzying pace with large amounts of money being poured into AI startups. 533

High (70% or more) Medium (30%–70%) Low (0%–30%)

464 377

25% 36 million jobs 36% 52 million jobs

39% 57 million jobs

Source: Brookings Analysis of BLS, Census, EMSI, Moody’s and McKinsey Data

Top AI Startup States in the United States, 2018 The vast majority of AI investment is concentrated in a handful of states with California leading the group.

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1 California

466

308 207

$1,147

$2,613

$3,297

$4,093

$5,425

$9,334

2013

2014

2015

2016

2017

2018

Investment ($M)

Deals

AI is estimated to add $15.7 trillion to the global economy by 2030. Source: CB Insights

Industries across the U.S. are integrating AI into their processes, fundamentally altering how business is done.

Health care AI-driven diagnostics sort through mountains of information to suggest possible conditions and treatment, deliver anesthesia or assist professionals in medical procedures.

53 DEALS • $1,917M INVESTED

Finance AI can collect financial data and use predictive analytics to

2 Massachusetts

Education AI can track students’ learning and estimate their

13 DEALS • $247M INVESTED

3 New York

10 DEALS • $110M INVESTED

4 Texas

3 DEALS • $10M INVESTED

5 Washington

3 DEALS • $9M INVESTED Source: CB Insights

anticipate changes in the stock market and manage investments.

understanding of a subject, provide appropriate feedback, and develop key learning habits.

Transportation While self-driving cars and trucks may be the most anticipated development, AI can currently collect data from several sources to optimize and adjust shipping routes and adjust distribution networks. Manufacturing AI is guiding robots on the assembly, packaging and shipping lines. Next level AI-driven robots will be used to solve logistics and ordering issues and even request new product designs.

the future of work

Average automation potential of current job tasks performed in the state

47%–48% 46%–46.9% 45%–45.9% 44%–44.9% 42%–43.9%

While automation will make inroads everywhere, it will be most disruptive in the heartland states— the same region hit hardest by IT era changes. Source: Brookings Analysis of BLS, Census, EMSI, and McKinsey Data

Automation potential for major industry groups ACCOM M O DAT I O N A ND FO O D SE RVIC E S MAN U FACT U RI N G T R ANS P O RTAT I O N A ND WAR E HO U SING AGR I C U LT U RE , F O RE ST RY, FISHING AND HUNTING

MI N I N G , Q UA RRYI N G , AND O IL AND GAS E X TR ACTIO N OT H ER S E RV I C E S (E XCE PT P UBL IC ADMINISTR ATIO N) CO N ST RU CT I O N W H O L E S A L E T RA DE U T I LI T I E S Source: Brookings Analysis of BLS, Census, EMSI and McKinsey Data

75 million

jobs globally are expected to be lost to AI by 2022

but…

133 million

new jobs will be created, and the productivity of existing jobs will be vastly improved Source: World Economic Forum

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R ETAI L T RA DE

73% 59% 58% 57% 53% 51% 49% 47% 44% 43%

csg national task forces

What’s Next? Embracing the Future Subcommittee Key Issues and Resources The Aspen Institute

The Washington, D.C.-based nonprofit public policy organization has a Future of Work initiative with a goal to identify concrete ways to address the challenges American workers and businesses face due to the changing nature of work in the 21st century. Its most recent report in this series is Automation and a Changing Economy (April 2019), which first explores how automation impacts the economic security and opportunity of the American worker and, second, identifies strategies to better prepare American workers for the changes to come. Another report, Future of Work Initiative State Policy Agenda (February 2019) highlights a set of policy options that state policymakers can pursue in response to the changing nature of work. For more information, visit aspeninstitute.org.

Brookings Institution

The Washington, D.C.-based nonprofit public policy organization has highlighted how 21st century emerging technologies such as artificial intelligence and advanced robotics are poised to transform modern society. Their work includes the ongoing series, A Blueprint for the Future of AI, analyzing the new challenges and potential policy solutions suggested by these technologies. As part of this initiative, the Metropolitan Policy Program at Brookings published a report Automation and Artificial Intelligence: How machines are Affecting People and Places, in January 2019. For more information, visit brookings.edu.

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Consultancies: Accenture, Deloitte, McKinsey & Company

Accenture, the global management consulting and professional services firm, examines future work insights in reports like The Big Disconnect: AI, Leaders and the Workforce (July 12, 2018), which found that investment in artificial intelligence is not being matched by investment in reskilling. Deloitte, the multinational professional services network, focuses on human capital trends, in publications like Forces of Change: The Future of Work (November 9, 2017), which pointed to a need to reimagine lifelong education and reassess legal and regulatory policies as two implications for policymakers. McKinsey & Company, the New York-based management consulting firm, has an extensive library of future of work publications including Skill Shift: Automation and the Future of the Workforce (May 2018) and Jobs Lost, Jobs Gained: Workforce Transitions in a Time of Automation (December 2017). For more information about Accenture, visit accenture.com. For more information about Deloitte, deloitte.com. For more information about McKinsey & Company, mckinsey.com.

Information Technology and Innovation Foundation

The Washington, D.C.-based think tank focuses on technology policies that spur innovation. It has published several reports advocating greater deployment of information and other emerging technologies as ways to increase productivity, competitiveness and globalization. Among its most recent publications are Why the United States Needs a National Artificial Intelligence Strategy and What it Should Look Like (December 2018); Will AI Destroy More Jobs Than It Creates Over the Next Decade? (April 2019); ITIF Technology Explainer: What is Artificial Intelligence? (September 2018); and The Task Ahead of Us: Transforming the Global Economy with Connectivity, Automation, and Intelligence (January 2019). For more information, visit itif.org.

MIT Technology Review

The magazine, owned by MIT, periodically features articles exploring the impact of automation and AI on the labor market. Among its most recent articles are Every Study We Could Find on What Automation Will Do to Jobs, in One Chart (Jan. 25, 2018), How AI is Changing Knowledge Work: MIT’s Thomas Malone (Jan. 24, 2019), The State of Artificial Intelligence (Jan. 8, 2019), From Rust Belt to Robot Belt: Turning AI Into Jobs in the US Heartland (June 18, 2018), and Nine Charts that Really Bring Home Just How Fast AI is Growing (Dec. 12, 2018). For more information, visit technologyreview.com.

Vox

Founded in 2014, Vox is a news and opinion website noted for its concept of explanatory journalism. It has periodically published high-quality articles on the emergence of new AI technologies and how they will impact the labor market. Some examples include Automation is Making Human Labor Force More Valuable than Ever, Why the Impact of AI is Up for Debate, AI Disaster Won’t Look Like the Terminator, and Why the Rise of the Robots Won’t Mean the End of Work. It has also produced Shift Change, a six-part video series about automation, robotics and the future of work. For more information, visit vox.com.

the future of work

Whatâ&#x20AC;&#x2122;s Next? Embracing the Future Subcommittee Roster CO-CHAIR

CO-CHAIR

Alaska

Maine

Senator Mia Costello

Representative Andrew McLean

Deputy Commissioner Amy Carter Georgia

Senator Bill Hansell Oregon

Assemblyman Gordon Johnson New Jersey

Representative Corey Mock North Dakota

Representative Tom Phillips Kansas

Representative Lee Qualm South Dakota

Assemblywoman Ellen Spiegel Nevada

Representative Kitty Toll Vermont

Representative Margie Wilcox Alabama

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Senator Juan Barnett Mississippi

csg national task forces

C S G Th e Fu t u re o f Wo r k N a t i o n a l Ta s k F o r c e EQUITY AND INCLUSION SUBCOMMITTEE

Everyone Deserves an Equal Chance To Participate by Brandy Whisman

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Mike Mower, deputy chief of staff to the governor of Utah, believes that “everyone deserves an equal chance to compete in the workforce.” But disparities in wealth, education, workforce training and access often create obstacles to the workforce for traditionally underserved populations.

As our demographics shift, Americans are becoming more ethnically and racially diverse than ever before. According to the National Equity Atlas, the majority of Americans will be people of color by 2044. This growing diversity is an asset that contributes to enhanced collaboration, motivation and innovation in the workforce. Our country’s growing diversity can contribute to immense economic growth. According to Policy Link, in 2012, using a conservative estimate, America’s annual GDP would have been $2.1 trillion higher with racial equity. The country’s largest 150 regions could collectively grow their GDP by 24% by addressing racial inequities, a 10% gain over the national average of 14%. Similarly, gender equity produces a profound economic return. In a 2015 report, McKinsey Global Institute found that $12 trillion could be added to the global GDP by 2025 by advancing women’s equality. That number could more than double to $28 trillion if women were to play an identical role to that of men in the global labor market.

Improving gender and ethnic diversity in the workforce is critical to ensuring that the United States is prepared for the jobs of the future. Mower noted that the “focus should be on ensuring that all barriers that would prevent any particular group from their fair chance to compete and succeed in society is minimized—or better yet—totally eliminated.” Creating livable, sustainable communities can alleviate some of the barriers to the workforce for underserved populations. Accessible public transit, living wage employment, paid parental leave, and assistance programs for people with disabilities are some examples of factors that can contribute to creating a livable community. Access to reliable, affordable transportation is critical to addressing equity and inclusion in the workforce. Only 30% of urban jobs are accessible by public transportation, according to the Brookings Institution. Accessible transportation is even harder to come by for those in low- or middle-skill jobs in urban areas. While one-third of high skill jobs are accessible, only one-quarter of low- to middle-skill jobs are accessible via a 90- minute transit ride in urban areas. Brookings suggests coordinating strategies regarding land use, economic development and housing with transit decisions in order to achieve accessible, efficient transit connectivity. Recognizing that transportation can be a barrier for many, Illinois state Rep. André Thapedi, co-chair of the CSG Future of Work Equity and Inclusion

the future of work

The focus should be on ensuring that all barriers that would prevent any particular group from their fair chance to compete and succeed in society is minimized—or better yet—totally eliminated.” Mike Mower, Utah deputy chief of staff to the governor

Many of these lower wage workers also do not have health insurance. “Another big barrier to equity and inclusion in the workforce is the lack of access to insurance coverage to receive proper health care as well as paid time off for sickness or doctor visits,” Thapedi said. “Unfortunately, in low-paying positions the workforce may be less productive due to unauthorized time off when workers face health issues. As a result, turnover rates are high, work production is reduced and employee morale is low.” State-enacted living wage policies can be an effective way to promote economic security, facilitating economic growth and upward mobility for

underserved populations. According to the Bureau of Labor Statistics, in 2017, 1.8 million workers earned wages at or below the federal minimum wage of $7.25 per hour. Skills training and certification are also step in the right direction, but lack of funding opportunities and access can prohibit participation. Thapedi noted that in “addition to the lack of facilities, many minority and underserved communities lack access to scholarships, stipends or other funds to access training that may exist outside of their neighborhoods.” As our population continues to grow and diversify, states must find a way to ensure that underserved populations can fully participate in the workforce. Addressing disparities in wealth, education, workforce training and access, and other areas is fundamental to building a stronger workforce. Investment in equity and inclusion is essential to ensuring states are prepared for the highly skilled jobs of the future that will sustain our economy.

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Subcommittee, recently sponsored legislation creating a transportation benefit program for employees. HB 2533 provides that an employer in Cook County with an average of 20 or more full-time employees shall offer a program that allows a covered employee to exclude from taxable wages and compensation the cost of a public transit pass—up to a maximum level allowed by federal tax law.

csg national task forces

Economic Inequity The Fair Labor Standards Act is the law that sets the federal minimum wage.

But

A full-time job at the current federal minimum wage isn’t enough to rent an average one-bedroom home anywhere in the United States

The U.S. Federal Minimum Wage

cannot account for the varied cost of living across states, and its one-size-fits-all approach to wages does not completely address income inequity.

Whereas

State-enacted Living Wage Policies

account for each state’s unique costs of living and can effectively promote economic growth and upward mobility for underserved populations.

OWSLEY COUNTY KENTUCKY (Low Per Capita Income) HOURLY WAGES

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POVERTY $6.03 MINIMUM $7.25 LIVING $15.00

Source: Out of Reach 2018: The High Cost of Housing, the National Low Income Housing Coalition, https://reports.nlihc.org/sites/default/files/oor/OOR_2018.pdf.

A Tale of Two Counties POVERTY AND MINIMUM WAGES are the same for both counties, but some COSTS OF LIVING for similar families in either county differ widely, especially housing costs and taxes.

THE LIVING WAGES shown here are the hourly rates each adult must earn while working full-time, 2,080 hours per year to support a two-adult, two-child family.

FAIRFAX COUNTY VIRGINIA (High Per Capita Income) HOURLY WAGES

POVERTY $6.03 MINIMUM $7.25 LIVING $19.17

Food

$8,822

Child Care

$11,915

Child Care

Medical

$6,609

Medical

$7,762

Housing

$7,440

Housing

$21,516

Transportation

$11,459

Transportation Other Annual Taxes

$11,459

HOUSING is almost 3x more expensive in Fairfax County than in Owsley County.

$5,935 $10,205

Food

Other Source: The Living Wage Calculator, first created by Dr. Amy K. Glasmeier at MIT in 2004. Owsley County Data: http://livingwage.mit.edu/counties/ 21189. Fairfax County Data: http://livingwage.mit.edu/counties/51059.

Annual Taxes

$8,822 $12,056

$5,935 $12,212

the future of work

How Businesses Can Benefit from Equity and Inclusion

Companies

with strong equity, diversity

and inclusion programs

ED STAT

GDP

would have been

2012

higher with racial

Diverse hiring

practices attract people not only of varying age, gender,

tend to recruit and retain

race and cultural background

stronger applicants

but also from different career

and better employees seeking forward-thinking employers

stages, which advances Innovative

Diversity

Diverse companies

ideas and creativity

are more prepared to compete

brand and profit

in the global marketplace

by showing cultural competence

by understanding differences

that better reflects the

and communicating with and effectively interacting with people of various cultures.

customers and clients

$2.1 trillion income Equity This Amount Roughly equals the

economy of California

Performance

of Employees improves when

they feel valued for

their uniqueness rather than focusing their

worries on an unfriendly

work environment

Diversity tackles

implicit bias by

encouraging mindfulness in behavior, judgments and risk in the workplace

Information provided by ILLINOIS STATE REP. ANDRE THAPEDI, co-chair of the Equity and Inclusion Subcommittee.

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can improve a company’s

modern needs of diverse

Our country’s growing diversity is an asset that can contribute to immense economic growth. According to PolicyLink, using a conservative estimate, in 2012 America’s annual GDP would have been $2.1 trillion higher with racial equity. Similarly, the country’s largest 150 regions could collectively grow their GDP by 24% by addressing racial inequities, a 10% gain over the national average of 14%. Recent studies have shown that equity and inclusion in the workforce not only benefit employees but also benefit customers and employers.

csg national task forces

Equity and Inclusion Key Issues and Resources PolicyLink

PolicyLink is a national research and action institute advancing racial and economic equity. PolicyLink develops initiatives to advance policies that enable an equitable economy, healthy communities of opportunity and a just society. PolicyLink offers webinars, articles and studies on equity in action. Visit policylink.org for more information.

Deloitte

Deloitte’s Leadership Center for Inclusion has changed the conversation on strategic inclusion. With groundbreaking research, Deloitte demonstrates how inclusive leadership impacts innovation, productivity and company growth. The Billie Jean King Leadership Initiative and Deloitte recently joined forces to identify the issues impacting today’s diverse workforce. The resulting report, The Radical Transformation of Diversity and Inclusion: The Millennial Influence, examines generational views of diversity and inclusion and their impact on innovation, engagement, creativity and other business outcomes. Visit deloitte.com for more information.

National Equity Atlas

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The National Equity Atlas is a policy tool for community leaders and policymakers that examines data to track, measure and champion inclusive growth in America’s regions, states and nationwide. The Atlas provides data on racial inclusion and the economic benefits of equity for the 100 largest cities, 150 largest regions, all 50 states and the United States as a whole. Visit nationalequityatlas.org for more information.

McKinsey Global Institute

The McKinsey Global Institute, the business and economics research arm of McKinsey & Company, provides facts and insights on topics that contribute to decision-making on critical management and policy issues. A recent report, The Power of Parity: How Advancing Women’s Equality Can Add $12 Trillion to Global Growth, focused on the impact that advancing women’s equality could have on the global GDP. Visit mckinsey. com/mgi for more information.

Brookings Institution

The Brookings Institution conducts in-depth research that leads to solutions to problems facing society at the local, national and global level. In a recent report, Missed Opportunity: Transit and Jobs in Metropolitan America, Brookings highlighted the critical need for accessible public transportation to address equity and inclusion in the workforce. Visit brookings.edu for more information.

the future of work

Equity and Inclusion Subcommittee Roster CO-CHAIR

CO-CHAIR

Illinois

Arkansas

Representative Andre Thapedi

Representative DeAnn Vaught

Senator Becky Massey Tennessee

Representative Donna Bullock Pennsylvania

Deputy Chief of Staff Mike Mower Utah

Representative Jeff Currey Connecticut

Representative John Patterson Ohio

Senator Jimmy Higdon Kentucky

Representative Melissa Sargent Wisconsin

Representative Javier Martinez New Mexico

Senator Michael Von Flatern Wyoming

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Assemblyman Michael Benedetto New York

csg national task forces

The Future of Work N a t i o n a l Ta s k F o r c e Pa r t n e r s

ENSURING MORE AMERICANS BENEFIT FROM THE DIGITAL ECONOMY By Fred Humphries, Corporate Vice President of U.S. Government Affairs at Microsoft

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Microsoft is proud to partner with the CSG Future of Work National Task Force to explore ways that states can leverage the revolutionary changes taking place in today’s workforce development. We’re in the midst of an unprecedented social and economic transformation that will impact every person and every organization on earth, and Microsoft believes that corporations like ours have a responsibility to ensure the future we’re building is for everyone.

Addressing this issue involves changing the way people are educated and trained, and the way companies hire and support their employees. Reshaping the labor market for the 21st century is an enormous task that is bigger than any one company. That’s why Microsoft is working with businesses, governments, nonprofits and educational institutions to help those already in the workforce or trying to re-enter build new skills and gain work experience, as well as equipping future students with the digital skills critical to ensure both financial stability and opportunities for growth. Microsoft is leveraging its position as a leading global technology company to develop technological solutions, make strategic investments in skills development and employ-

ability programs, and modernize its practices as an employer to address the skills gap and lead by example as we work to ensure that this industrial revolution and the technology driving it creates economic opportunity for all. We look forward to partnering with the Future of Work Task Force and subcommittees to dive into these issues and help develop innovative solutions that can be implemented at the state level. We’re glad to have the opportunity to participate in the conversation and exploration around concepts that are at the very heart of the work we do. We look forward to working with policymakers to explore the links between education and careers and to finding ways to ensure state workforces can accommodate shifting needs. We’re excited to support the development of innovative approaches that can help state leaders in their own efforts. Lastly, we’re committed to working with policymakers to examine issues and barriers that underserved communities face and identifying ways to promote and encourage equity and inclusion. Microsoft is unwavering in our commitment to create a future workforce that is open, inclusive and accessible to all.

LEAD PARTNER

PARTNERS

csg center of innovation

The CSG Center of Innovation Finds Opportunities for State Outreach The CSG Center of Innovation is an initiative that leverages external funding to provide education, convenings and technical assistance to the states on focused policy topics. Leaders in the U.S. departments of Justice, Labor, and Defense and other federal departments and agencies have repeatedly trusted CSG to help them develop healthy intergovernmental relationships. Often federal funding streams are available to create and deliver needed and requested services to the states. Private foundations sometimes want to engage with state officials because they understand that most of the decisions impacting public policy outcomes are made in state capitols. The CSG Center of Innovation provides a one-stop platform for linking private foundations with public officials in the states. The CSG Center of Innovation is currently engaged in several grant-based projects. The State Exchange on Employment and Disability, or SEED, is a formal collaboration between CSG and the U.S. Department of Labor’s Office of Disability Employment. The project will allow CSG to host a Disability Employment 101 Training at the CSG 2019 National Conference, as well as a session on the future of the workforce. “Our goal is to address the needs of state leaders to ensure that all individuals in their state with the desire to work are able to seek fulfilling employment,” said CSG Policy Analyst Dina

Klimkina. “This not only empowers people, but bolsters states through workforce development and economic growth.” The Retaining Employment and Talent After Injury/Illness Network, or RETAIN, grant is a part of the CSG disability employment policy portfolio and is focused on identifying new, replicable strategies to help disabled individuals stay on the job. “RETAIN is changing the lives of people who acquire mid-career disabilities by fostering communication between stakeholders involved in the return-to-work process,” CSG Research Associate Sydney Geiger said. CSG, the National Conference of State Legislatures and the National Governors Association Center for Best Practices launched a three-year project, Occupational Licensing: Assessing State Policy and Practice, to enhance the portability of occupational licenses. States were elected to join the consortium through a competitive application process. The participating states will become familiar with occupational licensing policy in their own state, learn about occupational licensing best practices in other states, and begin implementing actions to remove barriers to labor market entry and improve portability and reciprocity. “Occupational licensing is a massive labor market institution that affects 1 in 5 workers,” CSG Senior Policy Analyst Matt Shafer said. “This

project helps states begin to look for solutions to problems caused by variance among state occupational licensing policies and remove barriers to workforce entry for disproportionately affected populations such as military spouses and individuals with criminal records.” The U.S. Department of Defense Federal Voting Assistance Program funds CSG to help active military personnel stationed overseas face the unique challenges in exercising their right to vote in U.S. elections through the Overseas Voting Initiative, or OVI. The project aims to improve the return rate of overseas absentee ballots from service members and U.S. citizens abroad. As part of this effort, OVI maintains a working group of 30 election officials who provide state policymakers and state and local election officials with best practice guides to ensure the men and women of the U.S. military and Americans living overseas are able to vote. “The reports that we create are driven by the members we serve—a working group consisting of local and state election officials chaired by Secretary of State Kim Wyman of Washington and Secretary of State Jim Condos of Vermont,” OVI Program Manager Taylor Lansdale said. “Our team is unified in the pursuit of ensuring that our overseas citizens are not forgotten during elections and our service men and women have their say in the democracy they defend.”

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csg national task forces

Looking to the Future of Disability Employment

by Dina Klimkina

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In today’s increasingly complex global economy, building a strong, inclusive workforce is vital to each state’s economic success. More and more states are recognizing that inclusive workforce development practices are an economic imperative, and in their efforts to implement such practices, they are learning that people with disabilities—including veterans with service connected disabilities—are a key part of the solution.

“Wherever you come from, when all people who want to work can work, local economies are bolstered and communities are strengthened,” said Jennifer Sheehy, deputy assistant secretary for disability employment policy at the U.S. Department of Labor. “Making that happen is something that requires action on all levels— national, state and local.” That is the spirit behind the State Exchange on Employment and Disability, or SEED, a unique state-federal collaboration between the U.S.

Department of Labor’s Office of Disability Employment Policy, The Council of State Governments, the National Conference of State Legislatures, and several other leading organizations representing state and local policymakers. SEED ensures state-level policies on workforce development are inclusive to all Americans by helping policymakers address barriers to employment for individuals with disabilities. Recognizing that states lead the nation on policy innovation, SEED, through its partnership with CSG, offers states the policy tools and resources required to develop and implement meaningful, disability-inclusive workforce development polices. A range of policy assistance resources are available to CSG’s members, including subject-matter expertise and legislative testimony; sample, customizable policy options; and resources designed to assist policymakers in crafting legislation. CSG also acts as a convening body, bringing together policymak-

ers and subject matter experts to facilitate the creation of policy solutions to address complex challenges facing state workforce development today. Since CSG first began its collaboration with SEED in 2015, disability employment and inclusive workforce policies have generated widening attention in the states. Acting as a catalyst for these efforts, the National Task Force on Workforce Development for People with Disabilities was a foundational initiative created by and for states that served to launch the SEED collaboration and bring needed support to this critical policy area. The task force produced Work Matters: A Framework for States on Workforce Development for People with Disabilities, which represents a culmination of intensive deliberation and research by the 60-member task force and offers states 13 broad policy options and 48 suggested strategies, as well as more than 240 examples of innovative, successfully-imple-

csg center of innovation mented, state-level programs and policies. Today, the Work Matters Framework remains a cornerstone document for promoting the development of disability employment policy across the United States. Following the national task force, CSG and SEED joined forces again in support of Kentucky Gov. Matt Bevin’s state-level task force to examine workforce development issues across five target populations. The Kentucky Work Matters Task Force brought together every department of Kentucky state government with members of the private sector to identify workforce development policy options and recommendations, and the subsequent Kentucky Work Matters Report has led state policy leaders to take significant action. The Kentucky task force culminated in the signing of Executive Order 2018-328, which established the Employment First Council to ensure all state agencies work toward making sure people with disabilities have opportunities to work and offer valuable skills to their employers while receiving a competitive wage. “Work Matters was life changing,” said Kentucky Education and Workforce Development Cabinet Secretary Derrick Ramsey, who has since engaged in several new innovative workforce development programs. Other states have expressed interest in establishing similar statelevel task forces. Helping ill and injured workers remain on the job or return to work after an illness or injury was identified as a key issue by the National Work Matters Task Force. So, in 2018, CSG convened the Stay at Work/Return to Work, or SAW/ RTW, Leadership Team in collaboration with SEED to address this critical policy area. The resulting toolkit and webinar identified chal-

lenges, actionable policy options, best practices and implementation strategies to assist state policymakers in facilitating positive SAW/RTW outcomes. “State officials are the primary influencers when it comes to adopting policy that promotes and facilitates the transition back to work for individuals who have become disengaged from the workforce due to… disability,” said Tennessee state Sen. Becky Massey. Earlier this year, CSG and SEED also launched The National Task Force on The Future of the Workforce. Co-chaired by New Hampshire state Sen. Lou D’Allesandro, CSG 2019 national chair, and Pennsylvania state Rep. Dan Miller, the task force is examining how the rise of the gig economy, advances in automation and technology, and changes in apprenticeships will impact the future of work for individuals with disabilities. The Task Force on The Future of the Workforce held its first meeting in Cambridge, Massachusetts, in February and met again in April at CSG Headquarters in Lexington, Kentucky. A final report of findings and recommendations from the National Task Force on The Future of the Workforce will be released at the CSG 2019 National Conference in San Juan, Puerto Rico. The National Conference will feature a panel discussion and a half-day Disability Employment 101 session for states to learn more about promoting inclusive employment practices in the new economy. For more information on Work Matters, The National Task Force on the Future of the Workforce, or to receive state policy assistance, please contact Dina Klimkina at dklimina@csg.org.

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csg national task forces

Occupational Licensing: Assessing State Policy and Practice

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by Carl Sims, Clay Fannin, Max Morley

Occupational licensing is a means for states to safeguard the health and safety of the public by requiring certain practitioners to meet specific training and education requirements. However, where overly burdensome or disparate state licensing laws and regulations exist, barriers are created for workers entering the labor market or seeking to relocate to another state. These barriers can result in significant economic losses for a state, and these issues are compounded by the fact that the number of jobs requiring a license has grown significantly over the past 60 years, increasing from 1 in 20 to 1 in 4. States have an interest in finding the right balance of ensuring the proper protection of public health and safety while minimizing the associated economic costs of licensure. To assist states in this endeavor, the U.S. Department of Labor’s Employment and Training Administration awarded CSG, in partnership

with the National Conference of State Legislatures and the National Governors Association, funding for a multiyear project titled Occupational Licensing: Assessing State Policy and Practice. The specific aims of the project include helping states improve their understanding of occupational licensing issues and best practices, identifying current policies that create unnecessary barriers to labor market entry, and creating an action plan with states that focuses on removing barriers to labor market entry and improves portability and reciprocity for selected occupations. To achieve these goals, the project partners are providing direct technical assistance to a learning consortium of states. Through a competitive application process, 11 states were selected to join the consortium in the first phase of the project in 2017: Arkansas, Colorado, Connecticut, Delaware, Indiana, Illinois, Kentucky, Maryland, Nevada, Utah and Wiscon-

sin. Five additional state teams were added during the second phase of the project in 2018: Idaho, New Hampshire, North Dakota, Oklahoma and Vermont. The consortium state teams predominately consist of representatives from the governor’s office, the state’s department of occupational licensing and legislators. The project partners assist the teams in convening during the course of the project to discuss and develop state strategies to identify and enact improvements to their occupational licensure framework. Utah has been a leading state in implementing occupational licensure reform. Since joining the consortium, the state has passed legislation to improve licensure mobility for military members and their spouses, establish competency-based licensing requirements, and allow the state’s Division of Occupational and Profes-

csg center of innovation sional Licensing to offer required examinations in multiple languages.

improve licensure mobility has also benefited from discussion with other states.”

Mike Mower, deputy chief of staff to the governor and a member of the state’s project team, reflected on the state’s active role in addressing occupational licensure through the project.

In addition to providing consortium states convening opportunities, the project also offers resources that support states in executing their action plans. For example, to help state leaders better understand the national licensing landscape, CSG and its project partners developed the National Occupational Licensing Database. This database provides information on the licensing criteria for 31 occupations, including pharmacy technicians, electricians and cosmetologists. The database allows users to conduct a comparative analysis of state licensing criteria for education, training, experience, cost, renewal and other requirements. CSG and its partners are in the process of expanding the database to 50 occupations.

“What has been very helpful for us is that the project provides us an extended opportunity to evaluate our occupational and professional license requirements,” Mower said. “We are able to make sure that as the market changes, we are keeping abreast of the challenges to workers requiring a license.” In addition to individual state team meetings, the consortium states meet annually through the duration of the grant for a consortium-wide meeting. The annual consortium meeting allows the teams time to engage in peer learning with other states, hear from subject matter experts, and revise and further develop their action plans. To date, the consortium has met in Tucson, Arizona, and Clearwater, Florida, with the next gathering being planned for Park City, Utah, in September. Colorado’s occupational licensure team said they have greatly benefited from the state-tostate interaction that the project provides. “One of the biggest values we have gotten from the project is the ability to collaborate and learn from other states,” said Ronne Hines, director of Colorado’s Division of Professions and Occupations. “For example, state peer interaction helped guide our efforts when we streamlined our process to recognize credentials in lieu of foreign transcripts. Our work to

Another focus of the project are the population groups—military spouses and families, immigrants with work authorization, people with criminal records, and unemployed and dislocated workers—that are disproportionately affected by the requirements and variances of occupational licensing. To better help state leaders understand these effects, the project partners have put together a series of reports titled Barriers to Work. These documents focus on the unique challenges to initial licensure and barriers to license portability specific to these four populations. Further project information including published policy reports, blog articles and webinars can be found on CSG’s project website, licensing.csg.org.

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csg national task forces

Overseas Voting Initiative Visits USS America at California Convening

by Jessica Kirby

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Election officials around the country have an up-close view of how local residents participate in the voting process, which includes registering to vote, finding the appropriate polling place and casting ballots. But election officials do not always get to witness the different ways in which their absentee voters, particularly military and overseas voters, participate in elections.

The Council of State Governments’ Overseas Voting Initiative, or OVI, convenes state and local election officials to explore options to overcome the obstacles voters face when ballots have to be mailed internationally or sent via email. CSG convened the OVI working group in San Diego, California, in March to discuss the military and overseas voting processes in their respective states and jurisdictions. Working group members saw first-hand what the process looks like for service members aboard an amphibious naval ship. The OVI working group comprises state and local officials, including two secretaries

of state—Washington Secretary of State Kim Wyman and Vermont Secretary of State Jim Condos—who serve as the group’s national co-chairs. The closed meeting also included U.S. Election Assistance Commission representatives and Service Voting Action Officers, or SVAOs, from every branch of the military, as well as representatives from the State Department and Military Postal Service Agency, or MPSA. As part of the meeting, the group was given the opportunity to tour the USS America at the Naval Base San Diego. While on board, several sailors spoke to the group about life on base versus life at sea where they can have up to a thousand people on the ship. Unfortunately for the Uniformed and Overseas Citizens Absentee Voting Act, or UOCAVA, voters, high-speed internet and daily postal services are not typically available. They must make extra effort to ensure they have enough time to receive and return ballots before each jurisdiction’s deadlines. The

election officials heard directly from the service members about the technological and postal obstacles the sailors face and how this impacts the process of casting their ballots. “My team and I at FVAP have greater exposure to our service members to continue reminding us why this project is so important. We are thankful that The Council of State Governments strives to provide these opportunities for the working group members to also see the obstacles that UOCAVA voters face while on duty,” said David Beirne, director of the Federal Voting Assistance Program. By observing the process for the UOCAVA voter, the working group members can return to their states and jurisdictions to compare how current policies align with the realities of voting from Navy ships or elsewhere. “As a national co-chair for OVI, I felt very proud as we toured the USS America in San Diego. I am thankful The Council of State Governments provides these opportunities for myself and the

csg center of innovation other astounding election officials in our group to speak directly with the service members who we aim to serve through a better voting process,” said Washington Secretary of State Kim Wyman (R-WA).

national efforts. The first meeting did not disappoint, and I came back to Pennsylvania with several new ideas for us to consider and recommendations on ways to improve our process based on feedback from panelists.”

As election policies continue evolving alongside ever-changing technology, it is important for election officials to keep in mind that overseas and military citizens may not have access to the same technology as stateside voters.

The OVI meetings provide a closed forum for open and honest conversations amongst the members on the challenges in meeting federal requirements, while working to ensure that practical absentee voting options are given for UOCAVA citizens.

“As a new member, I found it invaluable to hear directly from our active duty military about the challenges they face when exercising their right to vote,” said Barb Byrum, Ingham County clerk in Michigan. “It was a fascinating experience to board and tour the USS America.” Since the passage of the Uniformed and Overseas Citizens Absentee Voting Act in 1986, election officials have been required to allow certain U.S. citizens to register to vote and vote absentee for federal offices. UOCAVA covers U.S. citizens who are active members of the Uniformed Services, the Merchant Marine, the Public Health Service Commissioned Corps, and the National Oceanic and Atmospheric Administration, their eligible family members and U.S. citizens residing outside of the United States. OVI’s goal is to facilitate the conversations that are necessary to recommend best practices for serving these voters. “I am delighted to join the Overseas Voting Initiative on behalf of the Pennsylvania Department of State,” said Jessica Myers, director of policy at the Pennsylvania Department of State. “It is an excellent opportunity to explore ways to improve the voting process for our military and overseas voters, while providing information on our state’s experience to inform

“The Council of State Governments has created a safe venue for states to come together to have honest conversations about our challenges and successes so that we may take what we have learned home to continue enhancing our own election processes and lightening the burdens on our military and overseas voters,” said Secretary of State Condos (D-VT). “I am proud to help guide this effort alongside my Co-Chair, Secretary of State Wyman (R-WA).” The working group is currently focusing efforts on two subgroup areas: Sustainability of UOCAVA Balloting Solutions, or SUBS, and Data Standardization Implementation, which originated during the first OVI project. “The Council of State Governments has the unique ability to convene state and local officials and facilitate candid discussions about pressing policy issues,” said Taylor Lansdale, OVI program manager. “The OVI team is committed to bringing that ability to bear for state and local officials as they examine how to best serve UOCAVA voters. We are very proud that we could connect our members with the sailors aboard the USS America and Service Voting Action Officers. I believe that our members left inspired by what they experienced in San Diego.”

ISSUE 2/3/4 2019 | CAPITOL IDEAS

csg national task forces

Grant Aims to Help Employers and States RETAIN Workers

ISSUE 2/3/4 2019 | CAPITOL IDEAS

by Sydney Geiger

On- and off-the-job injuries or illnesses remove millions of employees from the workforce each year. When employees shift from short-term to long-term disability benefits, apply for Social Security Disability Income, or SSDI, or permanently leave the workforce, it is costly for the employee, employer and state. Employers have a strong interest in avoiding employee turnover, which is widely acknowledged as the most expensive personnel expense. Employment increases quality of life for individuals and increases tax revenues for states. Implementing effective return-to-work programming results in positive outcomes for all stakeholders. To create opportunities to strengthen this sector of the workforce, the U.S. Department of Labor Office of Disability Employment Policy, in partnership with the Employment and Training Administration and Social Security Administration, is funding the Retaining Employment

and Talent After Injury/Illness Network, or RETAIN, grant. The RETAIN grant awarded eight states with nearly $19 million to implement an 18-month pilot project.

Minnesota, Ohio, Vermont and Washington were the eight states awarded. While each has the same mission, the projects are adaptable to specific state needs.

The projects will be funded in two phases. After the Phase 1 pilot project, a subset of the recipients will competitively apply for Phase 2 funding. Phase 2 will include a 30-month project implementation and a 12-month evaluation.

Each state created a leadership team comprising representatives from state health services, state workforce development, and other public and private stakeholders. The team will work to foster collaboration between health care providers and employers to assist injured or ill workers in remaining in the workforce.

Similar projects in Washington have had successful results. Washington has implemented the Centers of Occupational Health and Education, or COHE, the Stay at Work, or SAW, and the Early Return to Work, or ERTW, programs. While these programs solely focus on work-related injuries, RETAIN has a unique approach because of its focus on both on- and off-the-job injuries. California, Connecticut, Kansas, Kentucky,

“Starting off with committed partners across state government is going to set us up for strong successes,” Kathy Sheppard-Jones, a member of Kentucky’s RETAIN leadership team, said during the CSG 2018 National Conference in December. The Kentucky Department of Workforce Investment is leading the RETAINing Ken-

csg center of innovation tucky’s Workforce through Universal Design, or RKW-UD, project. A variety of Kentucky stakeholders including state cabinets, health care providers, labor and industry, and nonprofits, including The Council of State Governments, are collaborating on the efforts. The project’s aim is to help Kentuckians stay at work and return to work in the event of an injury or illness. “CSG is excited for the opportunity to partner with the state of Kentucky to continue our dedication to creating an inclusive workforce. The RETAIN project is a continuation of our work on disability employment including our work with the State Exchange on Employment and Disability and our recently published Stay-atWork/Return-to-Work Toolkit,” said Elizabeth Whitehouse, director of the CSG Center of Innovation.

work-related or not. The project will be implemented starting in June 2019. “The workforce system has to work for everyone,” said Brooken Smith, chief of staff of the Kentucky Education and Workforce Development Cabinet. “We have to get people engaged. Those who are injured or with a disability are a key constituent. We must help them achieve their dreams and sustain their quality of life.” Providing supports and services for people who have acquired mid-career disabilities strengthens the quality of life of citizens, allows businesses to prosper, and stimulates state economies.

The universal design project intends to prevent long-term work disability through early, collaborative health and employment-related services. This includes training health professionals with best practices for patients who are at risk of leaving the workforce due to mid-career disabilities. Another aspect of the universal design model is to implement returnto-work service coordinators who work directly with ill or injured workers and other program participants such as employers or health care providers. The Kentucky RETAIN team has spent the last eight months planning, recruiting employers and training the return-to-work service coordinators for the implementation of the project. The target population will be people who have acquired mid-career musculoskeletal injuries in the health care sector regardless if the injury is

ISSUE 2/3/4 2019 | CAPITOL IDEAS

CSG 2019 POLICY ACADEMY SCHEDULE CSG Policy Academies provide state leaders customized training and a “deeper dig” on critical policy topics facing the states. To learn more about CSG Policy Academies, please contact registration@csg.org or visit csg.org/policyacademies.

M E D I C A I D 101

Washington, D.C. | Oct. 9–11 Understanding the details of Medicaid is difficult, especially for a new legislator unfamiliar with the intricacies of the program. Following an election year, in 2019 up to 35% of the country’s state legislatures will be new members. In legislatures across the country, often only a handful of members are schooled in Medicaid’s complexities. While this knowledge is critical in helping inform legislative decisions, no succession plan exists to replace the institutional knowledge of senior officials. CSG’s Policy Academy educates and equips the next generation of legislators to provide appropriate oversight over state Medicaid programs. In 2019, CSG will convene its eighth Medicaid Policy Academy for newly elected legislators serving on health committees in the states. Faculty will consist of seasoned health chairs and Medicaid directors as well as experts from industry and academia.

GROWI N G G R E E N

San Juan, Puerto Rico | Dec. 4 More than half of the states have legalized marijuana for recreational or medicinal use. That’s a massive shift in public policy from just a decade ago. With this shift comes a slew of legislative, regulatory and fiscal questions for state policymakers to tackle. CSG’s Growing Green one-day Policy Academy, held as part of the CSG 2019 National Conference, provides an overview of the landscape for state regulations, economic development and job creation, and increased tax revenues as well as the impacts on state budgets. Faculty will include executive branch officials responsible for oversight of licensing and public health issues related to these policies.

T EC H S TAT E S A N D T H E R AC E TO 5G San Juan, Puerto Rico | Dec. 4

A strong innovation economy will contribute to economic growth and create jobs. The tech industry has also seen unemployment rates lower than the national average. Recognizing these opportunities, many states are positioning themselves to attract businesses and technological innovations like 5G. But what is 5G and how can states maximize these opportunities? This one-day Policy Academy, a collaboration between The Council of State Governments and Women in Government, explores the complexities of these public policy decisions and unintended consequences of action or waiting too long to address these burgeoning issues.

PR I VAC Y A N D C Y B E R SEC U R I T Y San Juan, Puerto Rico | Dec. 4

State governments handle billions of pieces of personal data every day; securing that information is both increasingly important and difficult. Security breaches can result from something as simple as a lost laptop or as complex as a sophisticated, intentional attack from cybercriminals. Cyberattacks can lead to personal identity theft and create major disruptions in the ability of states to deliver crucial services to residents. While cybersecurity is an issue of increasing importance, states are often unprepared. This Policy Academy, held as part of the CSG 2019 National Conference, will explore state solutions to cybersecurity and privacy concerns. Faculty will consist of state chief information officers as well as experts from industry and academia.

T H E E N E RGY L A N DSC A PE San Juan, Puerto Rico | Dec. 4

In partnership with the National Association of Regulatory Utility Commissioners, or NARUC, CSG will convene legislators on energy committees to explore the myriad public policy energy challenges and opportunities facing the states. The electric grid, new technologies, natural gas uses, energy efficiencies, nuclear and solar options, and water challenges are among the issues that may be considered. Faculty will include NARUC member commissioners and energy chairs. This one-day Policy Academy will help legislators and commissioners to better understand their respective roles and how their decisions and rules impact each other as they seek to best serve in their capacities.

The Council of State Governments 1776 Avenue of the States Lexington, KY 40511

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