January 29, 2018

Key Trends in State Capitals for 2018

While congressional action and federal legislating is a year-round endeavor, most state legislatures operate on a part-time basis and, with some exceptions, usually start and end their sessions in the first quarter or so of each calendar year. Consequently, we will see a flurry of state legislative activity in the coming months as policymakers grapple with the myriad issues their constituents continue to face.

Likely “big picture” issues to sit front and center for these legislators include the following:

  • Tax reform
  • Healthcare reform
  • Opioids
  • Election cybersecurity
  • Budgets

In addition to these general issues, the following are snapshots in a few specific states where Cornerstone is actively engaged.


A big focus continues to be on rural Georgia.  Within the conversation surrounding rural Georgia, we expect broadband discussions to continue – how to best serve those who do not have internet access or high-speed access at least. The Georgia House of Representatives created the House Rural Development Council during the 2017 Legislative Session, which is a two-year endeavor to look at the big picture and consider how government policy on issues like healthcare, transportation, and tax impact the economies of rural Georgia. The goal is to create an environment where Georgia’s economic prosperity reaches every corner of the State.


After having gone two years without a full-year budget, it is uncertain whether a state budget agreement can be reached again in 2018.  Last year, a coalition of Democrats and Republicans in the Illinois Legislature passed a budget over the objections of Governor Bruce Rauner.  In 2018, the question is whether Governor Rauner will be willing to negotiate a full-year state budget, if the Legislature is able to come together and compromise on a budget solution again, or whether no budget will be passed.

Additionally, discussions are ongoing with members of the General Assembly and the Department of Healthcare and Family Services to redesign the Hospital Assessment Program that provides about $3.5 billion in Medicaid funding for hospital and other healthcare services. The tax and payment structure to hospitals has not been fully updated in a number of years and will expire in state statue on June 30, 2018 if nothing is done to continue the program.  Negotiations commenced late last summer and are anticipated to wrap up soon.  Once legislation becomes law in Illinois, the federal government will need to approve the new program structure.


The 2018 Session of the Maryland General Assembly began on January 10th and runs through April 10th.  Typically, nearly 3,000 bills are introduced during each legislative session and with upcoming elections for all statewide offices on the horizon, an extraordinary increase to the number of proposed bills is expected.  While it’s difficult to predict what will be the key issues consuming the legislature’s focus, at this point they are likely to include a series of healthcare and pharmaceutical affordability proposals, as well as renewable energy, alcoholic beverage regulation, tax and budgetary proposals, paid sick leave, and an increase to the minimum wage. Cornerstone’s Maryland team will be focused on advocating aggressively on these issues as they impact our clients.

Maryland imposes a 3% tax on all healthcare bills administered through hospitals.  On behalf of our clients we have and will continue to advocate for the reduction and elimination of this “Sick Tax” in an effort to reduce the cost of healthcare in Maryland.

We will also work to ensure that the state budget contains the funding necessary to address the information technology and cyber security needs, and capital construction funding of state agencies that are important potential partnerships for the state and our clients.


The Mississippi Legislature gaveled into session on January 2nd for a 90-day period. It is expected to be a busy 2018 Session with several major topics on the agenda, including Medicaid and education funding.

The “Medicaid Technical Amendments Bill” is up for extension this year, which will likely see various changes to the way the Division of Medicaid operates. Everything from provider reimbursements to managed care to eligibility determinations will be up for debate over the next three months. Governor Phil Bryant recently appointed his Deputy Chief of Staff, Drew Snyder, as the interim Executive Director of the Division, who will play a key role in the debate.

Education funding will again be a highly discussed item this session as leaders negotiate a potential new funding formula for local school districts.

Other hot topics include the enactment of a statewide lottery, funding for roads and bridges, agency consolidation, and the always present budget debate.

These are just some of the issues businesses and not-for-profit organizations will encounter during the 2018 state legislative cycle. Cornerstone will continue monitoring around the country and periodically update throughout the year.