Health care has again made news with many states reporting large increases in proposed health insurance premiums. Some insurance companies like United Health have announced they are pulling out of certain insurance markets due to large financial losses. These issues all but guarantee that health care will again be a flashpoint in an election year.

No matter who is elected president or controls Congress, states will have some big decisions on health care in the next few years. A new paper I coauthored with Brian Blase from the Mercatus Center gives an overview of looming health care issues that governors and state legislatures need to be ready to address.

A Republican president would likely repeal part of the Affordable Care Act, and state lawmakers need to be prepared to regain oversight of their state health care markets. Many states passed state legislation to duplicate part of the ACA. A first step for any state lawmaker would be to see how they separate their state from some of the ACA requirements.

No matter who is president, Medicaid spending is going to be an important concern for states. National leaders for both parties have looked at reducing Medicaid payment rates, and federal auditors are trying to reduce Medicaid gimmicks that states use to garner more funds.

While state lawmakers may not control federal health care policy, they can control state licensing restrictions. Lawmakers should look at state health care regulations like certificate of need that will restrict competition and increase costs. Ohio, and other states, is trying to use civil society through charity care to help provide medical care to its citizens. These state solutions will become more important health care costs continue to increase.