Stateline
Vol. 27, No. 8 • September 2018
MidwestTHE MIDWESTERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS
INSIDE CSG Midwest Issue Briefs 2-3 No sure bets for states • Economic Development: Ohio passes law to support blockchain-based businesses Legal climate for sports wagering has changed, but impact in • Health & Human Services: Indiana seeks to improve perinatal care with new rating system Midwest remains unclear as legislators weigh risks and benefits • Agriculture & Natural Resources: Minnesota, Iowa expand health-plan options for farmers by Tim Anderson ([email protected]) • Criminal Justice & Public Safety: Wisconsin invests in infrastructure to improve juvenile justice he state of gambling in the Midwest betting is that it is happening already Legislative activity in Midwest Around the Region 4 already varies considerably from one — illegally, via offshore or online sports jurisdiction to the next. on legalization of sports betting books. Voters to decide future of redistricting, T marijuana laws in some Midwestern states Want to try your hand at a casino table “We’re not creating an activity; the game? You have no such chance on one numbers show that,” says Indiana Rep. Capital Closeup 5 side of the Iowa-Nebraska line, where the Alan Morrison, who has sponsored Some states allow legislative vacancies to be filled latter’s constitutional language prevents legislation in his state (HB 1325). by appointment; others require special elections commercial casinos. Cross the Missouri National estimates have ranged River from Omaha into the Iowa town of anywhere from $50 billion to $150 billion Question of the Month 5 Council Bluffs, though, and three casinos a year. Do states in the Midwest require that students are only minutes away. By legalizing sports betting, Morrison receive instruction in financial literacy? How about playing a table-style casino says, Indiana can regulate operators, game while at a bar or other local estab- Legislation introduced in 2018 (or strengthen consumer protections, im- Profile 8 2017, but still active this year) Minnesota Sen. Ann Rest lishment, via a “video gaming terminal”? prove business for the state’s existing In Illinois, more than 6,000 locations casinos, and bring in some additional now have these terminals. For most tax revenue for the statesBut Miller says FirstPerson 9 “I’ve seen some estimates that within Iowa Rep. John Wills on how and why his state is other states in the region, this type of there are downsides to consider as well, a year, 35 states [across the country] will investing more in water quality projects activity is nonexistent, or at least limited including a potential rise in problem have legalized sports betting. I would take to charitable or tribal gaming. gambling. the under on that; I don’t think it’s going CSG News & Events 10 These state-by-state differences in Keith Whyte, executive director of the to expand that quickly.” Legislators from all 11 Midwestern states complete gambling are the result of a mix of consti- National Council on Problem Gambling, CSG’s premier regional leadership program That’s partly because some lawmakers tutional language, politics and legislative will oppose what they view as a major expan- says one group should be of particular decision-making. Capitol Clips 12 sion of gambling, and also because of the concern — young males between the These same factors are likely to cause ages of 18 and 24. • Illinois OKs marijuana as opioid replacement newness and complexity of the policy issue. states in the Midwest to take varying ap- They are most likely to bet on sports, • Minnesota boosts hiring of disabled workers With debate over sports betting ex- proaches to intrastate sports betting. In May, • Michigan turns to experts for infrastructure help pected to intensify in the months ahead, are prone to gambling problems, and the U.S. Supreme Court overturned a federal • Ohio invests in school safety, officer training here are four questions that the Midwest’s would be most impacted by advertising law that had blocked this type of gambling legislators will be asking as they consider and increased availability, he says. activity, and a handful of states outside the any new legislation. “What we see coming down the pike region already have new laws in place. with technology is that you’ll be able In some Midwestern states, the odds Question #1: Will there be a to bet on every single play, every single Stateline Midwest is published 11 times a year seem pretty good that sports betting will rise in problem gambling? action, every single athlete, every single by the Midwestern Office of be authorized (maybe as early as next game, every single sport — 24-7,” Whyte The Council of State Governments. year). In others, legalization appears One of the arguments for legalizing sports adds. Annual subscription rate: $60. much more of a long shot. To order, call 630.925.1922. This year, bills to authorize sports betting PLEASE TURN TO PAGE 6 have been introduced in six of the Midwest’s 11 states. Not coincidentally, each of these Debate over the legalization of sports states — Illinois, Indiana, Iowa, Kansas, betting will intensify in the Midwest’s Michigan and Ohio — already has existing state capitols in the months ahead as commercial or non-tribal casinos up and the result of a U.S. Supreme Court ruling that overturned the U.S. Professional CSG Midwestern Office Staff running. (Many of the introduced measures and Amateur Sports Protection Act. To Michael H. McCabe, Director would run sports betting through these date, most of the proposed bills in this Tim Anderson, Publications Manager licensed gambling establishments.) Jon Davis, Assistant Editor/Policy Analyst region envision sports betting being “Sports betting will continue to pick Cindy Calo Andrews, Assistant Director run through casinos, with individuals Ilene K. Grossman, Assistant Director up momentum in the states, but I also having the option to make wagers via Lisa R. Janairo, Program Director think you’re going to see some resistance,” their mobile devices. In some states, Laura Kliewer, Senior Policy Analyst says Drake University law professor Keith though, legalization seems unlikely Gail Meyer, Office Manager Laura A. Tomaka, Senior Program Manager Miller, co-author of the 2016 book “The due to constitutional bans and/or Kathy Treland, Administrative Coordinator and Meeting Planner Law of Gambling and Regulated Gaming.” political opposition to gambling. CSG MIDWEST ISSUE BRIEFS
Issue Briefs cover topics of interest to the various groups and policy committees of CSG Midwest, including the Midwestern Legislative Conference, Great Lakes Legislative Caucus, Midwest Interstate Passenger Rail Commission and Midwestern Radioactive Materials Transportation Committee. Economic Development
Ohio hopes giving blockchain decentralized computer networks, in which data is One week after SB 220 was signed into law, data, contracts legal status will divided and publicly stored among several computers Cleveland announced that businesses and nonprofits draw more economic activity instead of one database or server. Records, currency in the city would have free access to data and research and electronic information stored through blockchain from the Toronto-based Blockchain Research Institute. hio lawmakers are hopeful that new blockchain are verified by several sources Supporters also see new jobs for those trained in legislation will make the state a leader in devel- and can’t be erased or altered. blockchain coding and are looking to universities to Ooping the emerging technology and attracting Therefore, transactions made graduate students with the skill to work with block- businesses that would use it. through blockchain technology chain and carry that skill into the private workforce. In June, the legislature approved SB 220, which are transparent, efficient and “In my position as a state senator, I want to send a gives legal standing to data recorded through block- highly secure. (Blockchain is clear and loud signal that Ohio is innovative, that we chain technology. It took effect upon Gov. John Kasich’s most commonly known as the are thinking about today’s and tomorrow’s economy,” signature in August, making Ohio the first Midwestern technology behind Bitcoin.) Dolan says. “And if you are a young person in Ohio, you state to consider records or contracts secured through Ohio Sen. In addition to being used know that you can get a job in a sector of the economy Matt Dolan blockchain technology an electronic form and record by businesses for transactions, that is growing and that is new. under the Uniform Electronic Transactions Act. blockchain can provide the “If Ohio creates a workforce that can provide coders “What that did was send a message to anyone in public sector with a safe and secure way of recording familiar with this latest technology to companies who the private sector, and hopefully the public sector, who and storing records, such as birth certificates, licenses want to go into blockchain, that’s a win,” Dolan says. wants to conduct business using blockchain technology and other documentation. “It’s a burgeoning industry, and we want to be part of that it is acceptable in Ohio,” says Sen. Matt Dolan, Technology experts point to blockchain as the next it here in Ohio. sponsor of SB 300, the original blockchain bill. generation of the Internet, one that will eventually “It’s the image that we want Ohio to be part of,” he SB 300 included language that put electronic become commonplace in the flow of digital commerce, adds. “When you think of tech, you don’t necessarily signatures obtained through blockchain technology storage of public records, and everyday transactions. think of Ohio, but if we can take the lead in blockchain on par with other forms of electronic signatures. That Proponents in Ohio hope that by being among technology then we fill that space and people start provision was the only part of the bill to survive when the first states to recognize blockchain transactions, talking about Ohio like they talk about Boston and it was approved as an amendment to SB 220, which the move will translate into attracting blockchain Austin, Texas, and the Silicon Valley. We want a deals with cybersecurity issues. developers and companies, adding to Ohio’s growing slice of that. This is what getting out ahead on this Blockchain technology is based on a series of tech sector. technology can do.”
Brief written by Laura Tomaka, CSG Midwest staff liaison to the Midwestern Legislative Conference Economic Development Committee. She can be reached at [email protected]. The caucus co-chairs are Michigan Sen. Ken Horn and South Dakota Sen. Kevin Killer; its vice chair is Ohio Rep. Dave Greenspan.
Health and Human Services
‘What is the best hospital for my delivery?’ ” Allen says. Indiana puts perinatal ‘levels Indiana’s levels of perinatal care of care’ standards into state law “The goal being to place the mother at the best possible place for her and her baby.” to reduce infant mortality Levels Definition Indiana has been trying to reduce infant mortality arlier this year, Gov. Eric Holcomb signed SB 360, for years, says Sen. Ed Charbonneau, who sponsored making Indiana the third Midwestern state to I Basic care for low-risk pregnancies SB 360 in his chamber. (The bill cleared both houses Eenshrine in state law a perinatal “levels of care” II Special care for high-risk pregnancies unanimously.) It became one of Gov. Holcomb’s sig- rating system for hospitals and birthing centers. Specialty management of severe maternal/fetal nature measures for the 2018 session after his State III SB 360 requires the Department of Health to create complications of the State address, in which he set a goal for Indiana a program to certify levels-of-care designations for of having the best (lowest) infant mortality rate in the obstetrics and neonatal care for hospitals and facilities Regional centers capable of Levels I-III service country by 2024. IV and can handle the most complex/critically ill that provide birthing services. They will be measured patients “Despite focusing on it, our death rate is still an in six categories ranging from organization to obstetric appalling 7.5 out of every 1,000 births,” Charbonneau capabilities, personnel, equipment and medications. Source: 2015 Revised Indiana Perinatal Hospital Standards says, adding the state’s response “has to be a multi- A 2012 paper from the American Academy of faceted approach. It can’t be just one thing, but this Pediatricians shows that states with levels-of-care other facilities to identify gaps between their then- one thing will help.” programs have lower infant mortality rates, lower levels of service and the levels to which they aspired Elsewhere in the Midwest, according to Jamila health care costs and better outcomes. once SB 360 became law. That survey was completed Vernon, media relations manager for the American Preparation of a ratings system began several years in June 2017; the department is now drafting rules to College of Obstetrics and Gynecological Care, Illinois ago in anticipation of SB 360’s passage, says Martha implement SB 360 and hopes to post them for public is rewriting its rules to reflect the AAP’s 2012 neonatal Allen, director of the department’s Maternal & Child comment in the next few months, Allen says. guidelines, while Iowa just rewrote its rules to include Health Division. In June 2015, Indiana adopted All facilities should be rated by the end of 2019; levels of maternity care. revised standards for perinatal hospitals (based on ratings will be posted in the facilities and online, and Kansas, Michigan, Minnesota, Nebraska, North guidelines from both the AAP and American College will be promoted through news media, she adds. Dakota, Ohio, South Dakota and Wisconsin either of Obstetricians and Gynecologists). “The goal is that families can go online and don’t have levels-of-care laws at all or only focus on The department then surveyed 89 hospitals and determine, based on their location and circumstances, neonatal levels of care, Vernon says.
Brief written by Jon Davis, CSG Midwest staff liaison to the Midwestern Legislative Conference Health and Human Services Committee. He can be reached at [email protected]. The committee’s co-chairs are Illinois Rep. Robyn Gabel and Kansas Rep. Susan Concannon; its vice chair is Nebraska Sen. John McCollister.
2 STATELINE MIDWEST SEPTEMBER 2018 Agriculture & Natural Resources
to have them involved again in insuring farmers,” Miller To increase farmers’ insurance % of state’s counties with only one options, two Midwest states try says. (Medical cooperatives, established through the Farm Security Administration, once covered hundreds insurer participating in A ordable ‘coop,’ ‘association’ models of thousands of U.S. farmers into the 1940s.) Care marketplaces, 2018 esidents living in more than half of the Still, several regulatory hurdles had stood in the nation’s counties have only one insurer to way of Minnesota’s law, as had concerns about the 90.6% choose from on their state’s Affordable Care potentially adverse impact on the state’s individual R 5.7% Act health insurance exchange. insurance marketplace. These cooperatives can “cherry 0% 15.3% This lack of options is most prevalent in rural pick” healthy consumers, opponents argue, leaving 18.1% areas: 41 percent of enrollees in non-metro counties sicker individuals on the exchange with higher costs. 100% 100% vs. the overall rate of 21 percent, according to the But in 2016, as enrollment in the ACA approached, 47.7% Kaiser Family Foundation. seven Minnesota counties had no insurance option. 12.7% 60.9% Could the creation of agricultural cooperative This gave momentum to the cooperative idea. 0% health plans help fill insurance gaps, offer more The Minnesota cooperatives now in place meet
choices for consumers and lower costs? all of the ACA’s insurance requirements, and are Source: Kaiser Family Foundation and CSG Midwest calculations Minnesota lawmakers hope so, and their passage self-insured and owned by members. of SF 1 in 2017 marked the start of that state’s policy Iowa, meanwhile, has embarked on a new strategy this year, with opponents of SF 2349 saying it was a experiment with this type of health insurance option. of its own to address concerns about high insurance path to “substandard coverage that will divide the “Farmers can join together in self-insured plans costs and limited or no consumer options. healthy from the sick.” like those used by large employers,” explains Rep. SF 2349, signed into law earlier this year, allows But Sen. Dan Zumbach, the bill’s floor manager, Tim Miller, who helped guide the legislation through for association health plans, particularly via a partner- believes the recent changes will give individuals more the House. By the start of this year, two agriculture ship between the Iowa Farm Bureau Federation and affordable options when choosing health insurance: cooperatives, 40 Square and Land O’ Lakes, had jumped Wellmark Blue Cross Blue Shield. The idea is for “[It’s] about getting people on a plan where they have into the market and enrolled more than 1,700 people. a “nonprofit agricultural organization” (the Farm some coverage to take care of health care.” The 2017 Minnesota law defines “agricultural Bureau) to sponsor an affordable health care option, To be eligible for the coverage offered under cooperative health plans” and exempts them from ex- and for another entity (Wellmark) to administer it. SF 2349, Iowans will need to be Iowa Farm Bureau isting statutory language on employer insurance and Under the Iowa law, these newly authorized Federation members; sign-ups were expected to multiple-employer welfare arrangements. These new “association health plans” are not considered official begin in fall 2019. plans are instead regulated by the U.S. Department of insurance plans, and thus not subject to typical state Even before the ACA, people in rural counties Labor; therefore, all enrollees are required to be cor- or ACA rules. As a result, they can offer relatively were less likely to be covered by their employers, and porations with at least one employee. The state statute low premiums for young and healthy consumers, more likely to be on individual insurance policies and requires the corporation to be an agriculture-related but people with pre-existing health problems could paying a higher price for insurance. Rural health care business — any type of agriculture corporation, such be charged more or denied coverage. markets are difficult for insurers because of a mix of as a farm registered as an LLC, is eligible. Iowa’s law is an example of how some states are factors — a smaller and older customer base, plus a “Minnesota is the land of 10,000 cooperatives; trying to do “end runs around the Affordable Care dearth of health care providers that makes it difficult they play a big role in rural Minnesota; so it is natural Act,” The Washington Post noted in an article earlier to negotiate payment rates.
Brief written by Carolyn Orr, staff liaison to the Midwestern Legislative Conference Agriculture & Natural Resources Committee. She can be reached at [email protected]. The committee’s co-chairs are Iowa Sen. Kevin Kinney and Minnesota Rep. Paul Anderson; its vice chair is Illinois Rep. Norine Hammond.
Criminal Justice & Public Safety
But Wisconsin’s new vision for juvenile justice Wisconsin restructures juvenile took a significant investment from the Legislature. justice system, with infrastructure For example, the existing facility in northern investments paving the way Wisconsin will be replaced with a smaller one for ig changes are coming to Wisconsin’s juvenile juveniles who have committed the most-serious justice system in the years ahead, with a $80 offenses. The Legislature authorized $25 million in 00 Bmillion infrastructure investment that will shift borrowing to build this facility. Another $15 million 00 509 371