The Healthcare Federalist

Top Health Trends for State Health Policymakers to Watch in 2023

Part One: Broad Workforce, Economic, and Health Policy Shifts
By Courtney Burke

This three-part blog series outlines 10 important health policy issues from 2022 that are worth monitoring in 2023. As the blogs are published they will be added here.

Part One: Broad Workforce, Economic, and Health Policy Shifts

Part Two: Internal Industry Economic Trends

Part Three: Service Delivery, Quality, and Equity Trends

The transition to a new year is a good time to reflect on what happened over the last 12 months and anticipate what it may mean for the upcoming year. For those in state healthcare policy, this three-part blog outlines 10 important issues from 2022 that are worth monitoring in 2023.

The 10 issues are broken into those occurring at a macrolevel, such as the federal Public Health Emergency, workforce shortages, and pressures from rising prices. The second set of trends include those internal to the industry with a focus on economic and market forces in health. The third blog focuses on service delivery, quality, and equity trends.

First up, broad workforce, economic, and health policy shifts:

  1. Declaration of a Public Health Emergency (PHE)

    Although a PHE in and of itself is not a “trend,” the way the most recent PHE, which was implemented in order to combat the spread and impact of COVID-19, changed the trajectory of healthcare coverage, access, and delivery could be considered “trend altering.” For example, the PHE dramatically expanded coverage. It also allowed new ways of care provision, such as delivering care in people’s homes rather than a hospital, and allowing for more widespread use of telehealth to prescribe needed medications to patients who would normally be required to get those prescriptions in person.

    What states should watch in 2023. The federal public health emergency is set to expire on January 11, 2023. Although it is not yet known if the federal government will renew the PHE in January, several states may decide to make permanent state-level policies that increase regulatory flexibility. The choices of states to continue or end these policies that have “altered trend trajectories” in areas such as coverage, care delivery, or oversight will be worth watching in 2023.

  2. Healthcare workforce shortages

    There is a national shortage of healthcare workers. All provider sectors of health, including acute care, long-term care, and home care, experienced these shortages. Geographically, almost all states experienced this trend. Looking ahead, a 2021 report from Mercer indicates that, “New York and California will have the largest labor shortages of (the healthcare) workforce, each projected to fall short by over 500,000 workers by 2026. Only a few states in the country are projected to have surplus labor in low-wage healthcare workers, including Washington, Georgia, and South Carolina.”

    What states should watch in 2023. As documented by the National Conference of State Legislatures, states have approached workforce challenges in a variety of ways, such as working with K-12 and higher education institutions to expand the pipeline of people working in the health field, providing flexibility in scope of practice, building provider resiliency, creating financial incentives for recruiting and retaining staff, or making it easier for staff to work across state lines with different licensure requirements. In 2023, policymakers will need to be aware of which states, sectors of healthcare, and job titles are seeing the most challenges. It will be important for state policymakers to be ready to implement additional strategies to alleviate workforce shortages. The ability to track these employment trends in real time also will be critical to developing policies to address these shortages.

  3. Price inflation

    Nearly all sectors of the economy experienced price inflation in 2022. Cost increases are particularly important to watch in the health sector as revenue has generally not kept pace with costs (as noted above). The trend of price inflation may be of particular concern to state health policymakers because it can impact the ability of people to afford insurance coverage or pay for care.

    What states should watch in 2023. The rate at which prices for healthcare delivery, supplies, or insurance increase in 2023 will be important because it will impact not only the financial sustainability of many providers but it may also impact affordability and access to healthcare by consumers. If the costs for certain supplies in healthcare continue to increase at accelerated rates, states may look for ways to counteract those cost increases whether through cost containment or by providing supports to people who need care that may have become unaffordable.

The three trends outlined in this blog are all worth keeping an eye on in 2023. The degree to which the trends continue may have significant implications for state health policymakers. But these aren’t the only trends to keep an eye on. The second blog in this three-part series will review developments related to internal issues in the healthcare industry.


Courtney Burke is senior fellow for health policy at the Rockefeller Institute of Government