Steven C. Anderson, IOM, CAE
NACDS President and Chief Executive Officer

Recently, NACDS provided a summary of the 2014 mid-term elections, with an emphasis on the federal level. As promised, this memo includes an overview of the state elections, which will shape the operating environment on pivotal state issues.

2014 State Legislature Elections: Increase in Republican Control and Divided Control of State Governments
Many individuals characterized the results of the 2014 mid-term elections as a Republican wave – and if that term is appropriate for the federal elections it also pertains to results at the state level. It also is worth noting that the last two midterm elections have reflected the historical trend that the party not in control of the White House made gains in the state legislatures and in the U.S. Congress.

This year’s midterm elections have resulted in significant Republican gains in state legislatures, with three state legislatures moving to Republican control. Due to this shift, Republicans now control 30 state legislatures, Democrats control 11, eight legislatures are divided, and Nebraska is unicameral.

The elections also produced an increase in the number of states in which one party does not have control of the entire state government.

2014 Governors’ Races: Republicans Boost Margin
Republicans will hold at least 31 of the country’s 50 governorships next year, including gubernatorial offices previously held by Democrats in Arkansas, Illinois, Maryland and Massachusetts. In Alaska, Independent challenger Bill Walker defeated incumbent Republican Governor Sean Parnell. The governors’ race in Vermont remains undecided. In Vermont, the election will go to the state legislature for it to decide in January because no candidate was backed by a majority of the voters.

State Leadership: Organizing in the Aftermath
With 11 new governors to date, control of three state legislatures shifting to the Republicans, and a total of 19 state governments under divided control, efforts in the states turn toward the build-up of gubernatorial transition teams and action to determine chamber leadership positions and committee chairs.

Although some states are making progress in the interim, many states with changes in party control will have a slower start in the New Year as they inaugurate new governors, and as legislators work to organize new chamber and committee leadership. Also of interest are key vacancies in state agencies, such as recent departures of state Medicaid Directors in Iowa, Minnesota, Nebraska and Wisconsin.

Pharmacists Serving in Legislatures
In the recent federal election analysis, NACDS noted that a former Georgia State Senator, pharmacist and pharmacy owner, Earl Leroy “Buddy” Carter (R), won his bid for the U.S. Congress. In other good news, beginning in 2015, 47 pharmacists will serve in 25 state legislatures across the country – including 37 Republicans and 10 Democrats. Georgia and Mississippi have the most pharmacists serving in the state legislatures, with four each. Newly elected pharmacists include Justin Boyd (R) of Arkansas, Jeff Stone (R) of California and Paul Chace (R) of Maine. Incumbent pharmacists, Maryland Delegate Donald B. Elliott (R) and North Carolina Representative Tom Murry (R), lost their bids for re-election. Also unsuccessful were newcomers Brian Caswell (D) of Kansas, Mike Seiber (D) of Kentucky and Tim McMenamin (R) of Oregon. Texas State Senator Leticia Van de Putte (D), a pharmacist, lost her bid for Lieutenant Governor, but will continue to serve in the State Senate.

Individual State Results

Alabama
From Governor Robert Bentley`s (R) decisive victory to other races on the ballot, Republicans defeated challengers with relative ease, and maintained control of every statewide office. Constitutional amendments supported by the Republican-controlled Legislature were approved or appear on their way to ratification. Notably, Governor Bentley stated last week that the state`s General Fund budget will be the biggest problem before lawmakers next year. The state will have a deficit of at least $200 million in the budget when a fiscal lifeline expires. Voters in 2012 approved of taking money from a state trust fund to support the budget, but that bail out expires this year.

Alaska
Governor-elect Bill Walker (I) ran as the Independent challenger and won. With the election of Governor Walker, it is expected that there will be a substantial shift in staff. Specifically, Health and Social Services Commissioner Bill Steuer, who oversees Medicaid, will be leaving. NACDS members operating in Alaska have faced various problems with the current Medicaid program. NACDS’ major issue focus for 2015 will be enhancing the ability of our members to immunize patients.

Arizona

The Governor’s office, the House and the Senate remain under Republican control. NACDS’ major focus during the 2015 legislative session will be immunization policy.

Arkansas
Republicans swept the Governor’s office and all statewide Constitutional offices. The Republican Party now claims supermajorities in both the House and the Senate.

California
Although the Democrats lost their supermajorities in both houses, California remains a Democratic majority state. The Democrats retained large majorities in the House and the Senate, as well as control all of the statewide Constitutional offices. Incumbent Governor Jerry Brown, Jr. (D) was easily re-elected to his fourth term.

Colorado
Governor John Hickenooper (D) was re-elected by a slim margin. Elections were also close in both houses; several races came down to several hundred votes, or less. In the Senate, the Republicans took control for the first time in a decade, now with an 18-17 majority lead. Democrats, although still in control, lost ground in the House, losing 3 seats resulting in a 34-31 majority. Colorado state law requires an automatic recount of all votes for any state races with a .5% margin or less. As such, several of these key races will trigger automatic recounts.

Connecticut
Governor Dannel P. Malloy (D) defeated Republican challenger Tom Foley by a larger margin than he did four years ago. The Senate Democrats lost one seat, but still remain the majority. New leadership is needed in the Senate, as President Pro Tempore Donald E. Williams, Jr. (D) has retired. The new President Pro Tempore will be Martin M. Looney (D) and the Majority Leader will be Bob Duff (D). The House Republicans picked up 10 seats bringing them to 64 seats, their highest membership in the House since 1994. Only 12 moderate Democrats are now needed to join with Republicans to create a majority and defeat liberal measures on the House floor. The additional 10 Republicans also play a huge part in the committee process. Although Democrats will still be in power (87 members), the increased Republican numbers will have an impact, especially when legislators are absent from committee votes. New leadership is also needed in the Republican Caucus. Representative Themis Klarides (R) will be the new minority leader, as Representative Lawrence F. Cafero, Jr. (R) has retired.

Delaware
While the Democrats retain a majority in the Senate, they lost their supermajority. In the House, the Democrats retain control; however, the Republicans were able to pick up two seats.

Florida
Incumbent Governor Rick Scott (R) defeated Charlie Crist (D) by a very narrow margin, 48.2% to 47%. The Senate maintained all of its members, meaning that Republicans have maintained control with Senator Andy Gardiner (R) as the incoming President. In the House, Republicans picked up six seats creating a supermajority. The House will be led by incoming Speaker Steve Crisafulli (R). Speaker Crisafulli, on potential Medicaid expansion in Florida, has stated, “

[w]e’ll wait and see what the federal government does, but we believe we stand firm with where we are right now, and that’s without expansion.”

Georgia
Incumbent Governor Nathan Deal (R) defeated State Senator Jason Carter (D), the 39-year-old grandson of former U.S. President Jimmy Carter, after extensive campaigning. Both the House and the Senate remain under Republican control. Governor Deal’s focus will remain on Georgia’s public education system and bringing more jobs to the state. Georgia currently has some of the highest unemployment rates throughout the country. Monday, November 17, 2014 marked the unofficial start of Georgia’s 2015 legislative session, as pre-filing of bills begins.

Hawaii
Democrats maintained control throughout the state with the incoming Governor-elect David Ige (D), as well as an overwhelming majority in both the House and the Senate.

Idaho
Republicans maintained statewide control with the re-election of incumbent Governor Butch Otter (R), the Senate with a 28-7 majority and the House with a 56-14 majority. NACDS’ greatest legislative concern in 2015 will be working toward the Legislature’s confirmation of the adoption of the Board of Pharmacy rules regarding biosimilars, as both the manufacturers and payers are lobbying against it.

Illinois
For the first time in 14 years, a member of the Republican Party, Bruce Rauner (R), won the Governor’s seat. Although it has been newsworthy, as Illinois is President Obama’s home state, meaningful power remains with the Democratic legislative leaders. Democrats maintained control of the Senate, led by Senate President John Cullerton (D), and continue to enjoy a veto-proof supermajority in the House of Representatives led by Speaker Michael Madigan (D). Senate President Cullerton has already begun to test Governor-elect Bruce Rauner (R) by stating his chamber will let the temporary state income tax increase sunset. Cullerton’s maneuver will put the new Governor in a position of needing to ask for a tax increase in his 2015 budget address or to propose budget cuts accordingly. In a budget cutting scenario, Medicaid is a likely source for reductions and, as such, pharmacy reimbursement could be at risk.

Indiana
The Republicans swept the state elections. All three statewide offices on the ballot – Secretary of State, Auditor, and Treasurer – were retained by Republicans and the Legislature remains in solid Republican control. In the state Senate, the GOP added three seats to their majority and will control the upper chamber, 40-10, when the 2015 legislative session begins in January. Republicans in the House of Representatives saw a net gain of two seats and now have a quorum-proof 71-29 supermajority. The Republican margin the House is the largest in 40 years and the margin in the Senate is the biggest in at least 60 years. Both of the state’s pharmacist legislators, Senator Ron Grooms (R) and Representative Steve Davisson (R), won re-election.

Iowa
The chambers remain the same, with a slim Democratic majority in the Senate and a strong Republican majority in the House. Having lost in the Governor’s election to incumbent Governor Terry Branstad (R), Senator Jack Hatch (D) will no longer hold a Senate seat and therefore step down as Chairman of the Senate Health and Human Service Appropriations Subcommittee, a key group of lawmakers for pharmacy issues. Chain pharmacy has enjoyed an effective working relationship with Senator Hatch, so that is a potential loss. With Governor Branstad’s re-election, we may see a new Medicaid Director appointed sooner than if a challenger had won. Meanwhile, pharmacist John Forbes (R) was re-elected to a second term in the House.

Kansas
After one of the more controversial election seasons for Kansas, the political landscape appears to remain relatively unchanged. Governor Sam Brownback (R) barely won re-election, the Senate remains with a Republican Majority at 32-8, and the House Republicans increased their majority to 98-27. Two pharmacists will continue to serve in the Legislature, Representative Don Hill (R) and Senator Vicki Schmidt (R). Along with KACDS , the main focus of NACDS’ 2015 effort will be to get e-prescribing adopted and work on legislation on medication synchronization, biosimilars, and patient identification.

Kentucky
Kentucky is divided, as the State Senate remains in Republican control and State House Democrats retained the majority. Republicans increased their numbers in the Senate to 26, leaving them with a 26-12 majority. The elections resulted in a status quo in the State House, 54 Democrats to 46 Republicans. The Governor’s seat will be open for election in 2015, as current Governor Steve Beshear (D) will reach his term limit.

Louisiana
While no state elections were held, a key runoff election will happen December 6th for the Senate seat currently held by Mary Landrieu.

Maine
In a surprise for some, Governor Paul R. LePage (R) was re-elected. In the Legislature, the House gained a pharmacist with newly elected Representative Paul Chace (R). While Republicans gained 10 seats in the House, the Democrats retained their majority. Republicans have a narrow majority in the Senate. The divide in the Legislature and the re-election of Governor LePage should prove beneficial towards pro-patient advocacy efforts.

Maryland
Republican gubernatorial candidate Larry Hogan beat Democratic Lt. Governor Anthony Brown and will become only the second Republican to govern Maryland in 40 years. State Senator Brian Frosh (D) was elected Attorney General. Capitalizing on a Republican surge nationally, Maryland Republicans picked up nine seats in the General Assembly – two seats in the Senate and seven seats in the House. The net gain of seven seats in the House will allow the Republicans a veto-proof majority.

Massachusetts
Post-election, the breakdown in the Senate is 34 Democrats and six Republicans. Republicans picked up the open seat of retiring Senate President Therese Murray (D) and defeated Senator Richard T. Moore (D), the Senate Pro Tempore and recognized expert on healthcare. The Senate will also have a new leadership team in January as Senator Stanley C. Rosenberg (D) becomes the new President. In the House, the Democrats control 126 seats and the Republicans 34, which is a gain of five for the Republicans. Speaker Robert DeLeo (D) will be entering his last two-year term as Speaker. He lost a great deal of his team through retirements last year, forcing a revamp, including the need for a new chair of the Committee on Health Care Financing. Both chambers still maintained supermajorities that allow them to override the Governor`s vetoes. Governor-elect Charles Duane “Charlie” Baker, Jr. (R) is a former Secretary of Administration and Finance and Secretary of Health and Human Services. It is anticipated that he will seek to reform government operations. His expertise is healthcare, as he spent ten years as CEO of Harvard Pilgrim Health Care.

Michigan
Republicans retained control over both chambers, but community pharmacy lost some stalwart supporters in the legislature. Senate Appropriations Chairman Dr. Roger Kahn, M.D. (R), a graduate of the Michigan Pharmacists Association’s “candidate school” and a strong supporter of pharmacy, was term-limited. Senator Bruce Caswell (R), who sponsored a successful MAC pricing bill in 2014, did not seek re-election. In the Executive Branch, the continuity of Governor Rick Snyder’s (R) re-election may prove helpful on collaborative practice agreement issues, including those related to point-of-care testing. Governor Snyder’s “blueprint” for reforming Michigan’s healthcare system has been useful in highlighting the important role of pharmacies and pharmacists in modern benefit designs. In addition, one of Governor Snyder’s earliest agenda items was to streamline regulation, which was helpful as NACDS navigated the technician regulation issue (SB 92).

Minnesota
The Republicans gained control of the House in the most recent elections, while the Senate and Governorship remain Democratic, resulting in a divided Legislature. Community pharmacy lost an ally with the exit of Representative Jim Abeler (R). During an unsuccessful Republican primary bid for the U.S. Senate, Abeler chose not to seek re-election to the state Legislature. With the re-election of Governor Mark Dayton (DFL), a new Medicaid Director may be appointed soon.

Mississippi
No state elections were held.

Missouri
Republicans now have a veto-proof majority in both chambers. Republican candidate Travis Fitzwater (R) won the Missouri House 49th District seat with about 62% of the vote. He is the son of Missouri Pharmacy Association Chief Executive Officer Ron Fitzwater, and he himself is the Chief Operating Officer. NACDS member and pharmacist Lynn Morris (R), owner of Family Pharmacy, and Dr. Keith Frederick (R), a pharmacist, were easily re-elected to their House seats. Meanwhile, Senator David Sater (R), a pharmacist, remains in office. In the Senate, Rob Schaaf (R) was easily re-elected, and he is an opponent of pharmacy’s efforts to advance prescription monitoring program (PMP) legislation. Beyond the Republican supermajorities, Governor Jay Nixon (D) will be negatively impacted by Amendment 10 to the Missouri Constitution, which was approved by voters on November 4. Among its provisions, the Legislature may now override gubernatorial withholding of line items in the state budget. Governor Nixon has used this prerogative liberally. Community pharmacy can expect a more rancorous budget process moving forward. Although Governor Nixon continues to advocate for Medicaid expansion, his chance for success is slim.

Montana
The Legislature will remain in Republican control with the House holding a 59-41 majority, and the Senate with a 29-21 majority; one Senate seat has yet to be claimed in Missoula due to a recount. Democrat Governor Steve Bullock stated he looks forward to working with elected officials and his agenda will include Medicaid Expansion, Pre-K Education and various other priorities outlined in his budget. The Legislative leadership was chosen November 14th— the President of the State Senate is rancher Debby Barrett ( R ) of Dillon and the Speaker of the House is attorney Austin Knudsen (R) of Culbertson. Pharmacy issues on the 2015 agenda include e-prescribing for all controlled substances and immunization expansion.

Nebraska
One of Governor-elect Pete Ricketts’s (R) top two priorities is to address cost and inefficiency in the state’s Department of Health and Human Services. Perhaps due to having an outgoing Governor, the state has operated without a Medicaid Director for many months. The appointment of a new Medicaid Director may bring clarity to important issues for community pharmacy, including addressing the AMP-based FULs and carving-in the pharmacy benefit to managed care. In the unicameral Legislature, it is notable that Senator Steve Lathrop (D), sponsor of the problematic prescription monitoring program (PMP) bill last year that ultimately resolved favorably for community pharmacy, was termed out.

Nevada
For the first time since 1929, Republicans control both the House and the Senate, in addition to the Governor’s seat. Governor Brian Sandoval led (R) captured more than 70% of the votes