Advocacy report: State of the states

August 2019 – Vol. 38, No. 7

Following the historic 2018 elections, this year’s state legislative climate promised to be eventful. With a record number of bills introduced, it has proven to be exactly that. Here is a snapshot of the state legislative activity during the first half of 2019:

  • All 50 states were in session.
  • Midterm elections created more diversity; women now hold a record 2,112 seats. There is also a historic consolidation of party control among state legislative chambers (Republicans control 31 legislatures, Democrats control 18, and only Minnesota is split).
  • By the end of the year, approximately 166,770 measures will have been introduced nationwide.
  • To date, the AAO-HNS is tracking 2,110 bills in 14 key issue areas.

Successful advocacy

The AAO-HNS Advocacy Team and our State Trackers actively review legislation in 14 distinct categories. The issue of hearing services has been predominant, with an influx of bills requiring health insurance coverage for hearing aids.

Much of the legislation covers only the services of audiologists for hearing assessments and hearing aids. Otolaryngologists are not being included in these bills, and in some measures, the legislation would grant audiologists inappropriate scope expansions. We are working to educate the sponsors of these bills about the serious medical ramifications of omitting otolaryngologists. Access to a physician medical specialist and an appropriate medical diagnosis are essential for patient care and effective programs.

The Academy, in conjunction with the State Trackers, the leadership of the state otolaryngology societies, and the state medical associations, has advocated for amendments to include physician specialists in these bills. These joint advocacy efforts have been successful in Nebraska with the enactment of the Children of NE Hearing Aid Act (LB15), which was amended to include otolaryngologists for diagnosis and medical clearance, and in Missouri (SB 101), where physicians were added to the bill as providers for patient assessments and distribution of hearing aids in a new statewide hearing program. In Florida, a similar bill for hearing aid coverage was halted to be appropriately rewritten and reintroduced next year. In South Carolina, HB 3284 will carry over to the 2020 legislative session, and advocacy efforts to amend the bill are already underway. A recently introduced hearing aid bill in Ohio, HB 243, is being considered for advocacy action.

On another priority front, AAO-HNS member advocates passed HB 2026, a bill requiring the Virginia Board of Health to screen for CMV in newborns that fail the initial hearing screening tests. New CMV bills have recently been introduced in Michigan and Pennsylvania.

Other legislative priorities

Information on other measures can be found in the State-mENT newsletter ( and on ENTConnect under the State Trackers community. Information on all 2,110 tracked bills can be found on our interactive map on the Academy website at

Advocacy continues

Twenty-five states carry over legislation from 2019 to 2020. As a result, advocates in some states could see legislation that stalled in 2019 come back to life again. In these states, now is the time to initiate meetings with bill sponsors and have those frank discussions. In states that start anew in 2020, be on the lookout for prefiled legislation. Working together, we can succeed!