This report examines the basic expenses Ohio families face, to better understand why so many Ohioans cannot afford to purchase insurance or pay their growing portion of costs for premiums, co-pays, costsharing, deductibles and prescriptions.

For undocumented immigrants, the explicit denial of coverage under the Affordable Care Act (ACA) has kept many without access to preventive services and basic health care. Although ACA enrollment in California has far outpaced any other state, over one million undocumented immigrants still lack access to quality, affordable health coverage. The inability to access health coverage has severely marginalized the undocumented community. For example, undocumented immigrants play a pivotal role in providing food for all Californians, since over half of farm workers are undocumented; however, they themselves are banned from partaking in the health care system despite serving as the backbone of our supermarkets and grocery stores. Moreover, undocumented immigrants have been found to contribute more in taxes than the federal government spends to provide services for them. Yet, despite their undeniably positive impact, barriers to coverage have limited the chances for undocumented immigrants to maintain their health. For members of the undocumented community who manage to stay healthy, including those we interviewed for this project, many attribute their well-being to luck and good fortune.

Polling conducted in advance of the 2018 legislative session in key battleground states showed broad support among likely voters for policies that provide working families with economic security. In particular, the polling found high levels of support for expanded healthcare coverage and paid family and medical leave policies, investment in K-12 education and teacher salaries, expanded funding to make child care more affordable, and expanded overtime pay to cover more workers. This provides a strong contrast to the agenda pursued by the Trump administration and the Republican-controlled Congress.

Health care is a top concern for many American families - and for good reason. Health care spending in the United States accounts for 17.9 percent of the nation's GDP, and medical bills are the number one reason for American bankruptcies. Prescription drug prices are a huge factor in those costs - in recent years, pharmaceutical companies and pharmacy benefi managers (PBMs) have rapidly increased prices. Additionally, new drugs have reached the market with price tags that easily exceed most Americans' annual income. Americans spent approximately $323 billion on prescription medicines in 2016, with some estimates of spending reaching over $400 billion by 2021. Fortunately, there are many policy options for states to address prescription drug prices.

The power of local governments to pass laws that protect the health, safety and welfare of their citizens is waning and under increasing attack. Over the past four years, a historic number of local interference (preemption) bills have been filed and passed in state capitals across the country. Over time, these bills, crafted to strip local governments of their power to act on everything from fracking bans to anti-discrimination measures, have become wider in scope and more hostile to home rule. More industries and special interest groups now consider preemption a legislative imperative, including the oil and gas industry and groups opposing LGBTQ rights.

The opioid crisis is ravaging communities across the nation and tearing families apart. The crisis has reached epidemic proportions with an estimated 2.6 million experiencing opioid drug abuse. The epidemic has had a detrimental impact in all parts of the country, claiming tens of thousands of victims each year and costing our nation billions of dollars in social, legal, and health care costs. In 1991, doctors wrote 76 million opioid prescriptions. By 2011, that number had nearly tripled to 219 million. Despite a modest drop in the number of opioid prescriptions since 2012, the number of deaths associated with abuse and overdose continues to rise; the mortality rate has quintupled since 1999, and opioid overdoses resulted in over 42,000 deaths in 2016.

More than 40 million Americans still do not have access to paid sick time, and these numbers are concentrated among the lowest-wage workers - 80 percent of whom lack access. The health impacts on employees and on the workplace can be jarring; those without paid sick days are 1.5 times more likely to report to work sick than those with paid sick days. During the H1N1 outbreak of 2009, for instance, eight million Americans reported to work ill - infecting as many as seven million of their co-workers. Meanwhile, allowing employees to stay at home with even one paid "flu day" would allow them to recover and could reduce flu transmission by an estimated 25 percent.

The Family and Medical Leave Act of 1993 (FMLA) was a momentous piece of federal legislation that secured the right of working Americans to take up to 12 unpaid weeks off of work for the birth of their child, to care for their newborn, to care for a loved one with a serious illness, or to respond to their own serious illness. Its passage represented a consensus that hardworking individuals should not lose their jobs if they become seriously ill and new mothers should be given time to recover from pregnancy and bond with their new child. However, over 20 years later, our country has fallen behind the rest of the world in paid leave protections. Workers are still not guaranteed any wage replacement while on medical leave and more than 40% of Americans do not qualify for leave under the FMLA at all. The United States remains the only advanced nation in the world that does not guarantee paid maternity leave for new mothers.

The report evaluating census data finds that LA County has some of the highest rates of income inequality and residents without health insurance.

Coordinated messaging from industry lobbyists and state legislators who support preemption is similar or identical across issues and states. This document lays out a number of predictable pro-preemption statements or messages, followed by accurate messages you can use to refute them, or to counter them in advance.