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Health care is top of mind for Pennsylvania leaders and lawmakers this year as the state legislature begins hammering out a new budget and considers a slew of new bills and policies.

In his annual budget address Tuesday, Gov. Josh Shapiro urged legislators to tackle workforce shortages, distressed hospitals and for-profit private equity health care operations.

Meanwhile, Republicans say they’re focusing on bringing down spending and costs of programs like Medicaid, an insurance program for people with low incomes.

Here are some of the top health care legislative priorities getting attention early this year.

Affordable Care Act protections

The Affordable Care Act, passed into law by Congress in 2010, guarantees essential health benefits like free annual exams and insurance coverage for blood tests and prescriptions, mental health and addiction treatment, emergency care and more.

The federal law also bans the practice of insurers denying coverage because of pre-existing conditions, allows children to stay on their parents’ plans until the age of 26, and offers insurance options to individuals and small businesses.

During his first presidential term, Donald Trump attempted to repeal the ACA, but failed in the legislature. In his second term, he has pledged to make changes to the program and how it is funded, with no specific details yet on those plans.

In his budget address, Shapiro said that Pennsylvania should adopt ACA protections into state law. About 1.2 million people in the state get health care through ACA plans, officials said.

“If we fail to do so and the ACA goes away, health care costs will dramatically increase for Pennsylvanians,” he said.

Pennsylvania Senate and House Democrats are spearheading a series of bills that would adopt ACA protections into state law, with early support from some House Republicans. Bills have been referred to respective banking and insurance committees.