Likely Public Health Legislative Trends for 2025 Prospective Public Health Legislative Trends for 2025 Maggie Davis Get an inside look at prospective public health legislative trends for 2025, based on ASTHO's legislative tracking efforts and member feedback. Drawing from member feedback and ASTHO’s legislative tracking efforts, ASTHO identified five key issues state and island legislatures are likely to work on for the upcoming legislative sessions for the annual 2025 Legislative Prospectus Series. Each brief provides public health leaders and policymakers with a synopsis of the topics, recent legislative trends, and anticipated legislation in upcoming sessions. Public Health and Health Care Workforce States are continuing to address workforce shortages within public health and the health care systems. ASTHO’s prospectus outlines strategies that legislatures are considering, from bolstering state public health funding to legislative efforts addressing nationwide workforce shortages through recruitment incentives, workforce commissions, and pipeline programs. Containing Spread of Infectious Disease State and territorial public health agencies are responsible for protecting the health and safety of their residents and have legal authorities to fulfill those responsibilities. In recent years, many legislatures have revisited the scope of these legal authorities, with states like Washington (SB 6095) expanding the health official’s authority to issue standing orders for a range of disease interventions. Similarly, legislatures may continue considering vaccine-related legislation. While many bills in recent years aim to weaken vaccine policy, state leaders have listened to medical leaders within their state who advocate for strong vaccine policies. In 2024, West Virginia’s governor vetoed HB 5105 that would have weakened school enrollment requirements, informed by strong opposition from the state’s medical community and evidence that the existing vaccine policy had prevented disease outbreaks. Data Modernization and Privacy Modernizing public health and health care data systems have taken big steps forward, including federal initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA), which establishes guiding interoperability principles and standards for health data exchange. Nevada enacted AB 7 in 2023 requiring new regulations governing health information exchanges (HIEs) and granting certain liability protections to providers using them. In the proposed rules published in August 2024, the Nevada Department of Health and Human Services intends to require that participating HIEs are TEFCA members. ASTHO anticipates more jurisdictions will allow public health agencies access to a wider range of privacy-protected health data through secure platforms like HIEs. Maternal and Child Health Public health supports mothers and children throughout their development. There are three emerging issues that legislatures are likely to work on in the next year: maternal morbidity and mortality, fetal and infant mortality, and youth mental health. One strategy to address youth mental health is using laws to regulate social media companies, requiring them to implement safeguards for minors who use their services. For example, California enacted SB 976 in 2024, which requires “addictive internet-based” services to gain parental consent before minors could use the service and limit the hours in which minors could use an application. Technology industry groups are challenging these efforts in court, with one suit asserting that California’s measure is unlawful governmental interference with First Amendment rights of minors. Substance Misuse and Overdose Prevention Although there was a significant decrease in overdose deaths in 2023, there are still legislative actions to help reduce substance misuse and prevent overdose likely to be considered in 2025. During the 2024 sessions at least 24 state legislatures considered bills to regulate products like kratom and hemp derived products (e.g., Delta-8). Additionally, at least 18 legislatures considered bills to decriminalize drug checking equipment like fentanyl and xylazine testing streps. ASTHO anticipates states legislators will continue implementing harm reduction efforts, policies to connect people with substance use disorders to care, and efforts to regulate products with potential for abuse or misuse in the next session. What We Know So Far The majority of states will convene their legislative sessions in January 2025, with at least 15 states scheduled to conclude their session by the end of April; there will likely be a flurry of legislative activity in the first quarter of the year. Already the Texas legislature has prefiled more than 1,200 bills for their 2025 session, covering topics including a health commissioner’s authority to establish routine childhood immunization requirements (HB 468) and making changes to the state’s maternal mortality and morbidity review committee reporting requirements (HB 713). Additionally, Virginia’s General Assembly convened its two year session in January 2024 and has a number of bills carrying forward into 2025 including bills related to suicide prevention (HB 80) and improving maternal health data quality (HB 286). ASTHO will monitor legislation related to these topics and more during the 2025 sessions and will provide relevant updates. OE22-2203 PHIG article yes