This brief focuses on how telehealth expansion during the COVID-19 pandemic has increased access to care for pregnant and postpartum women, and made maternal and child health care services like doulas and midwives more accessible.
During the early months of the COVID-19 pandemic, the federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act, temporarily expanding the use of telehealth technologies by removing various requirements and waiving certain restrictions. Many states also expanded telehealth access through changes to state Medicaid laws. These temporary policy changes created an uptick of telehealth use that improved access to care for millions of Americans—but questions remain about which policy changes will stick around beyond the pandemic. Currently, states are making decisions about what temporary policies to permanently implement and which policies to end without disrupting the delivery of care and further exacerbating health disparities.
Anticipating a rapid deployment of COVID-19 vaccines as they are authorized, the CDC developed COVID-19 Vaccination Program Operational Guidance in collaboration with state and local jurisdictions to outline how each jurisdiction will make an authorized vaccine widely available. In addition to the operational plans, there is a legal framework of federal and state laws supporting the distribution and administration of the FDA-authorized vaccines.
The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.
Learn how state and territorial legislatures can bolster or restrict public health legal authority, with examples from early COVID-19 as well as 2024.
ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.
Policy Trends Shaping Healthy Food and Chronic Disease in 2026 Policy Trends Shaping Healthy Food & Chronic Disease in 2026 Learn about policy trends shaping healthy food and chronic disease in 2026, such as regulating ingredients and modifying SNAP. A growing focus on links between nutrition and public health outcomes is driving legislative efforts across the country, with states actively responding to rising rates and the cost of chronic disease. As state legislatures consider ways to combat chronic diseases, they are also implementing policies aimed at addressing the food environment by introducing and enacting bills that regulate ultra-processed foods (UPFs), adjust SNAP benefits, and improve access to healthy food. Regulating Food Ingredients and Ultra-Processed Foods While efforts to define and regulate UPFs are still in development at the federal level, several states have decided to move forward with legislation targeting the use of specific artificial dyes and chemical preservatives in food products. West Virginia enacted HB 2354, prohibiting the sale or manufacturing of any food containing a list of specified dyes and certain preservatives. Similarly, Vermont is considering H 260, and New York is considering companion bills S 1239/A 1556. These bills aim to ban the manufacture, sale, or distribution of food containing a core group of chemicals (e.g., potassium bromate, propylparaben, and Red 3). Meanwhile, North Carolina introduced HB 440, which would prohibit additional color additives and ban the sale of food products containing nine specific dyes and chemicals. Pennsylvania introduced HB 1134, which focused on warning labels and would require foods with dyes Blue 1, Blue 2, Green 3, Red 40, Yellow 5, or Yellow 6 to include a label that states, “This product contains synthetic colors, which may have an adverse effect on activity and attention in children.” Leg Prospectus-2026 - CD - CA Restricting Ingredients in School Meals While previous years have focused on access to school meals, a growing wave of recent state legislation aims to eliminate UPFs, synthetic dyes, and chemical preservatives from children's diets. Several states have enacted or advanced bans on specific chemical additives in school meals: Utah’s HB 402 and Virginia’s HB 1910 prohibit schools from offering food containing common food dyes (Blue 1, Blue 2, Green 3, Red 3, Red 40, Yellow 5, and Yellow 6) or certain preservatives like potassium bromate and propylparaben. Similarly, Texas enacted SB 314 prohibiting specific additives in free or reduced-price school meals and SB 25, which mandates warning labels and expands state nutrition curriculum. In addition, other jurisdictions have introduced but not passed numerous bills proposing similar restrictions including South Carolina's HB 4339, which would prohibit certain additives in school meals. Modifying SNAP SNAP is the nation's largest federal food assistance program, providing benefits to low-income households. While the program is federally funded and administered by USDA through its Food and Nutrition Service, individual state agencies operate and manage eligibility and distribution. Since SNAP is governed by federal law, states must obtain a USDA waiver to implement changes that deviate from the federal rules. Several states are exploring waivers to limit the use of SNAP funds for purchasing candy and sweetened beverages or soft drinks, with Arkansas (SB 217), Idaho (HB 109), and Texas (SB 379) having passed legislation. Arkansas's new law requires the Department of Human Services to request a waiver to exclude candy and soft drinks, and reapply annually if denied. This dual ban was also the subject of bills introduced in Wyoming (HB 323) and South Carolina (HB 4061). Indiana (HB 1486) considered broader restrictions on “accessory foods,” aiming to prohibit the use of SNAP benefits for items like chips, energy drinks, sweetened beverages, soft drinks, and prepared desserts while New Jersey (A 5697/S 4348) introduced a narrower set of proposed restrictions, focused on soft drinks (including soda and sugary/sweetened beverages). Expanding Detection and Coverage for Chronic Diseases In response to high chronic disease rates — including diabetes, cardiovascular disease, cancer, and respiratory illnesses — states are enacting and proposing legislation focused on treatment coverage, awareness, and prevention. Several states are directly addressing obesity and pre-diabetes by mandating insurance coverage. Colorado (SB 25-048) enacted legislation requiring large group health plans to cover treatment for obesity and pre-diabetes, including medical nutrition therapy and metabolic/bariatric surgery. In Nevada, AB 555 caps patient cost-sharing for a 30-day supply of insulin for people with state-regulated commercial health plans. To aid early detection of diabetes, New Hampshire (SB 102), Louisiana (SB 26), and Florida (SB 958) enacted new laws requiring the creation of informational materials on Type 1 diabetes risk factors, warning signs, and screening available to students and parents. To reduce financial barriers to necessary cancer screenings, several states have enacted bills to mandate insurance coverage and/or lower the cost of diagnostic breast exams and supplemental testing. Virginia (HB 1828), Florida (SB 158), and Oklahoma (HB 1389) have enacted bills to limit or lower the cost of such breast imaging. Meanwhile, Colorado enacted HB 25-296, clarifying that health insurers cover medically necessary diagnostic and supplemental breast imaging that goes beyond routine screening. Looking Ahead ASTHO expects state and territories to continue advancing legislative proposals that focus on the prevention of chronic diseases and access to healthy foods in 2026. Future legislative action may include: Establishing policies to address food insecurity and promote access to nutritional foods by targeting food deserts. Exploring policy and leadership options to discourage the consumption of high-sugar drinks. Developing and adopting standards for healthy food procurement policies for state agencies and public institutions to increase the demand for nutritious products. Continuing to enact insurance coverage mandates for comprehensive chronic disease screenings and treatment. OE22-2203 PHIG article yes
In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.
States Reassessing Vaccine Policy and Public Health Powers Shalini Nair, Andy Baker-White Review of state policies to weaken vaccine requirements and reduce public health powers. Immunization is a key pillar of public health, crucial for protecting communities and preventing infectious diseases from spreading. State and territorial health officials and their departments play critical roles in setting and implementing immunization requirements, managing disease surveillance and outbreak response, and ensuring access to vaccines. In recent years, however, the immunization landscape has evolved as legislative changes alter public health authority and access to vaccines. As these challenges persist, public health officials must be informed and prepared to navigate the dynamic policy environment to ensure immunization programs’ continued effectiveness at protecting public health. The True Cost of Vaccine Skepticism and Misinformation In the years since the pandemic, rates of routine vaccinations among U.S. children have steadily declined; there has simultaneously been an increase in non-medical exemptions. While reasoning behind personal decisions about vaccination are not always clear, increasing prominence of vaccine-related myths is a significant contributor to this phenomenon. Perhaps the most glaring consequence of this decrease is best illustrated by the 2025 measles outbreak and the first measles-associated deaths in more than a decade. Previously considered to have been eliminated, measles is now under threat of resurgence as vaccine rates fall below the thresholds to uphold herd immunity. Health officials are also seeing declines in coverage for several other vaccine preventable diseases like pertussis, mumps, hepatitis, and even polio. Legislation Restricts Innovation and Sows Doubt About Vaccine Components The use of mRNA technology expanded in 2020 following its breakthrough success in COVID-19 vaccines. These mRNA vaccines prevented more than 120 million additional COVID-19 infections and 3.2 million additional deaths. Researchers are currently assessing mRNA technology to address pandemic influenza, HIV, Zika, and even cancer. During 2025 sessions, at least seven states introduced legislation to ban or limit using mRNA vaccines. Iowa’s SF 360 sought to prohibit any “gene-based vaccines” (i.e., those developed using mRNA or DNA technology); the bill was based on a widely debunked myth that mRNA vaccines can interact with and alter human DNA (they can’t). New York’s A 4798 would prevent administering COVID-19 mRNA vaccines until the department of health conducts a risk-benefit analysis. Several states have introduced legislation to prohibit selling — or require labeling foods that contain — vaccine or vaccine material. This bill is based on another common internet rumor that mRNA vaccines are being introduced into the food supply via livestock and produce (they aren’t). Nonetheless, Utah enacted a bill (HB 84) requiring that food intended for human consumption that contains a vaccine or vaccine material be designated as a drug. Similar bills were introduced in Florida (HB 525), Alabama (HB 316), and Tennessee (SB 616, HB 1100). Vaccine Authority’s Shifting Landscape While the federal government plays an important role in putting forth policy recommendations, the ultimate power to impose or revoke vaccine requirements and determine exemptions outside of health emergencies rests with states. In many jurisdictions, state health agency expertise determines the vaccines required for school enrollment. These decisions, while ultimately at the feet of state health officials, rely heavily on input from experienced, knowledgeable, and skilled agency staff. Recent legislative actions in several states seek to shift authority for determining school-based immunization requirements solely to the legislature. Idaho’s new law (H 290) removes the state board of health’s authority to determine which immunizations are required for daycare and school enrollment, as well as the manner and frequency of their administration. The bill also repeals a former law establishing the Idaho Childhood Immunization Policy Commission, created in 2010 to issue recommendations to the legislature and board of health. A similar effort in Maine (LD 727) would remove health department authority to determine school vaccine requirements as part of a larger repeal effort responding to the 2019 law disallowing vaccine exemptions based on religious or philosophical grounds. In New Hampshire, existing statutes define required immunizations for school attendance and allow the state health official to add to this list via the rulemaking process. Recently, lawmakers introduced a bill (HB 357) that would remove this add-on ability. If passed, existing commissioner-led requirements for vaccines such as varicella, hepatitis B, and Hib would expire in June 2026 and no future amendments could occur under this authority. Several other bills introduced in Texas (HB 468, HB 3304, SB 94, SB 117, HB 3852), West Virginia (SB 108, HB 2203), and North Carolina (HB 89) target shifting authority and/or modifying vaccine requirements for certain school types. Evidence-Based Policy as the Path Forward State and territorial health agencies are foundational to preventing the spread of infectious diseases through vaccine education and administration. ASTHO has identified public health expertise in developing vaccination policy as one of three recommended strategies that prioritize evidence-based public health authority and support agencies to protect and improve health. As this landscape further evolves, ASTHO will continue tracking legislative and executive action on this important public health issue. article yes
Public health leaders are positioned to prevent illness from the "tripledemic” of COVID-19, Influenza, and RSV with approved vaccines and preventative antibody treatments.
In the current legislative cycle, there are several policy strategies that support the development and integration of community health workers into the public health workforce, including dedicated federal funding and state laws supporting workforce development programs, certification standards, and Medicaid coverage.
Supporting policies that reduce HIV stigma and promote health equity is an important public health issue.
Learn about the role and impact of State offices of Rural Health in a Q&A with Alisa Druzba.
In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.
As the weather warms, state and territorial health agencies prepare to address a rise in public health risks associated with recreational water activities, such as water-related injury, drowning, waterborne disease outbreaks, and exposure to harmful algae or cyanobacteria.
States and territories have broad powers to protect public health and safety, including powers to prevent and control the spread of communicable disease typically exercised by state and territorial health departments. This authority is an essential tool in the fight to keep the public safe and healthy.
Vaccines are one of the greatest public health achievements of the last century, as well as some of the most powerful and cost-effective tools to prevent disease, disparities, disability, and death among children and adults. The COVID-19 pandemic and the unprecedented development and distribution of the vaccines against the novel coronavirus have generated much focus on state laws related to vaccinations. As state and territorial legislatures prepare to convene in the coming weeks, we can already identify several topics within vaccine law that policymakers across the country will consider.
Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.
Neonatal Abstinence Syndrome (NAS) has become more prevalent in the United States, with the hospitalization rate increasing from 2.9 to 7.3 hospitalizations per 1,000 newborn births between 2009 and 2017. NAS occurs in newborns who experience withdrawal from substances they were exposed to during pregnancy. While NAS is most often associated with exposure to opioids (e.g., Neonatal Opioid Withdrawal Syndrome), it can also be caused by exposure to other drugs such as cocaine, amphetamines, or barbiturates. Infants with NAS experience withdrawal symptoms including tremors, irritability, poor feeding, vomiting, dehydration, and increased sweating. These symptoms usually appear within 72 hours of birth.
Scientists are working quickly to develop a safe and effective vaccine to provide immunity to COVID-19. Once a vaccine is approved, it will likely be imperative for states to authorize as many health care professionals to administer it, since the demand is expected to be extremely high. In addition, legislation authorizing alternative providers within the immunization neighborhood (e.g., pharmacies, schools, workplace, and other clinical sites) can expand the places where vaccines are available and increase access to vaccination among vulnerable populations. By recognizing that not every person is reliably linked to a healthcare provider, these policies can allow for timely and consistent immunization services.