1149: Mid-Session Check-In: The Public Health Trends Shaping State Legislatures

JOHN SHEENAN:

This is Public Health Review Morning Edition for Thursday, June 18th, 2026. I’m John Sheehan with news from the Association of State and Territorial Health Officials.  Today, we hear about The Public Health Trends Shaping State Legislatures. Beth Giambrone, ASTHO senior analyst for state health policy, returns to discuss ASTHO’s Mid-Session Update, an annual review of the major public health trends emerging in state legislatures across the country. From expanding access to healthcare and strengthening rural health systems, to addressing nutrition, mental health, and vaccine policy, Beth breaks down the legislative developments that are shaping public health at the state level.  

Beth Giambrone, welcome back to the show. 

BETH GIAMBRONE:

Thanks for having me again. 

SHEENAN: 

So Beth, what is the mid-session update? 

GIAMBRONE:

So, the mid-session update is a blog post that we do once a year, and it's in conjunction with our legislative prospectus series. Now, for those that might not know, our prospectus series is a series of one pagers that we will put out in December of every year, that goes over some of the major public health issues from the previous year and just a wrap up of what happened in the state legislatures. And then we look ahead to what we think might be on the horizon for the next year within the legislative sessions. So, what the mid-session update does is it looks at those topics that we were thinking about that we might see. And we just talk about if there is any legislation, what that legislation might have entailed, and also highlighting any other major issues that came out of the legislatures that is an emerging issue or even just highlighting some of the more ongoing ones that legislatures have been looking at for the past three, four, five years. 

 SHEENAN:

And the blog points out that expanding access to care has been a major theme for state legislatures. How are they approaching things like community-based services and rural health care? 

 GIAMBRONE:

So, I'll start with the rural health care first, because that is top of mind for me lately. One of the biggest things that state legislatures are doing, especially to help with access to rural care, is starting to adopt interstate compacts. So, what an interstate compact is, it's a compact between groups of states that will allow a medical professional in one state, so say a doctor in one state, to be able to also practice in another state, either in person or via telehealth. And not have to worry about you know, getting certified in that state or making sure that you know, they're following the rules of each state. With those compacts being together, a medical professional can just do that and not have to worry about some of those extra issues or you know, check boxes that you have to do. What that does, especially for folks in rural or any other underserved area, especially in the area of telehealth, is that it gives them access to a doctor that they might not have been able to have before. And it also helps doctors who want to expand their practice and not have to worry about things like extra certifications or you know, things of that nature. So, that is one way that we're starting to see a real growth in interstate compacts between states. Off the top of my head, there's probably at least a dozen different types of interstate compacts that run the gamut from you know, doctors, to physician associates, to nurse practitioners, to behavioral health specialists, social workers. So, it can really be able to you know run the entire spectrum of health. So, the second part of your question about community-based services, one of the biggest ones is actually with doulas. That's something that we have really seen pick up in the last few years. And what we've seen around doulas is letting their services be covered by Medicare. Some states are looking at being able to certify a doula. You're also looking at making sure to increase access to doulas. So, you know, whether it's like in a hospital or you know, something like that. So that's really been one of the biggest ones that we've seen in terms of like community-based services in the last few years, especially in this past year. 

 SHEENAN:

Another interesting development, there's been interest in psychedelic substances. What are, what options are states considering there? 

GIAMBRONE:

So, what we're seeing there is a lot of states are starting to look at substances that might not have been used before and being able to use them to treat mental health conditions, such as like PTSD. The one that has been at the forefront for the last year or so and from the legislation that we were researching, you know, what we saw the most was around psilocybin. And because there are some states already that do allow the use of psilocybin for therapeutic purposes, we're definitely starting to see those types of legislation in other states to allow it for that therapeutic purpose as well. But this past year, one of the really interesting trends that we saw were states starting to look at rescheduling psilocybin pending any sort of rescheduling by the federal government. So, for example, if the federal government decides to reschedule psilocybin to you know, to a certain level, there are states that have already passed legislation that immediately says, okay, in our state it is also at the exact same level. So that's really been one of the most interesting ones that we've seen. In terms of any others, the one that we're starting to see that's starting to emerge more is Ibogaine. And that's also another substance that can be used to possibly treat mental health substance use disorders. So, what we're starting to see there are states that are starting to look at it from a research standpoint or from you know, for clinical trials and things like that. So we haven't seen it actually allowed for use for a therapeutic purpose, but there are definitely states that are starting to look at it and see if that is also another option. 

 SHEENAN:

States are also continuing to acknowledge that nutrition plays a big role in in in preventing chronic diseases. What are some strategies that lawmakers are still employing? 

GIAMBRONE:

So, what we're seeing there and that's been a very interesting one this past year because you know, obviously with chronic disease, you know, we've always looked at prevention and looked at treatments and things like that. And lawmakers are starting to think a little bit more holistically as well. And starting to think about you know, having access to healthy food. So, if you look at it you know, from the standpoint of like a school lunch, you know, we're definitely looking at states that are, you know, obviously have been banning certain food dyes, but they're also looking at other options around getting healthy food in schools as well. We saw a few states that were considering legislation that would require plant-based options for school lunches. You know, making sure that those foods that are in the schools themselves are healthy. For you know many students that is you know, the big meal of the day for them. I think that is something that has been definitely more at the forefront.

Something also to think about as well, when you're thinking about access to healthy food is actually getting the access to the food. So, depending on where you live, you could be living in what's called a food desert. So, you would be anywhere between you know, 10, 20, 40 miles away from the closest grocery store or the closest you know, food market, or you know, farmers market. So, if you don't have that access to be able to get healthy food, that makes it really difficult to be able to obviously stay healthy. So what states are starting to look at as well is trying to find ways to eliminate those food deserts, whether it's allowing for tax incentives for grocery stores to open in a rural area, or in another underserved area, allowing access to farmers markets. So, those are the two big ones that we've really seen from the access to food standpoint. 

SHEENAN:

And there's also been a lot of activity in the last, you know, year, year and a half, around vaccines. What are what are states doing in the vaccine space? 

GIAMBRONE:

So, what we've seen in vaccine policy in the last year or so is, states that are looking to modify or eliminate the role or the influence that ACIP has on vaccine policy within their jurisdictions. So, what we've seen there is either modifying the role that they have including other organizations, recommendations along with ACIP, so organizations such like the American Academy of Pediatrics, the Academy of Family Physicians, so on and so forth. There are a few states that are just eliminating ACIP's role entirely and going with these types of organizations. There are other states that are now asking their or mandating their state health agency, put together those recommendations. The thing to remember with this is that with when it comes to vaccine policy, a lot of people might just think that it's just about school immunizations and it's not. So, this is actually influencing every level of vaccine policy. So, when you're looking at obviously schedule recommendations for children, whether insurance will cover a certain type of vaccination or not. In some states, whether pharmacists are allowed to be able to administer vaccines, funding for vaccine purchasing programs, liability for medical professionals who administer vaccines. It's gonna run the whole gamut of vaccine policies.

SHEENAN:

I think that is a really great example of one of the reasons that it's really handy to follow these developments through, through series like the legislative prospectus. What would you say are some big takeaways for listeners and some reasons that they should keep track of this stuff? 

GIAMBRONE:

Honestly, the biggest reason why I think they should is that really public health is everywhere, even where you don't expect it might be. There's so much within legislation and public health legislation that there is no way I could have written everything into the mid-session update. I would have probably written a 20-page paper instead of a blog post. Public health will show up in all types of policies, housing policies, transportation policies, you know, justice policies. So, it's always connected. And so, I think with the legislative prospectus series and with the health policy updates as well, we're trying to give a snapshot to readers of what is happening within all of these different policies.

SHEENAN:  

Well, Beth Giambrone, thanks so much. 

GIAMBRONE:

Thank you so much again. It's great to see you. 

SHEENAN:

Beth Giambrone is ASTHO's senior analyst for state health policy 

ASTHO and the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine, with support from CDC, invites qualified professionals to apply to the next cohort of the Developing Executive Leaders in Public Health (DELPH) program. Qualified public health professionals must be currently employed at a local, island/territory, tribal, or state public health department. Federal employees are not eligible to participate in the DELPH program. Applications will be accepted through July 31, 2026. 

And to support applicants in the submission process, join ASTHO for the DELPH Open House on July 7, hosted by Director of Leadership Development Programs at ASTHO, Latoya Sahadeo. This interactive session is designed for prospective applicants to ask questions and hear best practices before the deadline. 

This has been Public Health Review Morning Edition. I’m John Sheehan for the Association of State and Territorial Health Officials.