Abortion, Health Workforce Top 2025 State Legislative Priorities

State lawmakers and interest groups are readying legislation on reproductive health access, prescription drug affordability, and more amid uncertainty on the incoming Trump administration’s approach to issues ranging from abortion to insurance coverage for low-income individuals.

President-elect Donald Trump’s administration is expected to withdraw Biden-era federal policies protecting abortion care in emergencies and health data privacy, leaving groups across the political spectrum to turn to states to shape what abortion and contraceptive access look like in 2025 and beyond.

Other policy areas that gained momentum in legislatures in 2024 are also ripe for a comeback in the new year, including regulating the health-care industry’s use of artificial intelligence tools and private equity consolidation. At the same time, many states are likely to address health workforce shortages by pursuing limits on noncompete agreements.

Republican threats to cut Medicaid spending at the federal level and uncertainty over how the Trump administration will handle the Medicare drug price negotiation program put more pressure on state legislators to address how high health-care costs are affecting their constituents.

Reproductive Health

In the aftermath of the US Supreme Court’s 2022 decision overturning the constitutional right to abortion, Trump has said the issue should be regulated at the state level. State lawmakers and lobbying groups are responding accordingly for 2025, preparing legislation on abortion medication, contraception, and pregnancy centers.

In California, Democratic lawmakers are hoping to advance multiple bills in early January, including one (AB 54) protecting the distribution and administration of medication abortion. Another (AB 67) would allow financial penalties on local governments that attempt to block abortion providers from opening.

On the other side, anti-abortion groups are rallying behind legislation to limit access to abortion medication. Americans United for Life is also looking at ways states can boost funding for crisis pregnancy centers that provide “critical resources to mothers and their families,” said Brad Kehr, the organization’s government affairs director.

Democratic state attorneys general have targeted these anti-abortion centers alleging the facilities promote misinformation on abortion.

Jennifer Driver, senior director of reproductive rights at State Innovation Exchange, said her organization is committed to working with state lawmakers to revive legislation protecting access to contraception, noting she is “still scanning where there is opportunity to actually get measures passed.”

AI Tools

The use of AI tools emerged as a growing area of interest for states in 2024, and lawmakers hope to revive bills on the use of automated tools in insurer denials and other areas of the health-care sector.

At least 40 states introduced or passed legislation on AI regulation in 2024, with a half-dozen measures related specifically to the health-care industry, according to the National Conference of State Legislatures.

Lawmakers in Georgia, New York, and Pennsylvania who introduced legislation to improve oversight of how AI tools are used in coverage decisions plan to revive these bills in 2025.

Private Equity Investment

Labor unions and patient groups have called for more rigorous action on private equity firms’ growing consolidation in health care, pointing to national research linking this trend to higher costs for patients and insurers, lower quality of care, and worse financial outcomes for entities acquired.

Massachusetts and Minnesota failed to advance private equity-focused investment bills in 2024, but lawmakers in both states have expressed interest in pursuing similar legislation in 2025. Pennsylvania could also revive legislation that failed to pass in 2024, Ropes & Gray LLP partners Christina Bergeron and Devin Cohen said in an interview.

But the attorneys noted that after California Gov. Gavin Newsom’s (D) veto of a bill that would have required approval from the state attorney general for certain private equity health-care acquisitions, states are more likely to pursue less restrictive legislation to avoid discouraging private equity investment that could be beneficial to communities in need.

Health Workforce Boost

Limiting noncompete agreements in the health-care sector has been a key focus for legislators interested in addressing workforce needs, as the federal government predicts widening shortages in the next decade among physicians, nurses, mental health professionals, and others.

States are poised to play an even greater role in the next year after a federal judge in 2024 blocked the Federal Trade Commission’s near-total ban on restrictive employment contracts.

Interest in strengthening noncompete limits could result in action in the next year in Florida and Massachusetts, said Russell Beck, a business and employee mobility litigator at Beck Reed Riden LLP. Lawmakers in Arizona, Colorado, and Missouri have also floated health-care-related noncompete bills.

Health-Care Affordability

Uncertainty over the Trump administration’s approach to Medicare and Medicaid programs is putting pressure on state lawmakers to address issues of affordability within their borders.

“With the incoming administration’s rhetoric regarding threats to Medicaid and threats to the Affordable Care Act, we need to be very aware that medical debt could explode if patients lose their insurance,” said Pennsylvania state Rep. Arvind Venkat (D), an emergency physician who has sponsored legislation to establish a medical debt relief program in his state.

Drug pricing analysts say it’s unclear how Trump’s pick to lead the Centers for Medicare & Medicaid Services—surgeon-turned-TV personality Mehmet Oz—will approach the Inflation Reduction Act’s Medicare Drug Price Negotiation Program.

“If efforts at the federal level went down in some way, there would be even more state interest” on prescription drug affordability, said Mark E. Miller, executive vice president of health care at Arnold Ventures. Part of this would be through the enactment of prescription drug affordability review boards that have the power to set limits on what health plans pay for certain medications.

A court decision is expected soon in Amgen Inc.’s lawsuit against the Colorado board over its decision to pursue payment limit rulemaking for Enbrel. The outcome in this case is likely to influence other states’ willingness to pursue legislation setting up their own review boards.