US State-Level Preemption Legislation, 2017-2018: Implications for Public Health Policy and Practice

We sought to systematically identify US state-level proposed legislation focused on preemption and introduced over a 2-year period. We analyzed each bill's objectives and intended impacts on local public health policy making and practice.

Using standardized search terms, we used the LexisNexis State Capital database to identify state-level bills relating to preemption that were introduced between January 1, 2017, and December 31, 2018. Information was abstracted from relevant bills via an electronic data collection form. Abstracted information was analyzed using descriptive statistics to identify preemption-related patterns and trends.

One hundred thirty-four bills were included in our analysis. The bills were introduced in 35 states and 28 received sufficient votes to pass into law. The majority of the 134 bills (89%), and all of the bills that passed into law (100%), removed or restricted local authority to regulate. Of the bills that became law, the most common topic areas in which local regulatory authority was restricted were firearms (14%), business and professions (11%), and employment (11%).

Lawmakers at the state level are introducing and passing legislation that preempts local regulatory authority on a variety of public health topics. To preserve local control, local leaders should anticipate the introduction of state preemption legislation, engage with public health stakeholders, and work to counter bills that would restrict local authority.