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Top Issues for State Lawmakers in 2024

December 20, 2023 (19 min read)

We enter 2024 in a world full of uncertainty and tension. Wars in Israel and the Ukraine. A looming presidential election that threatens to divide our divided country even more. An economy that may, or may not, be teetering on the edge of a recession.

With this as the backdrop, states will soon be starting their 2024 legislative sessions. Given the state of things these days, it’s hard to predict what may happen. But based on all we’ve seen in 2023, these are the issues we believe will get the most attention from state lawmakers in the coming year.


Workforce Development

As we reported back in May of last year and June of this year, there is a serious shortage of nurses, doctors, home-health workers and others who make up our nation’s healthcare workforce. It was already a problem before the pandemic—but COVID laid the crisis bare for everyone to see.

State lawmakers responded this year by considering a variety of bills addressing issues of concern to health care workers, including violence at hospitals and nurse-staffing ratios. California even passed a bill to raise the minimum wage of health care workers. 

With dire predictions about how big the health care worker shortfall will grow in the coming years, this issue is likely to remain a top priority for state lawmakers next year and beyond. Already Florida Senate President Kathleen Passidomo (R) has proposed a legislative package to address the health care workforce shortages in the Sunshine State.

Artificial Intelligence

AI drew a great deal of attention this year, including from a growing number of state lawmakers, as you’ll see throughout this story. That trend is sure to continue for the foreseeable future.

In the health care sector, specifically, perhaps the biggest issue policymakers will have to contend with is the regulation of automated decision making, a topic we explored back in August. AI holds the promise of being able to help with difficult health care issues, like mental health care. But there remain deep concerns about automated decision-making programs discriminating against certain marginalized groups. This is not a concern that will go away any time soon.

AI Bills Proliferating in State Legislatures

Lawmakers in at least 35 states have considered bills or resolutions relating to AI in 2023, according to data compiled by the National Conference of State Legislatures and the LexisNexis® State Net® legislative tracking service. Such measures have been enacted in 17 of those states.

Utilization Management

Another concern that isn’t soon to escape lawmakers attention is insurers’ cost-cutting practices, which we reported on in April.

Since the beginning of 2023, more than 100 bills were introduced in 29 states addressing so-called “utilization management practices,” that is cost-cutting measures by insurers, such as pre-approvals.

As with AI, lawmakers are concerned that such practices can harm marginalized populations and their scrutiny of them is likely to continue.


In September, we reported that over a dozen states had enacted legislation aimed at slowing down health care mergers by requiring the parties involved to observe certain waiting periods before closing their transactions.

With consolidation remaining a trend in our topsy turvy economy, you can bet legislators are going to continue to be focused on health care mergers, again out of concern for how they could impact patient care.

Medical Debt

On Dec. 13 New York Gov. Kathy Hochul (D) signed a bill (SB 4907) prohibiting hospitals and health care providers from reporting medical debt to credit agencies, and barring credit agencies from collecting information about such debt. Colorado enacted a similar measure (HB 1126) in June, and legislation aimed at reducing the financial burden of medical debt has been introduced in at least a dozen states this year. With 100 million Americans having collectively amassed about $200 billion in medical debt, according to an estimate from the Kaiser Family Foundation, this is an issue that is likely to just be getting started.

Medicaid and Mental Health

Medicaid unwinding was another big story this year, but as we reported in late September, states seem to be handling the issue primarily through non-rulemaking agency documents rather than legislation.

Kate Blackman, vice president of policy and research for the National Conference of State Legislatures, however, said Medicaid, which makes up about 30% of state budgets, was a “perennial issue that will continue to receive attention from policymakers across the country” in 2024.

“We expect next year that legislatures will continue to look at improving both access and efficiencies in their Medicaid programs and continue to look at things like waivers as well as managed care and managed care organization oversight,” she said.

She said mental health was expected to remain a priority for lawmakers next year as well.


Artificial Intelligence

As big of a concern as AI is in the health care sector, it’s perhaps an even bigger concern within insurance. Not only are state legislators worried about AI-driven insurance scams, a topic we explored in early September, but they’re also worried about discrimination in underwriting and claims adjusting handled by AI, which we reported on in December.

As attorney Karen C. Yotis of the Practical Guidance Team for LexisNexis® told SNCJ, AI in insurance is just exploding and for good reason: It offers insurers the opportunity to cut costs.

The AI wave is just beginning in this sector. Look for more legislation on this front.

Environmental, Social, Governance (ESG)

ESG has become a political issue, diving red and blue states, as we explained in May. As with any hot-button political topic, it's sure to pop up again and again in state capitols, if only because both Republicans and Democrats can use ESG legislation to score points with their bases.

But while the politicians are fighting their culture wars, compliance officers are going to be left scrambling to figure out how to comply with ESG policies as well as the desires of investors.

Usage-Based Insurance

As we explained in August, usage-based auto insurance has been around for more than two decades. But it’s recently started drawing more interest from insurance companies and consumers, due to cost savings. And that, in turn, has drawn the interest of lawmakers.

With technological advances, you can bet the spread of telematics to track a driver’s driving behavior will only continue, which will likely mean more legislation from state lawmakers.

Homeowners Insurance Crisis

State Farm and Allstate no longer sell property insurance to new customers in California. Farmers stopped offering new property coverage in Florida. A fifth of homeowners insurance policyholders in Louisiana had to cancel their policies.

As we reported in July, we appear to be on the brink of a homeowners insurance crisis in the United States—and our reporting this year is sure to just be the beginning. Climate change is making insuring certain areas of the country more costly, which is driving insurers like State Farm to abandon entire markets.

Few states addressed the issue legislatively this year. But more states may begin doing so next year and beyond, as the realities of climate change continue to be felt.


Pro-Union Policies

This was the year of the hot labor summer. The dual Hollywood strikes. The Detroit autoworker strike. The brief Kaiser Permanente nurses, ER technicians, and pharmacists’ strike. The narrowly averted hotel-worker strike in Las Vegas.

As we reported in late November, unions flexed their muscles in 2023, and they received a lot of support in state legislatures, in part because the public approved of these union actions in the wake of the pandemic. It remains to be seen how long that approval will continue, but expect pro-labor bills to keep coming in 2024.

Workplace Violence

Since the start of 2023, more than 100 bills including the words “workplace violence” were introduced in 27 states, reflecting lawmakers’ growing concern about the issue.

As we reported in mid-November, many of the bills introduced this year focused on workplace violence in a health care setting. But while that might be the sector where it’s most pressing, violence is a concern in many workplaces – so much so that California passed a bill that requires virtually all employers in the Golden State to establish “Workplace Violence Prevention Plans.”

As is often noted, policies enacted in California have a tendency to spread across the country. It’s likely other states will follow California’s lead and begin to look at workplace violence more broadly.

Paid leave

SNCJ reported in June about trends in paid leave, specifically that 44 states had introduced more than 300 bills related to the issue since the beginning of the year, in part because COVID-related measures were sunsetting and in part because the issue had grabbed lawmakers’ attention even before the pandemic.

As we noted in that story, paid leave legislation typically falls into two categories: laws over paid sick leave and laws over paid family and medical leave. But as lawyer Elias Kahn, senior product manager for labor & employment, tax and employee benefits and executive compensation on the Practical Guidance Team for LexisNexis, noted, a third category is looming: paid leave for any reason.

As we reported, states are just starting to explore this type paid leave. You can expect that to pick up in 2024.

Automated Decision Making

As we reported in April, there are not many formal policies governing the use of automated decision making and other forms of AI. That’s a problem because, as we mentioned, there’s a lot of concern about AI discriminating against marginalized populations.

It wouldn’t be surprising if labor’s deep concerns about AI—which surfaced in the Hollywood strikes—is soon reflected in state legislation. It’s a debate that’s just beginning.


Artificial Intelligence

ChatGPT put the spotlight on AI and its burgeoning power, and we’ve only seen a proliferation of the technology since the AI chatbot’s introduction. Advancements in this area have occurred so quickly that our March story about ChatGPT drawing lawmakers’ attention now seems, well, outdated.

As AI legislation has been mentioned in every sector we cover here at SNCJ, it should come as no surprise that this is easily one of the biggest issues we’re expecting to follow in 2024. It’s not a stretch to say AI has the potential to revolutionize virtually any industry, which will make it a critical policy matter for lawmakers in the coming years.

Children’s Online Safety

The fight to protect children online is just heating up and it is sure to be one of the biggest issues of 2024. We wrote about the topic twice this year, in February and October, but much has already changed.

A judge has blocked implementation of California's trailblazing Age-Appropriate Design Code Act, which would require any business serving up webpages likely to be accessed by California children to consider the children's best interests when designing the pages. California's attorney general is appealing the matter, and has joined with numerous other attorneys general in a wide ranging lawsuit against Meta over the harm its platforms, Facebook and Instagram, inflict on youth’s mental health.

Meanwhile, New Mexico’s attorney general has recently filed a lawsuit against Meta alleging that its platforms have knowingly facilitated child sex trafficking. At the same time, New York’s Democratic Gov. Kathy Hochul announced in an October press release a package of bills to protect children from the negative impacts of social media, particularly on their mental health. And in Florida, Republican Sen. Ileana Garcia has pre-filed a bill for 2024 that would call for social media companies to moderate their content.

Ample evidence that this will be a major battleground next year.

Data Privacy

Data privacy is another topic we covered more than once in 2023, in January and July. The big issue here is a lack of a federal data privacy law, which has opened the door for states to tackle the issue on a jurisdiction-by-jurisdiction basis.

Some states, like California, have attempted to address the issue through comprehensive legislation, while others have tackled it in a more piecemeal manner. The comprehensive approach seemed to gain momentum this year, with enactments in several states.

But we expect to see both approaches continue as technology continues to advance and the public becomes more and more aware of how their personal information ends up in third parties’ hands without their knowledge.

—By SNCJ Correspondent BRIAN JOSEPH

Please visit our webpage to connect with a State Net representative and learn how the State Net legislative and regulatory tracking solution can help you identify, track, analyze and report on relevant legislative and regulatory developments.


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