2022 State Elections Toolkit
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Key Takeaways:

  • We think there are two public health issues that you should keep an eye on in 2022 — vaccine mandates and cannabis legalization. We expect state lawmakers to pursue legislation related to these topics during the 2022 legislative sessions.
  • This post is part of our series on state policy issues to watch in 2022, where we explore seven policy areas and our predictions for the upcoming legislative year (elections, energy and environment, labor and employment, public health, social justice, tax and budgets, and technology).

As states kick off their 2022 legislative sessions, here are some of the main topics we expect lawmakers to explore in the area of public health. This post is part of our series on state policy issues to watch in 2022 (click here to see all issues areas).

Vaccine Mandates

  • Background: At the end of 2020, a year wrecked by the COVID-19 pandemic, the United States began a rollout program to vaccinate its residents against the virus which picked up steam in early 2021 and became widely available that summer. But at that point, vaccination became a political issue and vaccination numbers stalled. In a response to avoid shutdowns amid the delta variant outbreak, states ramped up their efforts to vaccinate as many of their residents as possible. This began with monetary encouragement via vaccine lotteries (the carrot) and led to an expanding series of vaccine mandates (the stick) for state employees, then health care and elder care workers, followed by employees and customers at public-facing businesses, and now we’ve reached the “all private businesses” stage of the mandate rollout.

  • Why It's Trending: In November, the Biden Administration announced federal vaccine mandates on government workers, government contractors, health care workers, and all on-site, private-sector workers at large businesses. This caused a huge backlash from conservative states, which quickly enacted legislation and issued orders to ban any such mandates. Much of these debates will get settled in the courts, but legislation will continue at the state level, especially if the federal mandates are invalidated by the courts. 

  • Current Landscape: The Supreme Court is hearing arguments on the federal vaccine mandate. At least 17 states have enacted legislation or an order preempting localities from mandating vaccines or prohibiting businesses from verifying vaccine status for employment or services. Last year, state lawmakers introduced 1,200 pieces of legislation related to COVID-19 vaccines. Over 100 of those bills were enacted in 38 states. 

  • 2022 Outlook: All eyes are now on the U.S. Supreme Court and its forthcoming decision on the challenges to the federal vaccine mandates. If the Court invalidates the mandate, expect states to return the legislative fight over vaccine mandates through 2022. Courts will also decide whether many of the state-level anti-vaccination efforts are legally enforceable. Additional issues for 2022 are whether states will include booster shots as part of their definition of “fully vaccinated,” how many cities will expand their vaccine requirements for private-sector businesses (New York City, Philadelphia, Chicago, Boston, and D.C. have already taken action this month), and if proof of previous COVID-19 infections will provide a vaccine exemption. 


Cannabis Legalization

  • Background: In 1996, California became the first state to legalize the medical use of marijuana. Sixteen years later, Colorado and Washington blazed a trail by becoming the first states to legalize marijuana for recreational use. Since then, we’ve seen an increased focus on both medical and recreational legalization nationwide. Over the past 13 months alone, 10 states approved measures to legalize the use of either recreational or medical marijuana.

  • Why It's Trending: Support for marijuana legalization has steadily climbed over the past few decades. In fact, it is a rare bipartisan issue with momentum in the states. As favorability continues to rise in the general populace so have legalization efforts throughout the country. Since the federal government has made no indication that it would remove marijuana classification as a Schedule I substance under the Controlled Substances Act but have also indicated a lack of interest to interfere with state-level legalization, states will continue to legalize and create marketplaces for marijuana use. 

  • Current Landscape: Currently, 18 states and D.C. have legalized recreational marijuana and 36 states and D.C. have legalized medical marijuana use. South Dakota and Mississippi voters approved ballot initiatives that would have legalized marijuana use but the courts struck down the measures. More than half of the country’s state legislatures considered legalization measures in 2021 and a handful have already announced their intention to take up the issue during the 2022 session. 

  • 2022 Outlook: Legislators in Florida, Kentucky, New Hampshire, and Rhode Island have already pre-filed or announced their intentions to introduce legalization efforts during the 2022 session. Additionally, a resolution to include marijuana legalization on the 2022 ballot was pre-filed in Missouri. It’s an election year, so expect to see marijuana legalization on the 2022 ballot in several states. Finally, states such as Ohio, Pennsylvania, and Wisconsin that currently have active legalization legislation are all permitted to carry over bills into the 2022 session.


This post is part of our series on state policy issues to watch in 2022 (click here to see all issues areas).