At least 20 states are pursuing legislation to limit access to gender-affirming care for transgender youth, while some states have proposed legislation to prohibit discrimination based on sexual orientation and gender identity.

Rhode Island Gov. Daniel McKee (D) released a Dec. 22 executive order addressing hospital capacity and flexibility for patient care given recent surges in COVID-19 cases and medical staff shortages.

As part of its final report and implementation plan, the Presidential Health Equity Task Force highlighted several states and communities that are improving equitable health care, including California's efforts to expand broadband services, the Cherokee Nation's vaccination efforts, and more.

So far, 26 states and Washington, D.C., publicly report varying data on race and ethnicity for individuals who have received the vaccination. States also have taken different approaches to addressing disparities in vaccine administration and vaccine hesitancy.

The Federal Emergency Management Agency is supporting vaccination sites in 19 states and U.S. territories. States vary in their approaches to distribute COVID-19 vaccines to children; some are prioritizing subpopulations of children while others are involving child health stakeholders in planning.

With expected gridlock between our new divided Congress, states could be the ones to drive major health policy activity in 2019.