As the country prepares to ring in the new year, new state laws will take effect around the country on a host of issues, including the use of artificial intelligence in health care and elections, paid family and medical leave and rising medical insurance costs.
Some states are looking for ways to soften the blow of higher health care premiums as Affordable Care Act tax subsidies expire after Congress failed to extend them. And on the verge of the coming year’s midterm elections, a slew of more restrictive voting laws are taking effect.
Here are some of the laws that go live in 2026:
Deepfakes in elections, AI misuse in health care
Thirty-eight states passed legislation this year to deal with the explosive growth of artificial intelligence, including on such topics as preventing the misuse of AI in elections and regulating how the technology disperses medical information, according to the National Conference of State Legislatures.
AI will continue to be a top issue for states despite President Donald Trump’s executive order in December seeking to limit state regulations on AI, said the group’s CEO, Tim Storey.
Trump issued his executive order — which aimed to prevent a piecemeal, state-level approach to AI regulation in favor of “minimally burdensome national policy” for the use of the technology — after Congress was unable to pass legislation over the past year. As a result, it lacks the strength that legislation would provide to rein in state-level actions given that Congress has the exclusive power to pre-empt state laws under the Constitution.
“States have taken the lead, as they have in so many issues,” Storey said at a recent news briefing. “AI is the big one.”
In the absence of federal legislation, several states have taken action, including on the issues of so-called deepfakes in elections and AI as a medical resource.
California passed legislation barring AI developers and businesses from giving patients the impression that they are interacting with licensed health care professionals when they are really speaking with chatbots. Oregon enacted similar legislation preventing AI programs from using the title “nurse” when they give medical advice.
Elsewhere, Montana and South Dakota passed laws this year that now require disclosures about using deepfakes in elections — measures that could come into play during next year’s midterms.
Deepfakes, which are images, video or audio that are digitally altered to create false representations of people’s statements or actions, have been used to cause confusion in state and national elections. During the 2024 presidential election, for example, NBC News reported that a political consultant used AI to create a robocall impersonating President Joe Biden, telling New Hampshire Democrats not to vote in the primary.
Congress has yet to pass legislation to prohibit deepfake content that could mislead voters during elections.
Paid family and medical leave
Maine, Delaware and Minnesota will have paid family and medical leave policies going into effect in 2026, joining several other states that already provide such benefits. Maryland, Vermont and Washington also passed legislation expanding or amending existing paid family leave policies, with the latter state’s changes taking effect this coming year. Paid family and medical leave allows employees to receive wages when they take leaves of absence for medical reasons, give birth or take care of family members.
Minnesota state Sen. Alice Mann, a physician who is a member of the state’s Democratic-Farmer-Labor Party, sponsored the state’s paid leave bill. She said witnessing her patients having to choose between taking care of themselves or loved ones and missing paychecks pushed her to back the legislation.
“I see people every single day who struggle. People are left with the choice of taking care of themselves, their family members, their new baby and not getting a paycheck anymore,” Mann said. “And that’s not an option that the rest of the world has to face.”
While federal law provides up to 12 weeks of unpaid job protection for people in need of medical or caretaking leave, the U.S. is the only developed economy without paid parental or medical leave. It’s also one of the only countries that don’t provide paid sick leave at a national level.
Mann said that while Minnesota’s legislation was passed in 2023, time was needed before it was implemented for people to actually know that the bill existed and understand how it works. That involved a $5 million public information campaign to educate “employers and community groups on what this policy is, what it does and how you participate,” she said.
Delaware’s and Maine’s policies, which were passed in 2022 and 2023, respectively, also go into effect this coming year.
“It’s a very popular policy, again, because we’re all human beings, for crying out loud, and if it wasn’t popular, we wouldn’t be the only country left without it, right?” Mann said. “It is sustainable. It is something that we all use. And so I hope, I expect, that other states will see this, realize this and move to have their own policies in place.”
Lapsing Obamacare subsidies
All 50 states will face rising health care costs starting in January after Congress was unable to pass legislation to extend expiring Obamacare premium subsidies before the end of the year.
In an August special session, Colorado became one of the few states to enact legislation aimed at softening the blow of the rising premiums, dedicating $100 million to offset premium hikes in the state’s health care exchange.
State Rep. Kyle Brown, a Democrat who sponsored the bill, said the $100 million will serve as “a bridge” for 2026, ensuring that Colorado has funds to sustain some subsidizing of its health care exchange and “cushion the blow” from the lapse in federal subsidies.
“Before we passed the bill, people’s premiums on average were expected to go up by 175% in Colorado. We passed the bill, and now they’re only going up by 100%,” Brown said. “Which is still like ‘yeah, instead of tripling, they’re doubling.’ But it could have been worse.”
According to KFF, a health policy research group, Affordable Care Act premium payments are likely to more than double because of the expiring subsidies. In Colorado, premiums for about 225,00 people will increase by an average of 101%, according to the state Insurance Division.
Brown said that he had hoped Congress would extend the Obamacare subsidies but that he came to the realization that the funds weren’t coming through after having watched the U.S. government shut down for six weeks last fall — the longest federal funding lapse in the country’s history — as Democratic and Republican lawmakers deadlocked over the issue. Rising health care prices and the high cost of living overall are expected to be top issues in the 2026 midterms.
“It feels like states are on their own. We don’t have a willing partner in the federal government anymore, and so we have to do what we can to take care of our folks and make health care as affordable and accessible as possible,” Brown said.
Stricter voting laws
This past year, 20 states passed 37 bills to restrict voting access and elections, according to the Voting Rights Lab, a nonprofit organization that tracks voting- and election-related legislation and aims to expand ballot access. That’s the most since 2021, it said.
Meanwhile, 23 states passed 51 bills intended to improve voting and elections, the group found, saying that is the fewest such measures since it started tracking state legislation.
Kansas and North Dakota eliminated grace periods for mail-in ballots postmarked by Election Day but arriving afterward, and eight states passed legislation to restrict or eliminate alternatives to photo ID as proof of voter registration, according to the Voting Rights Lab.
Many of the states that passed such bills might have been influenced by Trump’s executive order in March that pushed for broad changes in how the U.S. conducts its elections, said Chris Vasquez, director of legislative tracking at the Voting Rights Lab.
“I think the main thrust of the story of the year is sort of Trump in March issuing this executive order,” Vasquez said.
The order aimed to require that people provide proof of citizenship when they register to vote and required mail-in ballots to be sent in before Election Day. While the proof-of-citizenship requirement was blocked in U.S. District Court in Washington as an executive branch overreach, certain states have passed legislation mirroring other policies in the executive order.
“We did see 27 states introduce some sort of restrictive proof-of-citizenship legislation this year, which is triple what we saw in the previous legislative session,” Vasquez said. “That, for the most part, wasn’t successful. But then, where you did see some more activity was on the mail ballot deadline side.”
In 2026, he said, Vasquez will be keeping an eye on state redistricting and a related Supreme Court case that could limit the scope of the Voting Rights Act as harbingers of what could develop at the state level, including efforts to protect against further voting restrictions.
“I think, especially looking at the Supreme Court potentially really curtailing the ability of plaintiffs to bring Voting Rights Act claims in federal court, these state voting rights acts are essentially something to keep an eye on into potential work against potentially voter suppressive laws,” he said.