In New York, residents are able to access to abortion through the 24th week of pregnancy, are banned from carrying concealed firearms in sensitive places and can easily obtain the new Covid vaccines.
In Florida, abortions are available only through the sixth week of pregnancy, people can now openly carry guns without permits in most places, and the state’s surgeon general is eliminating vaccine mandates while signaling he wants to ban the Covid shot.
Politically, these two states haven’t had much in common for decades. And in this polarized era, those differences are increasingly reflected in the laws and guidelines local leaders are enacting, resulting in wildly different policy realities for Americans depending solely on whether they live in a blue state or a red state.
Those realities have become especially stark over the past few years, with states responding to major U.S. Supreme Court rulings on abortion and gun rights, and most recently, the Trump administration’s skeptical attitude toward vaccines.
“There are two very different realities right now,” said Mandara Meyers, the executive director of The States Project, a Democratic-aligned group that works to build the party’s power in state legislatures.
“Issues like safe, comprehensive health care are coming down to the kind of state that you live in and who has governing power in that state,” Meyers said. “That has become the reality of the red-state and blue-state existence.”
Brooklyn Roberts, a senior director on the Health and Human Services Task Force of the American Legislative Exchange Council (ALEC), an influential conservative group for Republican state-level legislation, added, “I think it’s safe to say that states are no longer taking a one-size-fits-all approach to health care and instead are doing what best fits the needs of their constituents.”
States diverge on vaccines
The latest split came after Health Secretary Robert F. Kennedy Jr. announced new restrictions on who was approved for the Covid vaccine, a significant break from previous guidance.
One week later, Florida Surgeon General Joseph Ladapo said he would work to end all vaccine mandates in the state. Ladapo said that “every last one of them is wrong and drips with disdain and slavery” and that forcing people to get vaccines was “wrong” and “immoral.”
The move, panned by public health experts, will effectively end requirements by the state that students going to public school receive certain vaccinations, including those for chickenpox, hepatitis B, pneumococcal diseases and other shots, but not for others, like polio and measles.
In doing so, Florida, a state that has increasingly trended rightward during the Trump era, will become the first one to make many vaccinations completely voluntary.
Idaho Republicans enacted a similar but more vague law in April that barred schools and some businesses from refusing admission or services to people who received certain medical “interventions,” which included vaccines. The bill featured numerous exemptions.
At the same time, a growing number of of GOP-controlled states have enacted laws in recent months that make the drug ivermectin available to people without a prescription. Texas became the fifth to do so last month. Ivermectin is a drug that’s intended use is to treat parasitic worms, but emerged during the pandemic as an unproven treatment for Covid.
On the same day as Florida’s vaccine announcement, a trio of Western blue states formed a regional alliance that effectively created their own vaccine guidelines based on “credible” scientific information, the Democratic governors of those three states said.
“Our three states share a commitment to ensuring that public health recommendations are guided by safety, efficacy, transparency, access, and trust,” California Gov. Gavin Newsom’s office said in a statement announcing the “West Coast Health Alliance.”
“This will allow residents to receive consistent, science-based recommendations they can rely on — regardless of shifting federal actions,” Newsom said. Hawaii joined the alliance days after it was announced.
And on Thursday, New York, New Jersey, Pennsylvania, Massachusetts, Connecticut, Maine and Rhode Island announced their own alliance — called the Northeast Public Health Collaborative — that also created its own vaccine guidelines, independent of shifting federal ones.
Both bodies formally issued guidance this week on who should get three common vaccines. That came right before Kennedy’s handpicked vaccine panel voted to restrict access to the measles vaccine that includes protection against the varicella, or chickenpox, virus. The panel also voted on Friday to end recommending the Covid shot for most healthy people, while postponing a decision on whether to end guidance that all newborn babies should receive the hepatitis B vaccine.
The state coalitions’ announcements follow a flurry of other moves by Democratic governors in the Northeast.
Earlier this month, Massachusetts became the first state to implement independent statewide vaccine coverage rules.
Massachusetts’ Democratic Gov. Maura Healey announced that the state will mandate that health insurance companies continue to cover vaccines recommended by the state’s Department of Public Health, making clear that those companies must not base their coverage decisions only on federal recommendations. Kennedy, a longtime anti-vaccine activist, announced in May that the Centers for Disease Control and Prevention would end a Covid vaccine recommendation for healthy kids and pregnant women.
In addition, New York Gov. Kathy Hochul signed an executive order this month expanding who can prescribe and administer Covid vaccines, giving pharmacists and other health workers a 30-day emergency window to provide the crucial shots ahead of the fall virus season. In her office’s announcement, Hochul said the order was meant to “combat the Trump Administration’s misguided attack on immunization and healthcare.”
Michigan Gov. Gretchen Whitmer took similar actions on Wednesday, directing state agencies to remove any obstacles for people to obtain a Covid vaccine and to oversee efforts to ensure the shots remain covered by health insurance plans.
The latest developments and the emerging patchwork of greatly varying health policies provide yet another example of how red states and blue states are heading in polar-opposite policy directions.
“States are supposed to be a laboratory for experimentation. What’s interesting about this moment is that [some] states are now a laboratory for what they perceive to be a hostile federal government,” said Shana Kushner Gadarian, a professor of political science at Syracuse University who studies the political ramifications of the Covid pandemic and the polarization and politicization of health care policy.
From the Democratic perspective, she said, “states like Massachusetts and New York aren’t just working together to just stock up on Covid vaccines. They’re going to make their own recommendations, because they don’t trust the federal government. … You see this kind of battle against the federal government.”
On the GOP side, she said, “a lot of the things that we would put under health and safety have now — because they’re wrapped up in things like individual choice and how much regulation we should have — moved kind of into the Republican side as things to stand against.”
“The diversity of approaches doesn’t end at vaccines. Variations in how patients are able to access care, pay for care and get information about the cost of their care are common,” said ALEC’s Roberts. She mentioned price transparency laws that both red and blue states have enacted making it easier for patients to know what bills to expect for medical care, as well as a recent ban on food dyes in Republican-controlled West Virginia. “Ultimately, what health care looks like and what options you have for care depend on which state you live in.”
Abortion and gun laws vary widely by state
Vaccines mark just the latest policy divide between Democratic- and Republican-led states.
Following the Supreme Court’s reversal of Roe v. Wade in 2022, a patchwork of abortion laws emerged across the country. The same has largely been true for guns for years, with states enacting a variety of laws that span the spectrum from open carry to assault weapon bans.
But the gap on those two issues has only grown during President Donald Trump’s second term.
In the years since Roe was overturned, various blue states looking to protect reproductive rights have implemented “shield laws.” Those laws essentially bar state officials from cooperating with investigations conducted by other states where abortion is illegal or restricted in cases where patients may have been prescribed abortion pills by mail.
And now, New York and Texas are waging legal battles against each other over those laws. Texas Attorney General Ken Paxton has sued a New York physician for allegedly prescribing pills for a medication abortion to a patient in his state, alleging that the doctor violated Texas’ near-total abortion ban. In addition, Texas Republicans this past week enacted a new law that increased the penalties that private citizens in the state can demand in lawsuits against out-of-state prescribers and distributors of abortion pills.
The issue of guns continues to percolate, too. Blue states have increasingly pursued gun restrictions in recent years, while Republican-led ones have largely pursued the opposite.
In Minnesota, Democratic Gov. Tim Walz is expected to convene a special legislative session focused on increasing gun safety in the coming weeks, following a shooting last month at a Catholic school that left two children dead, as well as the June assassination of state Rep. Melissa Hortman and her husband.
Meanwhile, Republican officials in Florida this week requested that prosecutors in the state no longer enforce an open-carry gun ban following a court ruling finding it unconstitutional.
And on immigration, some Republican-led states have enacted sweeping policies this year intended to bolster the Trump administration’s agenda. Earlier this year, Florida Republicans ended in-state tuition benefits at public universities for undocumented immigrants, while Tennessee and several other states established state immigration enforcement offices intended to aid federal immigration officials.
Conversely, blue states with cities that have implemented so-called “sanctuary” policies, like Los Angeles, have seen National Guard troops called in by Trump. Trump has also called in National Guard troops to Washington, D.C., citing high crime, even though he didn’t do so for nearly all of the cities with the highest crime rates, according to government data.
While the lack of state-to-state policy consistency on hot-button political issues isn’t a fresh or novel concept, the growing divide “just creates so much uncertainty,” said Brandon Scholz, a Republican strategist in Wisconsin, where ideological swings on the state Supreme Court and in the governor’s office over the past decade have resulted in seesawing policies on issues like reproductive rights and legislative maps.
“When you want to turn control back to the states” — a mantra used frequently by conservatives — “you’re going to have a patchwork, a quilt of policies,” Scholz said, describing the laboratory aspect of that approach.
“But it’s gotten to the point where it’s just so heavily [tied to] whoever holds the keys to the clubhouse — who is going to say, ‘Here’s what is allowed to happen and here’s what’s not,’” Scholz added.