LAUSR

Preemption occurs when a higher level of government removes or limits the authority of a lower level of government to act on a particular issue or across issues. The federal government can preempt state and local governments, and states can preempt local control. In 2011, the Institute of Medicine asserted that the federal government and states should avoid preempting public health policies through “ceiling preemption” and instead should set minimum requirements (also called “floor preemption”) to allow localities to provide additional protections. Minimum standards are appropriate to provide baseline support for the entire population and are responsible for some of the most important policy achievements in US history. For example, the federal Civil Rights Act provides baseline protections to certain groups of people but also allows for additional protections by state and local governments (e.g., for LGBTQ [lesbian, gay, bisexual, transgender, or questioning] individuals). Likewise, minimum state standards can provide broad public health protections while allowing communities to address their specific needs. For example, Kansas’s Indoor Clean Air Act provides a floor for secondhand smoke protection across the state and expressly allows communities to enact additional protections. Contrary to the Institute of Medicine’s recommendations, state legislators across the political spectrum are increasingly supporting ceiling preemption (hereafter referred to as preemption) of policies intended to improve community health and address social and economic disparities, including policies related to tobacco control, firearm safety, food and nutrition, paid sick days, minimum wage, fire sprinklers, factory farming, fracking, and LGBTQ civil rights. When state governments prohibit localities from innovating or addressing a topic of importance to their own community, they halt policy experimentation and public health progress and remove voters’ ability to determine the direction of their own communities. This use of state preemption may undermine public health and is our focus here. Industry lobbyists and legislators who support state preemption often use similar arguments across policy issues. Each of these pro-preemption arguments can be countered with evidencebased information revealing that in the vast majority of cases the true motivations for preemption lay elsewhere. Typical arguments in support of preemption are inconsistent with the reality of modern-day preemption, which is advocacy for deregulation of businesses and a retreat from democratic ideals, both of which have dangerous consequences for public health.