US General Election State-Level Ballot Measures and Legislative Implications for LGBTQ+ Health

Importance: The results of the 2024 US general election highlight both progress and potential threats to the health of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) populations. Understanding the scope and potential implications of these measures is critical for developing public health resilience strategies that promote equitable access to care for all individuals. Objective: To review 2024 state-level ballot initiatives with potential health implications for LGBTQ+ people and to highlight strategies for strengthening public health resilience against anti-LGBTQ+ legislation. Evidence Review: Using the National Conference of State Legislatures (NCSL) database, 154 records from the 2024 US general election were screened. Following coauthor consensus, 101 records were excluded based on their NCSL topic and/or unclear relationship to LGBTQ+ health. Fifty-three ballot measures were assessed for eligibility; 13 were excluded for having only perceived indirect or upstream implications for LGBTQ+ health; and 18 were excluded for not aligning with the primary domains identified by coauthor consensus: (1) reproductive health and abortion access; (2) gender-affirming care; (3) access to HIV and other sexually transmitted infection prevention, testing, and treatment; (4) marriage and family planning; and (5) mental health. Findings: Of 154 state-level ballot measures from the 2024 US general election, 22 (14%) were recognized as potentially having noteworthy health implications for LGBTQ+ communities across 5 domains. The majority of identified ballot measures (18 measures [81.8%]) were protective. The remaining were harmful (3 measures [13.6%]) or had a limited scope of implications (1 measure [4.5%]). Most protective measures (14 measures [77.8%]) passed. Four protective measures (22.2%) failed, and 2 of 3 harmful ballot measures (66.7%) passed. Conclusions and Relevance: In the 2024 general election, most state-level legislation that could have health implications for LGBTQ+ individuals and communities was protective. Of all proposed legislation, most passed.