What Coalitions Need to Counter Preemption: A Strategic Assessment of RWJF’s Preemption Work


Project Overview


To evaluate the impact of Robert Wood Johnson Foundation (RWJF) support to national organizations that work with state-level coalitions opposing preemption, identify opportunities to further support policies that promote health equity, and advise RWJF’s future investment to further oppose preemption.

Project Motivation

RWJF expanded its preemption strategy to combat a growing threat of state-level preemption -  the suppression of local-level policies that aim to address social determinants of health and promote health equity.

Prepared For

The Robert Wood Johnson Foundation

Building a national movement to counter state-level preemption policies which negatively impacts health equity requires an ecosystem of organizations who can provide strategic funding and technical assistance to support the efforts of state coalitions.

Preemption is a legislative or regulatory action a state or federal government enacts to eliminate or reduce the authority of a lower level of government over a given issue. In recent years, state-level pre-emption has been wielded as a tool to suppress local-level policies that aim to promote equity and address disparities in the social determinants of health. To better understand how to combat these policies, we interviewed 50 preemption stakeholders, including members of state-level coalitions opposing preemption in nine states, comprised of both health and non-health advocates as well as grassroots and grasstops organizations; and national organizations that support these state-level efforts, including organizations receiving support from RWJF.

Our assessment findings indicated that these RWJF-funded grantees provided key support to further the efforts of coalitions to oppose preemption policies. However, despite some progress, coalitions reported the need to develop a more comprehensive approach to effectively counter preemption. We identified 5 strategic areas that require more investment:

  • Preemption coalition formation
  • Legislative/policy advocacy strategies
  • Litigation strategies
  • Base-building/public outreach
  • Electoral strategies

National organizations can support state-level coalitions through funding and technical assistance to further this work. In furthering this work, organizations should consider an approach which shifts power to those most impacted. This includes: 

  • Centering leadership of efforts with communities most impacted
  • Prioritizing issues important to historically marginalized communities
  • Using equity as a factor in coalition decision-making

Please find two policy briefs that summarize the assessment's key findings below.

Related Staff

Drew Koleros

Drew Koleros

Senior Researcher

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