One issue that's yet to be raised is that following injurious accidents, there are frequently lawsuits. In these lawsuits, phone records of texts sent and received are often used as evidence. The problem here is that the Apple Watch, using the "Hey Siri" function, can send a text without the user's physical input. However, because the Watch sends the text through the cell phone, this action could still be considered texting and driving based solely on the phone records.
This puts lawmakers at a crossroads. Should this once definitive piece of evidence be no longer admissible, since the use of Bluetooth-enabled, hands-free devices (e.g., the Apple Watch) while driving is legal in most states? The alternative is a ban on all mobile communications while driving, or, at the very minimum, text messaging in all its manifestations (physical or hands-free).
I'm honestly hoping we'll see the second option pan out. As others have hinted, the use of any mobile device, hands-free or not, while driving impairs attention. Secondly, mobile phone records are the most definitive proof of negligence related to cell usage behind the wheel. If they no longer became admissible, then distracted drivers could perhaps not be proven guilty without a doubt (a cornerstone of the American judicial system), and their injured victims may not be able to receive as much compensation as they deserve in a lawsuit.
To completely solve the problem, I think we'd have to ban all non-emergency communications while anyone is traveling at >10 mph and yes, that means passengers in cars and trains won't be able to use their phones.