Ballot initiatives include cannabis, insurance measures

A number of states will vote on ballot measures related to substance use, insurance and other health-related issues on Nov. 5 — in addition to the 11 abortion-related measures before voters.

The health-related initiatives cover a range of topics.

California, South Dakota and Illinois voters will be asked about changes to insurance programs, while New Mexico, Nevada and Washington state will weigh changes related to care facilities.

Four states — Florida, South Dakota, North Dakota and Nebraska — will consider different cannabis legalization efforts, while California and Arizona voters will weigh in on changing drug-related penalties.

West Virginia will also vote on an initiative that asks voters if they favor prohibiting medically assisted suicide and euthanasia in the state constitution. Both chambers of the state legislature voted in March to place the measure on the ballot.

“I think that’s going to be big. That’s something folks are watching very closely, because this will be the first state that’s worked to put something in to ensure that there’s constitutional protections against physician-assisted suicide,” said Peter Northcott, director of state strategies for the National Right to Life.

Medical or physician-assisted death is legal in 10 states and Washington, D.C., for terminally ill patients who seek aid in being prescribed lethal medications. Euthanasia is illegal nationwide and refers to a provider administering the lethal medication to the patient.

Insurance

South Dakota’s Medicaid initiative, if passed, would seek to impose Medicaid work requirements on eligible individuals who have not been diagnosed with a physical or mental disability. The state previously submitted a waiver for a work requirements pilot program in 2018 that was never approved.

South Dakota expanded Medicaid in 2022 by ballot measure to cover more low-income, childless adults.

While work requirements are popular among Republican legislators, if the ballot initiative is approved, such requirements would have to be approved by the federal government, a move which would be unlikely were Democrat Kamala Harris elected president.

California will vote on Proposition 35, which would permanently authorize a tax on managed health care insurance plans and reserve revenue for Medicaid services.

And Illinois will vote on a measure on whether to advise elected officials to provide coverage for assisted reproductive treatments like IVF, though all health plans in Illinois currently cover pregnancy benefits. Unlike most other state initiatives, this is nonbinding.

Care services

Two states could see changes to how senior and long-term care is funded.

In New Mexico, Bond Question 1 would authorize the state to issue up to $30 million in bonds to fund senior citizen facilities. Washington’s Initiative 2124 would require people to opt in for coverage under the state’s new long-term services and support health care program, which is funded by a payroll tax and was approved under a previous ballot initiative.

In addition, California voters will choose whether to require health care providers spending more than $100 million in a 10-year period on anything other than direct patient care, and who have operated multifamily housing with more than 500 severe health and safety violations, to spend 98 percent of their 340B Drug Pricing Program discounts on direct patient care.

It has been dubbed the “revenge measure” by opponents, who note the proposition is backed by the California Association of Realtors and appears to target the AIDS Healthcare Foundation, which has backed three state rent-control measures.

State campaign finance data shows that opponents and proponents of the measure have raised $48.2 million as of filings through Oct. 19.

Nevada voters will consider updating language in the state constitution for public entities that serve individuals with mental illness, blindness or deafness.

Drug policies

A handful of states will vote on whether to legalize cannabis or psychedelics.

Recreational cannabis use is currently legal in 24 states, and this year Florida, South Dakota and North Dakota hope to add to that as voters in those states will vote on adult-only legalization measures. Nebraska voters will decide on two medical cannabis legalization initiatives.

Medical marijuana is currently legal in 38 states and the District of Columbia.

For the Florida initiative to pass, it will require 60 percent of the vote. Nebraska’s initiatives will require a simple majority as well as court approval.

South and North Dakota will be reattempting to pass failed legalization efforts from the 2022 midterms. Both states require a simple majority for passage.

Voters in Massachusetts will vote on whether to legalize plant-based psychedelic drugs, like psilocybin mushrooms, for people ages 21 and older. If approved, Massachusetts would be the third state in the country to legalize such substances, along with Oregon and Colorado.

In addition, two states will vote on whether to increase some drug-related penalties.

California’s Proposition 36 would classify certain drug offenses as felonies that require drug treatment. It would also increase penalties for certain drug crimes and require courts to warn individuals convicted of distributing illegal drugs of future potential criminal liability if they distribute deadly drugs.

Arizona is voting on Proposition 314, which would make it a felony to knowingly sell fentanyl if the drug results in another person’s death.

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(Sandhya Raman contributed to this report.)

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