November 7, 2018

Medicaid expansion, marijuana legalization, and more: See how states voted on our interactive map

Daily Briefing

    Voters across the country on Tuesday cast their ballots in this year's midterm elections, and the outcomes will have a substantial effect on several states' Medicaid programs and other health care initiatives.

    Voters cast ballots on state Medicaid expansions

    Voters in three states cast ballots to decide whether their states should expand Medicaid under the Affordable Care Act.

    In Idaho, 62% of voters approved Proposition 2, which directs the state to expand Medicaid to individuals with annual incomes up to 133% of the federal poverty line (FPL). Under the measure, the state will expand Medicaid coverage to an estimated 62,000 Idaho residents who currently do not qualify for Medicaid or subsidized insurance from the state's exchange market.

    In Nebraska, 53% of voters approved Initiative 427, which directs the state to expand Medicaid to individuals with annual incomes up to 138% of FPL. Under the measure, the state will expand Medicaid coverage to an estimated 90,000 Nebraska residents.

    Results on Utah's Proposition 3, which would direct the state to expand Medicaid to individuals with annual incomes up to 138% of FPL, were not completely returned as of Wednesday morning. However, according to Ballotpedia, 80% of precincts had reported their results, and 55% of voters in those precincts approved Proposition 3. As such, the Salt Lake Tribune reports that Proposition 3 likely will be approved, meaning Utah will expand Medicaid coverage to as many as 150,000 Utah residents.

    Results for Montana's I-185, which would direct the state to continue its current Medicaid expansion and to raise state taxes on tobacco products to fund it, also were not completely returned as of Wednesday morning, HuffPost reports. According to Ballotpedia, 80% of precincts have reported their results, with 54.6% of voters in those precincts rejecting I-185. The measure is likely to fail, meaning Montana could end its expansion, HuffPost reports. There are currently about 94,000 people enrolled in Montana's Medicaid program under the expansion.

    In Oregon, 61% of voters approved Measure 101, which directs the state to continue implementing taxes on health insurance and hospital revenue to fund its Medicaid expansion.

    Medicaid expansion also was a key issue for voters in several gubernatorial elections. For instance:

    • Florida voters elected Republican gubernatorial candidate Ron DeSantis, who does not support Medicaid expansion;
    • Kansas voters elected Democratic gubernatorial candidate Laura Kelly, who supports Medicaid expansion; and
    • Maine voters elected Democratic gubernatorial candidate Janet Mills, who has said she will implement a Medicaid expansion mandated by voters last year.

    In Georgia, Republican candidate Brian Kemp, who opposes Medicaid expansion, has a one-percentage-point lead over Democratic gubernatorial candidate Stacey Abrams, who supports Medicaid expansion. As of publishing, Abrams had not conceded the race.

    Other health care issues on the ballots

    Medicaid expansion was not the only health care issue at stake in Tuesday's elections.

    In California:

    • 60% of voters approved Proposition 4, which authorizes the state to issue $1.5 billion in bonds to children's hospitals for construction, equipment, expansion, and renovation; and
    • 62% of voters rejected Proposition 8, which would have directed the state to require dialysis clinics to provide refunds to patients and payers if revenue exceeds 115% of the costs of providing care to patients and implementing care improvements; and
    • 60% of voters approved Proposition 11, which allows ambulance providers to require workers to remain on-call during breaks, and requires employers to provide EMTs additional training and some paid mental health services.

    In Massachusetts, results on Question 1, which would allow the state to establish limits on how many hospital patients can be assigned to registered nurses, were not completely reported as of Wednesday morning, but 70% of voters in 40% of reporting precincts had voted to reject the measure, leading media outlets such as WBUR and MassLive to report that the measure has been defeated.

    Meanwhile, 67% of Massachusetts voters approved Question 3, which directs the state to continue implementing a law that prohibits discrimination based on gender identity in public places, including doctor's offices, hospitals, and other medical care sites.

    Results on Maine's Question 1, which would direct the state to create the Universal Home Care Program to provide long-term home health services to elderly and disabled state residents regardless of their incomes, also were not completely reported as of Wednesday morning. However, 63% of voters in 77% of reporting precincts voted to reject the measure, making it likely to fail, WGME reports.

    In addition, results on New Mexico's Bond Question A, which would authorize the sale and issuance of $10.77 million in bonds for senior citizen facilities, were not completely reported as of Wednesday morning. However, 70% of voters in 49% of reporting precincts had voted to approve the measure.

    Elsewhere:

    • 62% of Nevada voters approved Question 4, which requires the state's Legislature to exempt durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed by licensed health care providers from the state's sales and use tax; and
    • 50.2% of Oklahoma voters rejected State Question 793, which would have allowed opticians and optometrists to practice in retail establishments.

    Public health-related measures

    In Washington and Oregon, two similar grocery tax-related measures were up for a vote. In Oregon, 58% of voters rejected Measure 103, which would have prohibited both state and local governments from enacting taxes on groceries. Results on Washington's Initiative 1634, which would have prohibited local governments from enacting taxes on groceries, were not completely returned as of Wednesday morning, but 55% of voters in 64% of reporting precincts had voted to approve the measure, making it likely the measure will pass, the Seattle Times reports.

    While the measures had been framed in ads as supportive to budget-conscious shoppers and small farmers, opponents said the messages were misleading– as their major financial backers were large U.S. beverage companies like Coca-Cola and PepsiCo. Opponents claimed the companies were supporting the measures to stop a growing movement on taxing soda and other sugary drinks.

    In other public health-related initiatives:

    • 69% of Florida voters approved Amendment 9, which prohibits "the use of vapor-generating electronic devices, such as electronic cigarettes, in enclosed indoor workplaces";
    • 65% of Ohio voters rejected Issue 1, which would have directed the state to make drug possession and use liable for no punishment greater than a misdemeanor and require the state to redirect saved funds from the reduction of inmates to drug rehabilitation programs—a move proponents said would help address the opioid epidemic in the state;
    • 56% of Nevada voters approved Question 2, which makes Nevada the 10th state to provide sales tax exemptions for feminine hygiene products; and
    • 55% of South Dakota voters rejected Initiated Measure 25, which would have directed the state to increase taxes on tobacco by $1 per pack of 20 cigarettes and increase the tax on wholesale tobacco products from 35% to 55%.

    Abortion-related measures

    Voters in three states considered measures related to abortion.

    In Alabama, 59% of voters approved Amendment 2, which amends the state's constitution to "recognize and support the sanctity of unborn life and the rights of unborn children, including the right to life," as well as to state that no provisions of the constitution guarantee an individual's right to abortion or require the state to provide funding for abortion care.

    In West Virginia, 52% of voters approved Amendment 1, which amends the state's constitution to state that "nothing in this Constitution secures or protects a right to abortion or requires the funding of abortion."

    In Oregon, 64% of voters rejected Measure 106, which would have prohibited public funding for abortion care except when the care was deemed medically necessary or required by federal law.

    Marijuana-related measures

    Voters in several states also considered ballot initiatives focused on marijuana, both for medical and recreational use. For instance, in Missouri:

    • 65% of voters approved Amendment 2, which amends the state's constitution to legalize marijuana for medical use and implement a tax on marijuana sales that is used to fund health care services for veterans;
    • 68% of voters rejected Amendment 3 which would have amended the state's constitution to legalize marijuana for medical use and implement a tax on marijuana sales that would be used to fund a Biomedical Research and Drug Development Institute; and
    • 57% of voters rejected Proposition C, which would have directed the state to legalize marijuana for medical use and implement a tax on marijuana sales that is used to fund veterans' services, drug treatment, education, and law enforcement.

    Similar questions were on the ballots in Oklahoma and Utah. In Oklahoma, 57% of voters approved State Question 788, which authorizes the state to legalize the licensed growing, possession, and use of marijuana for medicinal purposes. In Utah, 53% of voters in 76% of reported precincts approved Proposition 2, which directs the state to legalize the medicinal use of marijuana for individuals with certain health conditions, meaning the measure likely will pass, Wall St. 24/7 reports.

    In addition, 57% of voters in 71% of reported precincts in Michigan approved Proposal 1, which directs the state to legalize the recreational use and possession of marijuana for individuals ages 21 and older and to tax marijuana sales, meaning the measure likely will pass, Wall St. 24/7 reports.

    In North Dakota, 59% of voters rejected Measure 3, which would have directed the state to legalize the recreational use of marijuana for individuals ages 21 and older and to establish a process to automatically expunge individuals' convictions for possessing a controlled substance that has been legalized (Modern Healthcare, accessed 11/7; Young, HuffPost, 11/7; Wood, Salt Lake Tribune, 11/7; Montana I-85, Ballotpedia, accessed 11/7; Baker, "Vitals," Axios, 11/7; Rohrer/Martin, Orlando Sentinel, 11/6; Terry Ellis, USA Today, 11/7; Diamond, "Pulse," Politico, 11/7; Metz, Palm Springs Desert Sun, 11/7; California Proposition 11, Ballotpedia, accessed 11/7; Massachusetts Question 1, Ballotpedia, accessed 11/7; Bebinger, WBUR, 11/6; Glaun, MassLive, 11/6; Tempera, MassLive, 11/6; WGME, 11/7; Maine Question 1, Ballotpedia, accessed 11/7; KTNV, 11/7; New Mexico Bond Question A, Ballotpedia, accessed 11/7; OU Daily, 11/6; Bach, Salem Statesman Journal, 11/6; Washington Initiative 1634, Ballotpedia, accessed 11/7; Romano, Seattle Times, 11/6; Hancock, Cleveland Plain Dealer, 11/6; Nevada Question 2, Ballotpedia, accessed 11/7; North, Vox, 11/7; KSFY, 11/7; Angell, Forbes, 11/6; Missouri Amendment 3, Ballotpedia, accessed 11/7; Missouri Proposition C, Ballotpedia, accessed 11/7; Ausick, Wall St. 24/7, 11/7; North Dakota Measure 3, Ballotpedia, accessed 11/7; Abrams, Time, 11/7; Alabama Amendment 2, Ballotpedia, accessed 11/7; West Virginia Amendment 1, Ballotpedia, accessed 11/7; Oregon Measure 106, Ballotpedia, accessed 11/7; Belluz, Vox, 11/6; Florida Amendment 9, Ballotpedia, accessed 11/7; Knapp, "Shots," NET/NPR, 7/6; Pear, New York Times, 9/9; Houghton, Bozeman Daily Chronicle, 4/11; Metz, Palm Springs Desert Sun, 11/6; WGME, 11/3; Zhang, Sun Chronicle, 11/4; Dyer, Albuquerque Journal, 10/25; Krehbiel, Tulsa World, 11/4; Loos, KATU, 10/24; Jacobs, New York Times, 11/4; Oklahoma State Question 788, Ballotpedia, accessed 11/6; Utah Proposition 2, Ballotpedia, accessed 11/6; WLWT5, 11/6; Hunt, MYNews4, 10/30).

    Tomorrow: The health care trends you need to know for 2019

    Bradford Koles, Jr., Executive Director

    With a new administration firmly in place, Congress has taken steps to repeal and replace the Affordable Care Act—but the effort remains incomplete. While the political winds continue to shift, executives must set course amid a new wave of health reforms.

    Join me tomorrow at 3 pm ET to hear the 2018 State of the Union, Advisory Board's objective analysis of the most important trends impacting provider strategy today.

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