While most eyes are on the presidential election results, voters in many states will also decide on health policy changes via statewide initiatives or ballot proposals. This year's proposals range from marijuana and medical marijuana legalization to Medicaid expansion funding.
Below, we round up the results of key health care ballot proposals considered in the 2020 general election.
- Louisiana's Constitutional Amendment 1 passed. The measure states that the Louisiana Constitution does not protect abortion as a right and, therefore, the state is not required to fund it.
- Colorado's Proposition 115 failed. The measure would have banned abortion after 22 weeks' gestation (as calculated from the start of the woman's last menstrual period) except in cases in which "an abortion is immediately required to save the life of a pregnant woman."
Marijuana and psychedelic drugs on the ballot
- Mississippi's Ballot Measure 1 passed. The measure details 22 conditions, including cancer and PTSD, that would qualify for medical marijuana use, sets possession limits for individuals of up to 2.5 ounces, and imposes a state sales tax on marijuana of 7%. The measure also will set the cost of a medical marijuana card at up to $50 and charges the Mississippi Department of Health with developing distribution regulations. The measure is slated to take effect by August 2021.
- South Dakota's Initiated Measure 26 passed. The measure creates a medical marijuana system for patients with debilitating medical conditions. Under the initiative, patients will be able to possess up to three ounces of marijuana and grow at least three plants, depending on their physician's recommendation. The state Department of Health will be tasked with setting up distribution regulations. The measure is slated to take effect July 1, 2021.
- Arizona's Proposition 207 passed. The measure legalizes marijuana possession and use for adults at least 21 years old. The ballot measure will enable eligible individuals to grow up to six cannabis plants and will place the Arizona Department of Health Services in charge of licensing and regulating marijuana businesses. The ballot, which will impose a 16% tax on marijuana sales, also allows individuals convicted of marijuana-related offenses to petition to have those charges expunged from their criminal records, beginning July 12, 2021.
- Montana's constitutional amendment, CI-118, passed. The amendment will let the state Legislature or a ballot initiative set a legal age for marijuana use. In addition, Montana voters approved a statutory measure, I-190, that will allow adults at least 21 years old to possess and use marijuana. The measure also makes it legal for individuals to grow up to four marijuana plants and four seedlings for personal use. The measure will impose a 20% tax on marijuana sales and charge the state's Department of Revenue with setting up and regulating a commercial system for growing and selling marijuana. The measure is scheduled to take effect in phases, with some provisions taking effect Jan. 1, 2021, and others taking effect Jan. 1, 2022.
- New Jersey's Public Question 1 passed. The measure amends the state's Constitution to legalize the possession and use of marijuana for adults at least 21 years old, as well as the growing, sale, and processing of marijuana for retail. The measure tasks the state's Cannabis Regulatory Commission with regulating the legal system for marijuana production and sales and requires the state's Legislature to set regulations related to marijuana use, growing, and sales. The measure also applies the state's 6.625% sales tax to recreational marijuana and allows the New Jersey Legislature to permit local sales taxes up to an additional 2% on recreational marijuana. The amendment is slated to take effect on Jan. 1, 2021.
- South Dakota's Constitutional Amendment A passed. The measure legalizes marijuana use for adults at least 21 years old and permits such individuals to possess or distribute up to one ounce of marijuana. The measure also will allow individuals to grow up to three cannabis plants if they live in a jurisdiction with no licensed marijuana retailers and will impose a 15% tax on marijuana sales. The measure also requires the state legislature to pass laws to legalize medical marijuana and hemp sales by April 1, 2022. Under the amendment, local governments are permitted to ban marijuana cultivation, sales, and other related activities.
- Oregon's Measure 109 passed. The measure allows patients ages 21 and older to legally purchase psilocybin mushrooms, also known as magic mushrooms, under the supervision of trained facilitators at "psilocybin service centers." Under the measure, the Oregon Health Authority (OHA) within two years must establish a program for licensed providers to administer psilocybin mushrooms, as well as any related regulations. OHA will determine who is eligible to be licensed to provide psilocybin mushrooms and the qualifications that must be met to become a licensed provider of the substance.
- Washington, D.C.'s Initiative 81 passed. The initiative instructs police to consider the non-commercial cultivation, distribution, possession, and use of a range of psychedelic plants and fungi as the lowest level of law enforcement priorities. In addition, the initiative asks the D.C. Attorney General and the U.S. Attorney for D.C. to stop prosecuting D.C. residents for engaging with such plants and fungi.
Tobacco and vaping
- Colorado's Proposition EE was approved. The measure will raise cigarettes and tobacco taxes in the state by imposing a tax on nicotine products to help fund health and education programs. The taxes will rise incrementally each year from 2021 to July 2027.
- Oregon's Measure 108 passed. The measure will raise taxes on a 20-pack of cigarettes from $1.33 to $3.33 and create a tax on vaping products of 65% of the wholesale sales price. The measure also adds a tax cap on cigars of 65% of the wholesale sales price, not to exceed $1.00 per cigar. The new taxes will take effect Jan. 1, 2021.
- Oklahoma's Question 814 was defeated. The measure would have allocated money from the state's Tobacco Settlement Endowment Fund to support the state's voter-approved Medicaid expansion.
- California's Proposition 14 results unknown. The measure would authorize $5.5 billion in state bonds for stem cell and other medical research for the California Institute for Regenerative Medicine (CIRM). The initiative would require CIRM spend no more than 7.5% of bond funds on operation costs. The remainder would go toward grants spent on companies conducting research, trials, and other programs related to stem cells, as well as start-up costs for some facilities. Some of the funding would be dedicated for certain initiatives, such as $1.5 billion that would have to be spent on research related to therapies and treatments for brain and nervous system conditions, such as Alzheimer's disease, Parkinson's disease, and dementia.
- California's Proposition 23 was defeated. The measure would have imposed new requirements on chronic dialysis clinics, including a requirement that the facilities have a physician on site while patients were treated and that facilities must report dialysis-related infection rates.
- Colorado's Proposition 118 was approved. The measure will create a paid family and medical leave program to provide at least 12 weeks of paid leave and implement certain job protections for individuals who request paid leave. The program will be funded by a payroll tax paid by employers and employees. The program is slated to take effect in 2023.
- Oregon's Measure 110 was approved. The measure makes personal possession of a controlled substance a Class E violation and establishes a substance use disorder treatment and recovery program funded in part by the state's marijuana taxes and savings from state prisons (Lopez, Vox, 11/3; Lopez, Vox, 10/16; North, Vox, 11/3; Facher/Florko, STAT News, 11/3).