Health-related ballots in the midterm elections

Much of the attention surrounding this year’s midterm elections concerned the candidates, but in addition to electing representatives, citizens also had the opportunity to vote on ballot measures. These questions appear on ballots to be approved or rejected by voters in an example of direct democracy.

This November, there were over 150 such measures across 37 states. They concerned topics from gun control to the voting rights of felons, and several were health related.

Medicaid expansion appeared on the ballots in four states: Idaho, Montana, Nebraska and Utah. In Idaho, voters voted to expand Medicaid eligibility to individuals under the age of 65 who have an income of 133 percent of the federal poverty level or lower. Nebraska and Utah affirmed similar initiatives, though the threshold for eligibility was at or below 138 percent of the federal poverty line.

Montana was the only state to reject an expansion of Medicaid eligibility, although their initiative included an increase of taxes on tobacco products in order to fund the expansion. That aspect of the initiative meant that it was subject to fierce lobbying by tobacco companies, who spent at least $17 million to oppose the measure.

An increase of taxes on tobacco products was also rejected in South Dakota, where voters rejected a measure that would have raised taxes on cigarettes and wholesale tobacco products, with a portion of the resulting revenue intended to support technical institutes.

Similar to Medicaid expansion, marijuana legalization, which was voted on in various forms in Michigan, Missouri, North Dakota and Utah, went three for four. Michigan affirmed a proposal to legalize marijuana, including for recreational use. In Missouri and Utah, marijuana was legalized for medical use. In North Dakota, voters rejected a measure to legalize the substance for recreational use and expunge the records of individuals with marijuana-related convictions.

In Massachusetts, voters supported the upholding of Senate Bill 2407, which provides protections for transgender individuals. The bill prohibits discrimination based on gender identity in public places, including restaurants and hotels, and was signed into law in 2016 – had the ballot measure been rejected, it would have meant the repeal of the law.

Abortion was another hot-button issue to appear on ballots. In West Virginia, voters approved an amendment stating that the West Virginia Constitution does not protect the right to an abortion or require funding for abortion services. A similar amendment approved in Alabama included additional language regarding the sanctity of unborn life.

Other health-related measures covered issues concerning EMTs and paramedics, dialysis clinics, nurses, medical equipment, and feminine hygiene products.

In California, voters approved $1.5 billion in bonds to go toward children’s hospitals. Another proposition concerning EMTs and paramedics was also approved. It allows employers to require that ambulance workers stay on-call during breaks, and it also requires employers to provide personnel with additional training and some paid mental health services.

A third health-related proposition in California was defeated, which would have required dialysis clinics to refund patients who were charged an amount more than 115 percent of the costs of patient care.

Massachusetts voters defeated an initiative which would have set limits on how many patients could be assigned to registered nurses working in a hospital.

Voters in Nevada considered two questions related to taxes and health products, both of which were approved.

One of the topics exempts physician-prescribed medical equipment, including mobility devices and oxygen tanks, from sales and use tax. The other exempts feminine hygiene products from sales taxes both on the state and local levels.

With the approval of this measure, Nevada joins nine other states as well as the District of Columbia, which provide sales tax exemptions for feminine hygiene products.

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