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Health care issues have been noticeably taking center stage in the 2024 presidential race with bountiful policy-talk from both sides about reproductive health care, the Affordable Care Act (ACA), and prescription drug prices. Many states also have health care related ballot initiatives including abortion access and legalization of recreational marijuana. Reproductive Health Care At least 11 states will be voting on initiatives related to reproductive health care:

• Nebraska will vote on two competing constitutional amendments: one to enshrine the state’s current ban on abortions after 12 weeks’ gestation, and another to expand access to abortion care to the point of viability (typically 24 weeks). Both ballot initiatives include exceptions for abortions beyond their proposed limits for cases of medical emergencies, rape, and incest.
• South Dakota will vote on a constitutional amendment to establish the right to an abortion for only the first trimester with exceptions for later pregnancies.
• Arizona, Florida, Missouri, Montana, and Nevada will vote on amendments to guarantee the right to abortion care to the point of viability with exceptions for later pregnancies.
• Maryland will vote on a similar amendment to guarantee access to reproductive health care, defined to also include abortion care.
• Colorado will vote on a constitutional right to abortion care that also repeals a provision banning the use of public funds for such procedures.
• New York will not be voting on abortion rights, but rather on whether to include “pregnancy, pregnancy outcomes, and reproductive healthcare and autonomy” to the list of protected classes in antidiscrimination legislation that also includes, race, sex, or sexual orientation, to name a few. This amendment will make it unlawful for someone to be discriminated against based on whether they are pregnant, lost a pregnancy, or terminated a pregnancy.
• Illinois will be voting to decide whether “all medically appropriate assisted reproductive treatments” – which includes in vitro fertilization – should be covered by any health insurance plan that provides coverage for pregnancy related services.

Legalization of Marijuana Following the trend of marijuana legalization we have seen in the last several years, five states will be voting this Tuesday on issues related to marijuana and psychedelic use.

• Florida, North Dakota, and South Dakota will be voting to legalize the recreational or personal use of marijuana.
• Nebraska will be voting to legalize marijuana for medical purposes and, on a separate initiative, to establish the Nebraska Medical Cannabis Commission tasked with regulating the state’s medical marijuana program.
• Massachusetts will be voting on an initiative to allow adults 21 years or older to grow, possess, and use natural psychedelic substances, and to establish a commission to regulate the licensing of psychedelic substances and services.

Other Health Care Issues

• California will be voting on a pair of propositions related to health care: Prop 35 would permanently authorize a tax on managed care plans with revenues to be used to help fund Medi-Cal services. Prop 34 would require providers who spent over $100 million over a ten-year period on anything other than direct patient care and who operated multifamily housing with over 500 severe health and safety violations, to spend at least 98% of their revenue from federal prescription drug discount programs on direct patient care. Prop 34 also authorizes the state to negotiate drug prices under Medi-Cal.
• Washington state will vote on an initiative to require individuals to opt into coverage under the state’s long-term care services and allows individuals to opt out of long-term coverage at any time.