Nearly two dozen of the 120 ballot measures before voters Tuesday had implications for health care, with tobacco, cannabis, and abortion among the key issues.
All five states with cannabis on the ballot voted in favor of the initiatives, while other measures faced mixed results. Colorado voters rejected an anti-abortion initiative, while Louisiana voters approved language clarifying that the state constitution does not protect abortion rights.
Earlier this year, two states voted in favor of expanding Medicaid eligibility in separate initiatives. Missouri passed a constitutional amendment that would expand Medicaid in August, and Oklahoma passed its expansion initiative in June.
As cannabis initiatives swept all five states where they appeared on the ballot, Arizona, New Jersey and Montana legalized marijuana for adult use.
Mississippi approved medical marijuana despite an effort by some state legislators to throw a wrench into things by proposing a much more limited alternative ballot proposal.
And in a first, South Dakota approved two initiatives on the same ballot to legalize medical and adult use marijuana markets.
New Jersey’s ballot initiative could spur nearby states like New York to action, given an effort by northeastern governors to harmonize their approaches to marijuana. But the details have to be sorted out by the state legislature before sales can begin.
The big story when it comes to drugs may be in Oregon, where voters decriminalized possession of all drugs except in substantial amounts, calling for small fines as penalties for smaller amounts.
Kassandra Frederique, executive director of the Drug Policy Alliance, the group behind the measure, said it’s the “biggest blow to the war on drugs to date” and hopes it will convince other states to follow suit in the same pattern as marijuana legalization. Oregon was the first state in the United States to decriminalize cannabis in 1973.
According to the Oregon Criminal Justice Commission, drug possession arrests are expected to fall dramatically: from 6,700 annually to 615. The representation of Black Oregonians in drug arrests is expected to fall by 95 percent.
The District of Columbia also voted to decriminalize psychedelic mushrooms, which can be used in spiritual practices and have shown clinical potential in people with depression, anxiety and substance use disorders, though some researchers say more studies are needed.
Two states introduced taxes on vaping products and e-cigarettes this year, as efforts by congressional Democrats to curb their popularity with young people have faltered on Capitol Hill.
In Colorado, voters approved Proposition EE to begin taxing e-cigarettes and vaping products and steadily hike taxes on all tobacco products. By 2027, vaping products will be taxed at a 60 percent rate, and cigarette packs will be $1.80 more expensive. The state expects the measure to be a big revenue booster. The new cigarette taxes are expected to take in $175.6 million by the next budget year.
The initiative could also have the effect of making the market for cigarettes less competitive. Discount cigarette makers like Liggett Group, Vector Tobacco and XCaliber International have accused legislators of cutting a backroom deal with tobacco giant Philip Morris. The proposal sets a minimum price for a pack of cigarettes, which will make it more difficult for lesser-known brands to compete, they alleged in an October lawsuit.
Oregon has likewise approved a ballot initiative that introduces a 65 percent tax on e-cigarettes and vaping products. The ballot measure also doubles taxes on cigars to $1 each, and tacks on an extra $2 in cigarette taxes, from $1.33 to $3.33 per pack. The revenue from cigarette taxes are expected to jump from $115 million from 2019-2021 to $350 million from 2021-2023.
Meanwhile, Oklahoma voted against directing a greater percentage of the funds collected from tobacco companies through the 1998 Master Settlement Agreement away from smoking cessation programs and toward Medicaid.
Voters in Colorado and Louisiana took different approaches on ballot initiatives that would place restrictions on abortion. The initiatives come at a time when advocates have pushed for increased attention on the issue as it is expected the Supreme Court may take on a case related to abortion with the addition of Justice Amy Coney Barrett.
Colorado voters rejected an initiative that would add restrictions to abortion based on the fetus’ gestational age and would have effectively banned the procedure after the mother is 22 weeks pregnant.
Carolyn Ehrlich, a senior political strategist at the American Civil Liberties Union, said the defeat of the measure is essential for Coloradans as well as those who travel from other states to receive care.
“We are in a critical moment in the fight for reproductive freedom, and every organizer, volunteer, and voter should be proud of how their work will protect abortion rights in Colorado and beyond,” she said.
Louisiana voters overwhelmingly passed a constitutional amendment that would say there is no right to abortion in the state constitution. Similar amendments passed in 2018 in Alabama and West Virginia.
Other results in three states touched in issues ranging from kidney dialysis to sex education.
California voters passed an initiative that would issue $5.5 billion in bonds for stem cell research in the state. The state also rejected an initiative that would add additional requirements to dialysis clinics. Clinics would need one physician on site during all operating hours and require permission from the state to close operations. It would also prohibit discrimination based on insurance type.
In addition to the abortion initiative, Colorado residents passed an initiative that would establish a paid medical and family leave program. The program would provide 12 weeks of paid leave funded through a payroll tax.
In Washington state, voters approved a referendum that would require teaching comprehensive sexual health education to all public school students.
Results had not yet been announced for a legislatively referred constitutional amendment in Washington that would authorize investment of funds related to long-term services. Proponents said this investment will help to ensure that long-term care is fiscally feasible in the long term.