Many citizen ballot measures passed into law in recent years involved issues within health care or public health, a study says.
Photo by Drazen Zigic, courtesy iStockphoto
When voters step up to the ballot box this November to make their choices of candidates for political office, they will also likely be asked to weigh in on measures that could affect their state’s health.
Forty-one states will have policy measures on November ballots, encompassing issues such as civil rights, the environment, health care and elections, according to the Ballot Initiative Strategy Center.
Ten states have ballot measures on reproductive freedom, the highest ever in a single year. The increase is linked to the 2022 decision by the U.S. Supreme Court to overturn the constitutional right for abortion, resulting in policies that have threatened access to health and reproductive care.
This year, two states have reproductive freedom measures sponsored by legislatures, while eight states have citizen ballot measures, most seeking to amend a state constitution to protect access to abortion care.
Montana collected over 81,000 signatures, or 10.5% of the state’s registered voters, for a citizen ballot measure that would amend the state constitution to allow reproductive freedom. The Montana initiative relies on precedent from a 1999 state Supreme Court ruling involving the constitutional right to privacy. If passed, Montana’s constitution will guarantee reproductive choice, including abortion access.
“People don’t want the government to restrict their right to get medical care that people have relied on for generations in the U.S., and ballot measures are a way to put those values into policy,” Sam Dickman, MD, chief medical officer of Planned Parenthood of Montana, told The Nation’s Health.
Amending state constitutions to guarantee reproductive freedom is a strong strategy in states such as Montana where legislatures do not support abortion rights, said Paula Lantz, PhD, MA, MS, professor of diversity and social transformation at the University of Michigan’s School of Public Policy.
“It really protects against the legislature passing very restrictive abortion laws,” Lantz told The Nation’s Health.
Other November ballot measures address topics such as economic justice, paid sick leave, workers’ rights and wages, and affordable housing.
Alaska and Missouri residents will consider broadening paid sick leave and an increase in minimum wage, while Nebraskans will consider paid sick leave. California has a ballot measure on expanding rent control on residential property and raising minimum wage.
Several states have measures on recreational use of marijuana and broadening gambling. Nebraska has two citizen-initiated measures on abortion: one supports choice while others would ban abortion in the second and third trimesters of pregnancy.
While citizen-initiated initiatives are a way to turn majority public opinion into policy, barriers are also being constructed by some state legislatures to derail the attempts.
Organizing a statewide ballot campaign takes time, organization and money, but the bar has been raised even higher in some states by requiring more signatures and demanding signature representation from more counties for initiatives to make ballots.
The most common ballot initiatives over the last decade have come from legislatures, which do not always reflect the interests of the majority of voters. Citizen-initiated measures and constitutional amendments accounted for only about 22% and 5% of initiatives over the past 10 years, according to a review co-authored by Lantz in September’s issue of Health Affairs.
Still, ballot measures offer a viable path for “direct democracy,” Lantz said. Of the 139 successful citizen-initiated statewide measures over the last decade, 76% were related to health care, public health or social determinants of health. Issues included abortion care, health equity, firearm safety, environmental exposures, affordable housing and worker rights.
“There have been significant polices implemented that are good for public health and that would not have been passed in legislatures that can’t get anything done,” Lantz said.
For more on measures on the November ballot, visit www.ballotpedia.org.
- Copyright The Nation’s Health, American Public Health Association
