Use this button to switch between dark and light mode.

Voters Weigh in on Abortion, Other Health-Related Issues

November 18, 2022 (6 min read)

Along with deciding which party will control Congress and many state legislative chambers next year, voters across the country also weighed in this month on over 100 ballot measures. A number of those measures dealt with abortion and other health-related issues that helped shape the general course of the election.

Voters Ponder Record Number of Abortion Measures

As one of the most divisive issues in American politics, abortion has featured prominently in U.S. elections for decades. But this year - in the wake of the Supreme Court’s decision overturning Roe v. Wade - voters considered a total of six abortion-related measures, the most ever, according to the National Conference of State Legislatures.

In California (Proposition 1), Michigan (Proposal 22-3) and Vermont (Proposal 5), voters enshrined the right to reproductive freedom into their state constitutions. In Montana, meanwhile, voters rejected LR-131, which would have required medical professionals to provide care for infants born alive during abortion procedures and made those who failed to do so subject to punishments of up to $50,000 in fines and 20 years in prison. And in Kentucky - where voters elected Republican U.S. Sen. Rand Paul to a third term by a nearly 24-point margin (61.8 percent to 38.2 percent) - a measure (Amendment 2) declaring that the state’s Constitution doesn’t include a right to abortion failed on a 47.6 percent to 52.4 percent vote. (Kansas voters also rejected an anti-abortion measure in the state’s Aug. 2 primary.)

Backlash over the Supreme Court’s abortion ruling appears to have helped Democrats defy pre-election expectations and recent history dictating that the party of the president usually suffers big losses in Congress and statehouses in the midterms. Exit polling indicated that abortion was the most important issue for nearly half of voters in Michigan, where Democrats took control of both chambers of the Legislature and re-elected Gretchen Whitmer governor, “giving the party a trifecta of power in the state for the first time in 40 years,” as the New York Times reported. In Pennsylvania, where the exit polls indicated abortion was the top issue for voters overall, a staunchly pro-choice Democrat claimed a Republican-held U.S. Senate seat, allowing Democrats to maintain control of the chamber.

The election results also suggest the battle over abortion isn’t over. Since the Supreme Court issued its abortion ruling in June, Michigan’s abortion measure was the only one that came to the ballot via the initiative process, according to the Initiative and Referendum Institute. All the other measures were placed on the ballot by their respective legislatures. But the Institute said “we can expect to see activists on both sides try to qualify them in the future, especially if legislatures stray too far away from citizen preferences on the issue.”

Many Other Health-Related Issues on the Ballot

In addition to abortion, a range of other health-related issues were on state ballots.

In Oregon, voters appear to have narrowly approved a measure making their state the first in the nation to establish a constitutional right to affordable healthcare (Measure 111). As of late Thursday (11/17) the vote stood at 50.6 percent to 49.4 percent, with 99 percent reported. Chris Stout, an associate professor of political science at Oregon State University, said the measure didn’t have as much support as some other measures on the ballot due to “convoluted language” and a lack of clarity about “where the money would come from to pay for the affordable health care for all.”

Voters in Arizona seemed to have much more certainty about Proposition 209, a ballot measure that would limit the amount of interest that can be charged on medical debt. The measure was passing 72 percent to 28 percent, also with 99 percent of the vote counted. Supporters touted it as a way to keep those with medical debt out of bankruptcy and poverty, while opponents said it was too broad and might actually end up making it harder for working residents to obtain loans, according to the Arizona Republic.

Massachusetts voters were also overwhelmingly approving a measure requiring dental insurers to spend at least 83 percent of the premiums they collect on direct care (Question 2), with the vote standing at 71.5 percent to 28.5 percent. The Kaiser Family Foundation reported that the state would be the first to impose such a medical loss ratio for dental insurance plans.

A measure was approved in South Dakota expanding eligibility for Medicaid (Constitutional Amendment D), making the state the seventh where voters have circumvented opposition to Medicaid expansion from Republican governors and state legislatures. That leaves just 11 states that haven’t expanded the program to those earning up to 138 percent of the federal poverty level, although that list includes the populous states of Florida, Georgia and Texas.

Colorado voters approved a measure (Proposition 122) making the state the second, after Oregon in 2020, to legalize the use of psilocybin mushrooms. The measure actually decriminalizes the possession and use of multiple psychedelic “natural medicines,” including dimethyltryptamine (DMT), ibogaine, mescaline and psilocybin, for those 21 and older. It also provides for “healing centers” for the supervised administration of the newly legalized substances.

Backers of the measure called its approval a “truly historic moment.”

“Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal,” they said in an emailed statement, as the Colorado Sun reported.

Finally, voters in California rejected a measure that would have required the state’s 600 outpatient kidney dialysis facilities to have a licensed medical professional on site when providing treatment (Proposition 29). Dialysis providers said that with most clinics open 16 hours a day, the measure would have required two to three doctors per facility, which would have been a financial burden that could have forced some clinics to close and made it more difficult for patients to get treatment, as the Associated Press reported.

The AP also noted the measure marked the third consecutive general election in which the state’s voters rejected dialysis industry regulations, and it was one of the most expensive ballot contests in the state’s history, with both sides collectively spending over $90 million.

California voters also approved a referendum (Proposition 31) on legislation enacted in 2020 banning the sale of flavored tobacco and vaping products (SB 793), thereby upholding that law. But the law now faces another hurdle. The day after the election R.J. Reynolds and other tobacco companies filed a federal lawsuit challenging it.

The tobacco companies contend the federal Tobacco Control Act preempts California SB 793.

California’s “ban falls under the TCA’s express preemption clause, which preempts ‘any [state] requirement’ that is ‘different from, or in addition to,’ a federal requirement about a tobacco product standard,” their lawsuit states. “A flavor ban is a paradigmatic tobacco product standard.”

That argument is the same one R.J. Reynolds used when it challenged Los Angeles County’s ban on flavored tobacco products in 2020, according to Courthouse News Service. That lawsuit was dismissed, and the Ninth Circuit Court of Appeals upheld that decision earlier this year.


Please visit our webpage for more information on the bills mentioned in this article, or to speak with a State Net representative about how the State Net legislative and regulatory tracking solution can help you react quickly to relevant legislative and regulatory changes.



Abortion Measures Draw Voter Support After SCOTUS Ruling

Voters considered a record six abortion-related ballot measures this year, in the wake of the Supreme Court’s decision overturning Roe v. Wade. On Nov. 8 voters in three states - California, Michigan and Vermont - enshrined the right to reproductive freedom into their state constitutions, while voters in two others - Kentucky and Montana - rejected anti-abortion measures. Kansas voters also rejected an anti-abortion measure in the state’s Aug. 2 primary.


News & Views from the 50 States

Free subscription to the Capitol Journal keeps you current on legislative and regulatory news.