Health is on the Ballot

While anticipation for the upcoming Presidential and Congressional elections grows as the Nov. 4 election day draws near, several health-related state ballot initiatives will be voted on across the U.S. The most contested health topic that will be on ballots in November is abortion. Ten states have ballot initiatives to determine abortion access policies, with Nebraska having two competing abortion ballot initiatives. The states with abortion ballot initiatives are as follows:

AZ

• Current Policy: Legal up to15 weeks from last menstrual period
• Proposal: Protect right to abortion up to viability and to protect life or health of mother
• Vote: 50+%

CO

• Current Policy: No limit
• Proposal: Recognize right to abortion and repeal law banning state funding of abortions
• Vote: 55+%

FL

• Current Policy: Legal up to 6 weeks last menstrual period
• Proposal: Protect right to abortion up to viability and when necessary to protect mothers’ health
• Vote: 60+%

MD

• Current Policy: Fetal viability
• Proposal: Protect right to abortion including the ability to prevent, continue, or end one's own pregnancy
• Vote: 50+%

MO

• Current Policy: Abortion banned
• Proposal: Protect ability to make and effectuate decisions around reproductive health, including abortion up to viability
• Vote: 50+%

MT

• Current Policy: Fetal viability
• Proposal: Protect right to abortion up to viability
• Vote: 50+%

NE

• Current Policy: Legal up to12 weeks from last menstrual period
• Proposal: Right to abortion until fetal viability or when needed to protect the life or health of the mother
• Vote: 50+%

NE

• Current Policy: Legal up to 12 weeks from last menstrual period
• Proposal: Constitutional amendment to ban abortion in the second and third trimesters, except in medical emergencies or when the pregnancy is a result of rape or incest
• Vote: 50+%

NV

• Current Policy: Legal up to 24 weeks from last menstrual period
• Proposal: Right to abortion until viability or when necessary to protect the life or health of the mother
• Vote: 50+%

NY

• Current Policy: Fetal viability
• Proposal: Amend state constitution equal rights provision to include anti-discrimination protections for pregnancy, pregnancy outcomes and reproductive autonomy
• Vote: 50+%

SD

• Current Policy: Banned
• Proposal: Amend constitution to bar state from regulating 1st trimester, 2nd trimester-- state may regulate decisions on abortion only to reasonably protect physical health of the mother, 3rd trimester-- state may regulate or ban abortion except when necessary to protect health or life of the mother
• Vote: 50+%

Marijuana & Recreational Drugs

Voters in several states will also consider a ballot initiative to make recreational marijuana use legal and Massachusetts will vote on a ballot initiative to make psychedelic drug use legal and to regulate its use. Below are the states considering marijuana or other recreational drug ballot initiatives:

• FL - Legalize the recreational or personal use of marijuana.
• MA - Allow persons 21 years of age or older to grow, possess, and use natural psychedelic substances, as well as establish a commission to regulate the licensing of psychedelic substances and services.
• ND - Legalize the recreational or personal use of marijuana.
• NE - Legalize the medical use of marijuana in the state.
• NE - Establish the Nebraska Medical Cannabis Commission to regulate the state's medical marijuana program.
• SD - Legalize the recreational or personal use of marijuana.

Medicaid

In previous elections, several states used ballot initiatives to consider Medicaid expansion under the Affordable Care Act. To date, all but 10 U.S. states have acted to adopt Medicaid expansion.  While Medicaid expansion is not on any of the 2024 state ballots, South Dakota is considering a ballot initiative that would allow the state to include work requirements on Medicaid beneficiaries.

• SD - Amend the South Dakota Constitution to provide that the state "may impose a work requirement on any person ... who has not been diagnosed as being physically or mentally disabled" for eligible individuals to receive Medicaid under the Medicaid expansion that took effect on July 1, 2023.

Drug Costs

The federal government is not the only government entity acting on drug costs. California is considering a ballot initiative that would require health care providers (interpreted broadly to include hospitals and other health systems) to pass on the benefits from federal drug discounts for prescription drugs.

• CA - Requires health care providers to spend 98 percent of revenues from federal discount prescription drug program on direct patient care.

Climate Change

Climate change is also on the ballot in some states. In Washington State, residents will vote on ballot initiatives that effectively repeal the aggressive climate action policies adopted by the state government.

WA - Prohibit carbon tax credit trading and repeal provisions of the 2021 Washington Climate Commitment Act (CCA), a state law that provided for a cap and invest in a program designed to reduce greenhouse gas emissions by 95 percent by 2050.

WA - Prohibit state and local governments from restricting access to natural gas.

To learn more about state ballot initiatives that impact health, please visit: Kaiser Family Foundation’s Ballot Tracker:  https://www.kff.org/womens-health-policy/dashboard/ballot-tracker-status-of-abortion-related-state-constitutional-amendment-measures/.

Or Ballotpedia:  https://ballotpedia.org/2024_ballot_measures.

TOBACCO CONTROL

California Enacts Tobacco Control Legislation

California Governor Gavin Newsom signed two tobacco control bills into law that will expand the state’s authority to regulate tobacco products. Both bills are supported by the ATS. These critical pieces of legislation will significantly enhance California's ability to regulate tobacco products and address the growing public health threat posed by flavored tobacco and synthetic nicotine.

SB 1230, the Strengthen Tobacco Oversight Programs (STOP) and Seize Illegal Tobacco Products Act, empowers the state to seize illegal e-cigarettes and strengthens oversight of flavored tobacco products, particularly harmful to youth. AB 3218 broadens the definition of menthol-flavored products to include additives that create a menthol cooling sensation. Both bills aim to prevent the tobacco industry from circumventing regulations and reinforce California's leadership in tobacco control.

ATS and CTS commend the passage of these bills, which are vital to protecting lung health  – especially for youth, who are disproportionately affected by menthol products that facilitate tobacco use and make quitting more difficult.

RESEARCH POLICY

ATS Urges Congress to Preserve Animal Model Research at DOD and VA

The American Thoracic Society joined with several other health and medical organizations in a letter urging Congress to allow continued animal model research, including cat and dog animal model research as part of Veterans Affairs and Department of Defense grants. Congress is currently considering passing legislation – the National Defense Authorization Act – that includes a provision to phase out cat and dog model research in the DOD research program. Congress has already passed legislation to phase out cat and dog model research in VA and supporters of the effort are trying to expand the research ban to DOD.

The sign-on letter notes that “(al)though new approach methods such as organ chips and computer models show promise, these methods are only useful for specific applications and often require confirmation studies in whole-body species, such as dogs and cats, to fully understand complex biological processes. For example, to minimize blood loss due to battlefield injuries, the DOD’s Veterinary Pathology Residency Program and Center uses animals to study how to decrease the period between injury and treatment… Therefore, without support for this research, the U.S. loses opportunities to provide life-saving medicine to patients while weakening our nation’s military and biomedical preparedness for emerging threats.”

With previous legislation, Congress directed the VA to implement a five-year plan for reducing research with sensitive species. However, there is an increasing bipartisan push by Congress to reduce and replace the use of animals in experiments funded by the federal government.

The ATS will continue to advocate for the ethical use of animals for research and testing for all federally funded research programs.

CLEAN AIR

U.S. Supreme Court Allows E.P.A. Power Plant Carbon Emission Rule to Proceed, for Now

The U.S. Supreme Court denied an industry emergency request to immediately block implementation of the Environmental Protection Agency’s rule to reduce carbon emissions for existing coal-fired plants and future gas-fired power plants. By rejecting the emergency request, the U.S. Supreme Court allows the E.P.A. to move forward with implementation of the power plant rule. While the agency can move forward with implementation of the rule for now, the rule still is facing legal challenges from the power industry and several Republican state attorneys general in the D.C. District Court of Appeals. Depending on the lower court action, the case could still be heard by the U.S. Supreme Court at some point in the near future.

“I am relieved the court is allowing the E.P.A. to move forward on policy to reduce carbon emissions from our nation’s power plants,” says ATS Environmental Health Policy Chair Alison Lee MD, MS.  According to the E.P.A., electric generation accounts for 24 percent of U.S. greenhouse gas (GHG) emissions, eclipsed only by the transportation sector (29 percent). “Reducing GHG emissions from power plants is an essential next step for the U.S. to meet our GHG emissions reductions goals and will have the added benefit of reducing other sources of air pollution. The health of our patients and our climate will benefit from the agency’s actions.”