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 We are pausing publication of The Daily Briefing out of respect for the tragic passing of Brian Thompson. We will resume publication of this daily newsletter in the coming days.

Daily Briefing

Mapped: Key healthcare-related ballot measures to watch


While most headlines during the 2024 election have been focused on the presidential and Congressional elections, a number of states have healthcare-related measures on the ballot this year. Here are the key ones to watch.

  • Proposition 139: Would amend the state constitution to provide for a fundamental right to abortion that the state of Arizona may not interfere with before the point of fetal viability (defined as the point of pregnancy when there is significant change of the survival of the fetus outside of the uterus without the application of extraordinary medical measures) unless justified by a compelling state interest (defined as a law or regulation enacted for the limited purpose of improving or maintaining the health of the individual seeking abortion care that does not infringe on that individual's autonomous decision making).
  • Proposition 315: Would prohibit a proposed rule from becoming effective if that rule is estimated to increase regulatory costs by more than $500,000 within five years after implementation, until the legislature enacts legislation ratifying the proposed rule.

Proposition 34:

  • Would require healthcare providers that spent over $100 million in any 10-year period on anything other than direct patient care and operated multifamily housing with over 500 high-severity health and safety violations to spend 98% of revenues from the federal discount prescription drug program on direct patient care.
  • Spending requirement would apply to entities that meet all of the following:
  • Participates in the 340B program
  • Owns or has owned at least one license to operate as a health insurance plan, pharmacy, or clinic in the state OR contracts with Medi-Cal as a primary care case management organization OR with Medicare as a special needs plan
  • Has spent more than $100 million on purposes not related to direct patient care in a 10-year period of its existence
  • Owns, operates, or previously owned and operated one or more multifamily dwellings that have received a combined total of at least 500 state or local high violations
  • Would penalize violators of the initiative with loss of tax-exempt status and licenses to operate health insurance plans, pharmacies, and clinics
  • Would permanently authorize Medi-Cal RX in state law

Proposition 35: Would permanently authorize a tax on managed care organizations based on monthly enrollees, which is set to expire in 2026, and require revenues to be used for increased Medi-Cal programs.

Amendment 79: Would create a right to abortion in the state constitution and allows the use of public funds for abortion.

  • Note: this initiative requires a 55% supermajority for approval.

  • Amendment 3: Would legalize marijuana for adults 21 years old and older and allow individuals to possess up to three ounces of marijuana.
  • Amendment 4: Would add the following language to the Florida Constitution's Declaration of Rights: "No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider." Also maintains the current constitutional provision that permits a law requiring parents to be notified before a minor can receive an abortion.

Assisted Reproductive Healthcare Advisory Question: Would advise state officials on whether medically assisted reproductive treatments, including in vitro fertilization, should be covered by any health insurance plan in Illinois that provides full coverage to pregnancy benefits.

  • Note: this is a non-binding advisory question that will have no legal effect the state's laws — advisory questions allow voters to express their general opinion on an issue.

Question 2 (Science and Technology Research and Commercialization Bond Issue):

  • Would authorize $25 million in general obligation bonds to the Maine Technology Institute for research, development, and commercialization of Maine-based public and private institutions in support of technological innovation. Specifically, funds must be allocated in the targeted sectors of life sciences and biomedical technology, environmental and renewable energy technology, information technology, advanced technologies for forestry and agriculture, aquaculture and marine technology, composites and advanced materials and precision manufacturing.

  • Question 1: Would add a new article to the Maryland Constitution's Declaration of Rights that establishes a right to reproductive freedom, defined to include "the ability to make and effectuate decisions to prevent, continue, or end one's own pregnancy."

Question 4:

  • Would create a Natural Psychedelic Substances Commission and Advisory Board to regulate the licensing of psychedelic substances and services.
  • Would authorize the personal use of limited amounts of psychedelic substances by individuals 21 years of age or older.
  • Would impose an additional excise tax at a rate of 15% on the sale of psychedelic substances.
  • Would authorize localities to levy an additional tax of up to 2% on psychedelic substances and regulate the time, place, and manner of the operation of natural psychedelic substance licensees.

Amendment 3: Would amend the Missouri Constitution to provide the right for reproductive freedom, which is defined as "the right to make and carry out decisions about all matters relating to reproductive healthcare, including but not limited to prenatal care, childbirth, postpartum care, birth control, abortion care, miscarriage care, and respectful birthing conditions." Providing that the state legislature may enact laws that regulate abortion after fetal viability, which is defined in the initiative as "in the good faith judgment of a treating healthcare professional and based on the particular facts of the case, there is a significant likelihood of the fetus’s sustained survival outside the uterus without the application of extraordinary medical measures."

  • CI-128: Would amend the Montana Constitution to:
  •  Provide a state constitutional "right to make and carry out decisions about one’s own pregnancy, including the right to abortion."
  • Allow the state to regulate abortion after fetal viability, except when "medically indicated to protect the life or health of the pregnant patient."

  • Question 2: Would revise language in the state constitution related to public entities that benefit individuals with mental illness, blindness, or deafness.
  •  Currently, Article 13, Section 1 of the Nevada Constitution, which refers to public entities for individuals with mental illness, blindness, or deafness as "institutions for the benefit of the insane, blind and deaf and dumb." The word "institutions" would be replaced with "entities" and the "insane, blind, deaf and dumb" would be replaced with "persons with significant mental illness, persons who are blind or visually impaired, persons who are deaf or hard of hearing and persons with intellectual disabilities or developmental disabilities."
  • Question 6: Would provide for a state constitutional right to an abortion, providing for the state to regulate abortion after fetal viability, except where medically indicated to "protect the life or health of the pregnant patient."

  • Bond Question 1: Would authorize the state to issue $30,758,100 in bonds to fund senior citizens' facilities, including for building upgrades and buying new equipment.

  • Proposal 1: Would add language to the New York Bill of Rights to provide that people cannot be denied rights based on their "ethnicity, national origin, age, and disability" or "sex, including sexual orientation, gender identity, gender expression, pregnancy, pregnancy outcomes, and reproductive healthcare and autonomy."

  • Constitutional Measure 1: Would amend language used in the state constitution to describe certain state institutions such as changing "insane" to "individuals with mental illness," "feebleminded" to "individuals with developmental disabilities," and "deaf and dumb" to "deaf and hard of hearing."
  • Initiated Measure 5: Would legalize recreational marijuana, allowing individuals to possess up to 1oz of marijuana, 4g of concentrate, 300mg of edibles; and allowing individuals to grow three plants with a limit of six plants per household.

  • Constitutional Amendment F: Would amend the South Dakota Constitution to provide that the state may impose a work requirement on eligible individuals in order to receive Medicaid under the Medicaid expansion that took effect on July 1, 2023. These work requirements would apply to individuals who are not diagnosed as being mentally or physical disabled.
  • Constitutional Amendment G: Would provide for a state constitutional right to abortion in South Dakota, using a trimester framework for regulation:
  •  During the first trimester, the state would be prohibited from regulating a woman's decision to have an abortion.
  • During the second trimester, the state may regulate abortion, but "only in ways that are reasonably related to the physical health of the pregnant woman."
  • During the third trimester, the state may regulate or prohibit abortion, except "when abortion is necessary, in the medical judgment of the woman's physician, to preserve the life and health of the pregnant woman."
  • Initiated Measure 29: Would legalize the recreational use, possession, and distribution of marijuana.

  • Initiative 2124: Would allow employees and self-employed individuals to opt out of paying the payroll tax and receiving benefits under WA Cares, the state's long-term services and supports trust healthcare program.

Amendment 1: Would amend the West Virginia Constitution to prohibit people from participating in "the practice of medically assisted suicide, euthanasia, or mercy killing of a person."


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