The 2022 midterm elections are upon us. And public health is once again prominent on the ballot.
Think back to the 2020 presidential election and just how stark a contrast Joe Biden and Donald Trump presented on COVID-19, climate change, and the Affordable Care Act. This year is no different. Voters across the country are choosing more than 6,000 state legislators and 36 governors who are, among other things, embracing vastly different approaches to public health issues like abortion, marijuana, Medicaid and others.
Candidates are increasingly far apart even on topics like childhood vaccines, with many Republicans newly embracing anti-vaccine rhetoric. In Minnesota, the Republican candidate for governor has raised a specter of bogeymen scientists saying: “There might come a day where a scientific and technological elite may control our public health policies…think about that.” We should think about that, and then strive to achieve it!
Beyond such extreme candidates, voters are also deciding 133 state ballot measures. Many states are putting public health directly on the ballot, asking voters to decide on high stakes health issues. Here I take a look at the major public health issues that are before voters this Nov. 8th.
Let’s begin with abortion
Since Roe v. Wage was overturned by the U.S. Supreme Court, states have moved quickly to either limit or protect abortion rights. Five states are considering abortion-related measures this year. Most prominent among them is Kentucky. Voters are deciding whether to add this phrase to the state constitution: “To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.” The state has a near-total ban on abortion that took effect after the Supreme Court decision. If voters reject this measure, the state’s highest court could invalidate the strict ban. Astute readers will remember that Kansas surprisingly rejected a similar measure just 3 months ago.
California, Michigan and Vermont are moving policy in the opposite direction. Michigan voters, for example, will decide whether to enshrine a right to “reproductive freedom” in their state constitution. That right includes, “the right to make and effectuate decisions about all matters relating to pregnancy, including but not limited to prenatal care, childbirth, postpartum care, contraception, sterilization, abortion care, miscarriage management, and infertility care.” Michigan, like Kentucky, has a near-total abortion ban that dates back to 1931. But in Michigan, two state courts are blocking its implementation. If voters reject the ballot measure, the courts will almost certainly have to step aside.
Marijuana and vaping
Legalizing recreational marijuana is on the ballot in five states. This reflects the 91% support for some form of marijuana legalization nationally. Citizens brought the measures to the ballot in four of the states: Arkansas, Missouri, North Dakota and South Dakota. Legislators in Maryland passed a constitutional amendment allowing for recreational marijuana in limited quantities, pending a constitutional referendum. That referendum is now on the ballot. If all five states enact the measures–which marijuana industry polling suggests is possible, if unlikely–just 13 U.S. states will remain without some form of legalized marijuana.
In California, voters are deciding whether to ban flavored tobacco products. The ban simply makes it a crime to sell flavored tobacco products. But the story of how this came to the ballot is interesting. In 2020, the state legislature passed a relatively bipartisan flavoring ban. But major tobacco companies led a successful $20 million campaign to gather enough signatures to put the issue on this year’s ballot. As a result, the law did not take effect as it awaits voters. If voters approve this law, California joins five other states with flavored tobacco bans, and it would be the second state to ban menthol cigarettes.
Medicaid and a right to health care
South Dakota is poised to become the 39th state to expand its Medicaid program through the process granted by the Affordable Care Act. Public support has been strong and citizens brought this measure to the ballot. The legislature, however, has been extremely resistant to expansion. It attempted to change the ballot initiative process itself to head off the public effort to expand Medicaid. It aimed to change the threshold from a simple majority of voters to 60% in order for ballot measures to pass. But voters resoundingly rejected that change and, in doing so, kept the door open to Medicaid expansion. If the Medicaid measure passes, an additional 42,500 people will become eligible [pdf], with the federal government footing most of the bill.
Oregon could become the first state in the nation to include health care as a human right in its constitution. In 2021, elected officials voted to include the right to health care in the state constitution, pending a public referendum. The chief sponsor of the amendment has called it “a guiding principle” and the amendment language is brief: “It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate and affordable health care as a fundamental right.” The measure also uniquely specifies that the state must balance healthcare funding against funding for public schools and other essential services. While breaking new ground, big questions arise about the legal implications of this amendment. Could the 7% of Oregon’s residents who are uninsured now sue the state if it does not meet its health care obligations?
An opportunity to be front and center
These are only a few examples of how public health is on the ballot in 2022. Smaller numbers of states are also considering actions on health care debt, alcohol delivery services, electric vehicle charging stations, water infrastructure, and public health-adjacent issues like the minimum wage and universal broadband internet.
Perhaps the subtext of seeing public health issues on the ballot so regularly is that the field is more divisive than ever. Yet, with so many issues arriving directly to voters through citizen action, public health also seems to be engaging more people. It presents public health with an opportunity to be front and center in communities, explaining these issues.
Gregory Stevens