HEALTH ON THE BALLOT: VOTERS WEIGH IN 

Volume 29, Issue 528                                                        November 24, 2008

Matthew Gever, Anna Wolke and Emma Sandoe

On November 4^th, as the nation was choosing a new president, voters in a number of states were deciding on issues closer to home.

Across the states, 153 ballot initiatives were up for consideration. Of these 86 were approved, many of which dealt directly with health policy.

In Maine, voters rejected a series of taxes enacted by the legislature designed to fund Dirigo Health, a subsidized health insurance program for small businesses and individuals earning less than 300 percent of poverty. In 2007, the legislature passed LD 2247, which imposed taxes on health insurance claims, alcoholic beverages and soft drinks as a means of funding the program. This was set to replace savings offset payments, which is an assessment charged to insurers based on savings to the health care system from Dirigo. Supporters of the beverage tax believe it would raise more revenue while decreasing the burden on insurers. "These tax dollars would have helped Maine address the crisis of ballooning health care costs," said Kurt Wise of the Maine Center for Economic Policy. Others were more concerned about the economic impacts of the taxes. "The bottom line is an increase in the price of beverages and a loss of sales revenue to the beverage industry," said Todd Gabe, an economist with the University of Maine, who added that decreased beverage sales could lead to the loss of up to 400 jobs in the state. With the taxes repealed, Governor John Baldacci has said that he will appeal to the federal government for further financial assistance with the program.

Marijuana was on the minds of voters in Michigan and Massachusetts. Voters in the Bay State approved Question 2, which decriminalizes the possession of up to one ounce of marijuana. Under the new law, offenders caught with an ounce or less face a $100 fine and a civil infraction, rather than a misdemeanor or potential jail time. State officials are now mulling over the regulatory structure necessary to implement Question 2, which is scheduled to take effect in either December or January.

Voters in Michigan passed Proposal 1, making it the thirteenth state to enact a law allowing for the medical use of marijuana. The law allows doctors to recommend marijuana as a treatment for certain debilitating illnesses as established by the department of community health (DCH), which generally include conditions such as cancer, glaucoma, multiple sclerosis, epilepsy and AIDS. The law also allows certain registered individuals to grow marijuana for patient use in an enclosed facility and requires DCH to establish an identification card system for eligible patients and growers.

Also in Michigan, voters passed Proposal 2, which allows for the donation of human embryos for stem cell research. Specifically, the law allows donation of embryos that were created for fertility treatments only and that would otherwise be discarded. Additionally, no embryos more than 14 days old would be permitted for research, and they can not be bought or sold. Until now, using an embryo for research purposes was a felony in the state.

Montana voters said "yes" to the sizable expansion of children's access to health insurance proposed under Initiative 155. The expansion—deemed the "Healthy Montana Kids" plan—will increase children's income eligibility levels for Medicaid and the State Children's Health Insurance Program (SCHIP). Children from families earning up to 185 percent of poverty will be allowed to enroll in Medicaid (up from 133 percent) and children up to 250 percent of poverty will be eligible for SCHIP (up from 175 percent). The state expects the expansion will cover 30,000 additional children.

Passage of the initiative also paved the way for a premium assistance program that will enable parents with access to employer-sponsored plans to add their children as dependents.  The initiative does not include details on this program, such as eligibility for participation.  To increase outreach and ease enrollment into Medicaid and SCHIP, I-155 also adopts efforts to use "enrollment partners", such as health care providers or schools, to assist in identifying and enrolling eligible children into public coverage. 

While voters approved of the expansion, it is now up to the legislature to appropriate the funds necessary for implementation. The $20 million per year necessary to implement the program has already been collected from a health premium tax.  "That money has already been set aside by the initiative, now the legislature just needs to point it toward the program," said Senator Mike Cooney.

The state will request additional funds from the federal government in order to implement the children's coverage expansion.

Voters in two states, Missouri and Washington, passed long-term care initiatives.

In Missouri, the passage of Proposition B will establish the Missouri Quality Home Care Council. The eleven-person group will address issues facing home care workers in the state and address the in-home workforce shortage. The Council will be given the power to:

• assess the quality and availability of home care service providers
• recommend minimum licensing standards for personal care attendants
• recommend wage levels to the legislature
• offer training for personal care attendants, and
• collectively bargain with a representative of personal care attendants.

Washington's ballot initiative I-1059 passed with over 2 million votes, an apparent record for the state.  The initiative will establish more rigorous requirements for long-term care workers providing care to the elderly and individuals with disabilities.  Workers will be required to undergo state and federal background checks and pass a home care aide certification exam.  The initiative also increases the hours of training required for long-term care workers from 41 to 75 hours.  The estimated cost of implementing the new standards is $30 million over the next two years.

Although the measure passed with a comfortable 72 percent of the vote, there was some opposition.  The state's Chamber of Commerce opposed the initiative because they believe it will require the state to foot the bill for excessive training of workers.