The NCSL Blog


By Kate Bradford

Contemplating which state and national officials to elect during a pandemic, voters in at least nine states face another choice—the opportunity to weigh in on their state’s health policy.

stethescope with moneySeveral ballot measures this year touch on health topics related to taxes, education, family leave, abortion, medical marijuana and even stem cell research. Here’s a look at what voters will decide.


Legislative referendums in three states ask voters to consider tax changes in support of health programs. Colorado Proposition EE and Oregon Measure 108 would increase taxes on tobacco and vapor products to fund public health and education programs, including for tobacco and nicotine prevention and cessation. Utahns will decide whether to amend the state constitution through Amendment G, which would provide the legislature flexibility to use income and property taxes to support children and individuals with a disability.

Oregonians will also weigh in on Measure 110, a citizen initiative decriminalizing the possession of certain amounts of drugs and redirecting a portion of the state’s marijuana tax revenue to boost funding for drug treatment programs.

Sex Education

Referendum 90 in Washington places SB 5395 – a law enacted by the legislature and signed by the governor in March – back into the hands of voters. This bill required public schools, beginning in 2022, to provide students comprehensive sexual health education, defined as instruction in human development and reproduction that is medically accurate, age-appropriate and inclusive. Instruction would also include information on abstinence, affirmative consent and bystander training, and parents can decide to opt their children out.

Thirty states and the District of Columbia require public schools to teach some form of sex education. Under current law, Washington school districts are required to teach methods to prevent sexually transmitted infections. Sexual health education programs are optional, but if one exists, it must meet certain requirements.

Family Leave

In Colorado, Proposition 118 would establish a 12-16 week paid family and medical leave program. The program would begin in 2023 and be funded through a payroll tax split equally between employers and employees. Eight states and the District of Columbia have approved legislation creating paid family and medical leave programs.


A legislative referendum in Louisiana and a citizen initiative in Colorado will let voters weigh in on abortion. Louisiana Amendment 1 would add a sentence to the state constitution stating there is no right to abortion. If approved, Louisiana would join Alabama, Tennessee and West Virginia as states with similar constitutional amendments. Colorado Proposition 115 would prohibit abortion after 22 weeks. Seventeen states currently prohibit abortion at 22 weeks.

Medical Marijuana

South Dakota and Mississippi will let voters decide whether to legalize medical marijuana for individuals with certain medical conditions. South Dakota Initiated Measure 26 would create a medical marijuana program for individuals with a debilitating medical condition certified by a physician. Mississippi’s ballot measure involves two separate initiatives voters can decide between. Initiative 65 allows medical marijuana for a list of certain debilitating conditions and Initiative 65A allows medical marijuana only for terminally ill patients, leaving the legislature to set additional details and regulations. A total of 33 states and the District of Columbia have approved medical marijuana programs.

Additional Measures

Washington Senate Joint Resolution 8212 would allow the legislature to invest public funds from the long-term care services and supports account into stocks or other methods of investment. Currently, the state constitution limits investment of state funds, with some exceptions, to government and corporate bonds.

In Oklahoma, State Question 814 would amend the state constitution to distribute tobacco settlement funds to help fund Medicaid expansion – another ballot measure approved by voters in June.

California Proposition 23 would establish certain requirements for kidney dialysis clinics and Proposition 14 would issue $5.5 billion in bonds to support stem cell research.

You can track these and others ballot measures in NCSL’s Statewide Ballot Measures Database.

Kate Bradford is a research analyst in NCSL’s Health Program.

Email Kate.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.