Roundup of State Ballot Initiatives on Health Issues

By Katie Booth

This November, voters weighed in on an array of state ballot initiatives on health issues from medical marijuana to health care reform. Ballot outcomes by state are listed below (more after the jump).

Voters in Alabama, Montana, and Wyoming passed initiatives expressing disapproval of the Affordable Care Act, while a similar initiative in Florida garnered a majority of the vote but failed to pass under the state’s supermajority voting requirement. Missouri voters passed a ballot initiative prohibiting the state executive branch from establishing a health insurance exchange, leaving this task to the federal government or state legislature. Florida voters defeated a measure that would have prohibited the use of state funds for abortions, while Montana voters passed a parental notification requirement for minors seeking abortions (with a judicial waiver provision). Perhaps surprisingly, California voters failed to pass a law requiring mandatory labeling of genetically engineered food. Several states legalized medical marijuana, while Arkansas voters struck down a medical marijuana initiative and Montana voters made existing medical marijuana laws more restrictive. Colorado and Washington legalized all marijuana use, while a similar measure failed in Oregon. Physician-assisted suicide was barely defeated in Massachusetts (51% to 49%), while North Dakotans banned smoking in indoor workplaces. Michigan voters failed to pass an initiative increasing the regulation of home health workers, while Louisiana voters prohibited the appropriation of state Medicaid trust funds for other purposes.

Affordable Care Act:

  • Alabama Health Care Amendment, Amendment 6: Approved 59.52% to 40.48% (prohibits mandatory participation in any health care system)
  • Florida Health Care Amendment, Amendment 1: Defeated 51.46% to 48.54% (required 60% support to pass) (would have prohibited passing laws compelling the purchase of health insurance)
  • Missouri Health Care Exchange Question, Proposition E: Approved 61.8% to 38.2% (“prohibit[s] the Governor or any state agency, from establishing or operating state-based health insurance exchanges unless authorized by a vote of the people or the legislature”)
  • Montana Health Care Measure, LR-122: Approved 66.83% to 33.17% (prohibits “the state or federal government from mandating the purchase of health insurance coverage or imposing penalties for decisions related to the purchase of health insurance coverage”)
  • Wyoming Health Care Amendment, Amendment A: Approved 76.98% to 23.02% (stating that “the right to make health care decisions is reserved to the citizens of the state of Wyoming”)


  • Florida Abortion Amendment, Amendment 6: Defeated 55.05% to 44.95% (would have “prohibited the use of public funds for abortions except as required by federal law and to save the mother’s life”)
  • Montana Parental Notification Measure, LR-120: Approved 70.24% to 29.76% (requires “parental notification prior to an abortion for a minor” with a judicial waiver provision)

Genetically Modified Foods

  • California Mandatory Labeling of Genetically Engineered Food, Proposition 37: Defeated 53.1% to 46.9% (would have required labeling for GMO food and prohibited labeling or advertising GMO food as “natural”)

Home Health Care

  • Michigan Home Health Care Amendment, Proposal 4: Defeated 57% to 43% (would have required training and background checks of in-home care workers, “set minimum compensation standards and terms and conditions of employment” for home health workers, and given collective bargaining rights to in-home care workers in negotiations with the Michigan Quality Home Care Council)

Marijuana and Medical Marijuana

  • Arkansas Medical Marijuana Issue 5: Defeated 51.44% to 48.56% (would have allowed use of marijuana for medical purposes)
  • Colorado Marijuana Legalization Initiative, Amendment 64: Approved 54.83% to 45.17% (legalized marijuana in the state)
  • Massachusetts Medical Marijuana Initiative, Question 3: Approved 63% to 37% (“eliminating state criminal and civil penalties related to the medical use of marijuana”)
  • Montana Medical Marijuana Veto Referendum, IR-124: Approved 56.53% to 43.47% (upholding more restrictive medical marijuana laws)
  • Oregon Cannabis Tax Act Initiative, Measure 80: Defeated 54.83% to 45.17% (would have “allow[ed] commercial marijuana (cannabis) cultivation/sale to adults through state-licensed stores; allow[ed] unlicensed adult personal cultivation/use; prohibit[ed] restriction on hemp”)
  • Washington Marijuana Legalization and Regulation, Initiative 502: Approved 55.44% to 44.56% (legalizing production, distribution and possession of marijuana)


  • Louisiana Medicaid Trust Fund Amendment, Amendment 1: Approved 70.84% to 29.16% (prohibiting “monies in the Medicaid Trust Fund for the Elderly from being used or appropriated for other purposes when adjustments are made to eliminate a state deficit”)

Physician-Assisted Suicide

  • Massachusetts “Death with Dignity” Initiative, Question 2: Defeated 51% to 49% (would have “allow[ed] a physician licensed in Massachusetts to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person’s life)


  • North Dakota Smoking Ban Initiative, Measure 4: Approved 66.66% to 33.34% (banning smoking in indoor workplaces)


Katie Booth Wellington was a Student Fellow during the 2012-2013 academic year. At the conclusion of her fellowship, she was a third-year law student at Harvard Law School with a focus on health care law. She attended Yale University, where she majored in English. Prior to law school, Katie worked for two years as a management consultant for pharmaceutical, biotech, and agribusiness companies. Katie was the joint Editor-in-Chief of the Harvard Journal of Law and Technology, which focuses on intellectual property law, health law, and technology law issues. During law school, Katie interned in the Health Care Fraud Unit of the United States Attorney’s Office in Boston and in the Health Care Group at Ropes & Gray. During her fellowship, Katie researched the problem of cyberattacks on wireless medical devices, focusing on the current U.S. legal and regulatory structure.

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