Voters proved predictably fickle in responding to a series of healthcare ballot measures spread over 10 states in the Nov. 2 elections.
Joy Wilson, health policy director for the National Conference of State Legislatures, says both the diversity of the 19 healthcare ballot measures and the election results made finding a single theme or trend nearly impossible.
"It's really hard to trace any common threads among them," says Wilson, whose bipartisan organization provides educational services and serves the staffs and legislatures of the 50 states. "It's interesting, but you can't make any broad statement about national sentiment or voter intent from this year's initiatives, outside of the same-sex marriage measures."
Four states offered medical malpractice liability reform measures and three states offered medical marijuana initiatives and tobacco tax increases to support healthcare funding. There were bond issues in California supporting expanded mental health services and children's hospitals, and one in Rhode Island for a university-based biosciences center.
"For the most part this year's ballot initiatives differed from one another in how they were to be funded and what they sought to accomplish," she says.
In Oregon, a state that already had legalized medical marijuana, voters rejected a move to expand the law. Montana, which did not have such a law, voted to pass one. In Alaska, where backers sought to legalize marijuana and remove civil and criminal penalties, the proposal failed.
The only three states to post referendums on funding public health programs with increases in tobacco taxes-Colorado, Montana and Oklahoma-passed those measures.
"Clearly on tobacco taxes dedicated to specific healthcare spending, there is a level of comfort," Wilson says. "They passed, but a number of state legislatures passed similar bills in the last year as well."
While same-sex marriage and tort reform questions drew most of the publicity among the 163 ballot measures in 34 states, California's propositions brought out both the voters-and the cash.
Californians, who spent nearly $200 million to support or oppose 16 propositions, spent one-third of that amount on five healthcare-related measures to fund stem-cell research, expand mental health and emergency services, build and repair children's hospitals, and mandate employer health insurance coverage.
Voters narrowly defeated, by 50.9% to 49.1%, the controversial proposition that would have required employers with more than 50 workers to provide health insurance to employees. "It was pretty close, but it did fail," says Jan Emerson, spokeswoman of the California Healthcare Association, the state's hospital association, which supported a similar but more comprehensive proposal. "The issue of the uninsured is clearly not going away. We will continue to be engaged in this."
Voters also sunk the hopes of emergency-care providers and social services agencies to shore up the state's badly frayed trauma system, which has seen the closure of at least 10 hospital emergency rooms in the past 18 months. The measure would have generated $500 million annually to reimburse physicians and hospitals for uncompensated emergency care and improvements in emergency services, funded through an increase in a phone tax. But the electorate nixed the proposal by a resounding 72% to 28%.
"This problem remains a huge drain on the entire healthcare system," Emerson says, adding that the providers would regroup.
On a brighter note, California voters overwhelmingly approved the children's hospital proposition, which authorizes $750 million in general obligation bonds to fund medical equipment purchases and construction projects, including seismic retrofitting, at 13 children's hospitals.
"That was good news for those hospitals," she says. "But a bigger problem looms for the rest of California's hospitals, many of which will need large influxes of capital to meet those seismic mandates (which take effect in 2008)."
Emerson's CHA members will also benefit from the passage of Proposition 63, which calls for a $750 million annual increase to expand mental health services. The measure will be funded by an added 1% tax on incomes greater than $1 million. Emerson says the CHA supported the measure, which will increase funding by $200 million to California hospitals providing mental health services. "Mental health services have been underfunded for two decades," Emerson says. "This is a huge boost."
California also became the first state to publicly fund stem-cell research, a measure that drew celebrities on both sides, with movie star Mel Gibson opposing the measure supported by Gov. Arnold Schwarzenegger. Nearly 60% of voters backed the measure, which authorized $3 billion to create and operate the California Institute for Regenerative Medicine. Supporters collected more than $25 million to promote the ballot measure.
Medical malpractice tort reform measures failed in Oregon and split in the remaining three states-Florida, Nevada and Wyoming-that had the issue on their ballots.
In Nevada, voters rejected an attempt to punish attorneys who file frivolous suits. Florida voters approved a proposal allowing patients to keep more in medical malpractice settlements and discouraging frivolous lawsuits, but they also passed two measures that doctors and hospitals opposed. Those prohibited the state from licensing doctors with three or more findings of malpractice and allow patients to view information on medical errors and physician credentialing, measures backed by trial lawyers. Wyoming voters rejected caps on noneconomic damages but narrowly passed a measure that mandates alternative dispute resolution or medical panel review before a patient can file suit.
In other states, voters in Rhode Island supported a measure to fund a $50 million bond issue to create the University of Rhode Island Center for Biotechnology and Life Sciences. And in another testimony to the strength of "moral issues" in the recent election, Florida voters approved a measure requiring parental notification for minors before the termination of pregnancies.