Healthcare ballot initiatives in the 2006 elections are attracting record amounts of money and media attention in the nine states where they are offered, though there are fewer healthcare initiatives than in past years, according to political observers.
Hospitals and healthcare providers in Arizona, California, Florida, Missouri and South Dakota are counting on smokers and increased tobacco taxes to support multibillion-dollar expansions in health insurance and prescription drug coverage, smoking education and treatment programs, and trauma care.
Tobacco -- the taxing of it, how to spend the historic state tobacco settlement and indoor smoking bans -- continues to dominate state ballot initiatives, said Joy Johnson Wilson, health policy director for the National Conference of State Legislatures, a national, nonpartisan organization serving state legislators and their staffs. Tobacco measures in seven states have galvanized hospitals, their associations and healthcare organizations in a fight against tobacco companies, their vendors, clients and advocates of limited government. In three of those states, voters face dueling smoking bans.
When they head to the polls Nov. 7, voters in 37 states will face a total of 203 ballot measures -- healthcare- and nonhealthcare-related -- backed by more than $350 million in donations from supporters and opponents, fast approaching the record $398 million spent in the 2004 election cycle.
A tally by the National Conference of State Legislatures estimates there are 18 ballot initiatives with a major healthcare component, though there are several others that affect the industry indirectly.
Opponents and supporters of two major California initiatives alone have spent $175 million as of Sept. 30, according to the California HealthCare Foundation, a not-for-profit foundation that tracks healthcare policies and issues, and the California secretary of state's office.
Wilson said there were many more initiatives that groups tried to get on state ballots, but they failed to qualify for lack of signatures. "The cost has gone up to get something on the ballot, and you need an organization to push those measures," Wilson said. "Many of the more controversial issues were likely to meet with significant opposition from moneyed interests, which could explain why they didn't get so far."
Politically, the issues span the ideological map from the red-meat conservative concerns of limiting abortion, shrinking government spending and banning gay marriage to the liberal and public health crowd's hot-button topics of raising the minimum wage, expanding healthcare coverage and imposing smoking bans. In addition, competing healthcare-related measures in some states could lead to voter confusion.
Besides tobacco taxes and smoking restrictions, voters must also sort through healthcare measures dealing with stem-cell research, prescription-drug coverage expansion and medical marijuana. Several nonhealthcare measures also could affect hospitals. The Taxpayer Bill of Rights, known as TABOR, initiative restricting state government spending is on the ballot in three states: Maine, Nebraska and Oregon. TABOR measures would shrink state government by tying budgets to inflation and population growth, essentially cutting funding that could support Medicaid and some emergency services.
Measures against gay marriage in eight states -- down from 13 in 2004 -- could eliminate domestic partnership health benefits and restrict hospital visits. And minimum-wage measures in six states may require healthcare companies to pay their employees more, but could help those currently unable to afford health insurance coverage to buy into it.
And a publicly financed election campaign measure backed by the California Nurses Association has opponents predicting universal healthcare will follow.
What's at stake, said Oliver Griswold, a spokesman for the Washington-based Ballot Initiative Strategy Center, a progressive think tank tracking ballot measures, is how voters define the meaning and function of government. Griswold said the ballot measures present serious questions about the role government should play in voters' everyday lives, in areas including privacy, abortion rights, gay marriage, minimum-wage mandates and the manner in which tax dollars should be spent.
While bellwether state California only offers a handful of healthcare-related initiatives this year, they are contentious and promise record spending. Proposition 86 is an effort supported by the California Hospital Association to triple the tax on cigarettes and other tobacco products to finance hospital emergency care, tobacco education and cessation programs and community clinics. The estimated $2.1 billion in added annual revenue would also fund health insurance for indigent children, nursing education, and research into cancer and other diseases. Roughly $788 million of the estimated revenue would go to hospitals.