Voters in a number of states decided on a variety of hotly contested state ballot initiatives Tuesday, including measures to regulate health insurance rate increases, hike medical liability damage caps, lay the foundation for new abortion restrictions, make experimental medical treatments more available to patients, and require health insurers to contract with any willing healthcare provider.
In two of the most expensive ballot initiative campaigns in history, California voters said no to Propositions 45 and 46. Prop 45 would have given the state insurance commissioner new authority to block health insurance rate increases. Prop 46 would have raised the cap on noneconomic damages in medical malpractice cases to $1.1 million and required drug testing of doctors. Insurers and provider groups spent tens of millions to defeat the two measures.
Abortion was the subject of several ballot measures, and the outcome was mixed. In Colorado and North Dakota, voters rejected anti-abortion initiatives. In North Dakota, opponents of Measure 1 argued that the initiative would block in-vitro fertilization and patients receiving the type of care they want at the end of life because of its broad and vague wording, which stated: “The inalienable right to life of every human being at any stage of development must be recognized and protected.” One in-vitro fertilization lab said it would close if the measure were approved.
Meanwhile, Tennessee voters approved a measure that said nothing in their constitution “secures or protects” the right to an abortion. The measure, an effort to reinstate abortion regulations struck down by the state's Supreme Court in 2000, has no immediate effect on abortion procedures, but is expected to lay the foundation for new restrictions.
In a measure closely watched by insurers, physicians and hospitals, South Dakotans voted to require insurers to contract with all providers willing to meet their criteria. Proponents have said legislation gives patients a wider choice of physicians and facilities and ensures they won't be penalized for seeing out-of-network providers. Insurers said it would interfere with their ability to offer cost-effective networks and keep premiums down. The measure was seen as a response to the growing use of narrow-network health plans, which have sparked controversy around the country.
In Arizona, voters overwhelmingly approved a ballot measure allowing terminally ill patients to seek drugs or devices not yet approved for use by the Food and Drug Administration. The “right to try” measure, similar to laws passed in Colorado, Louisiana, Missouri and Michigan, would allow drug and device manufacturers whose products are still in the investigational stage to offer those therapies to terminally ill patients once those products have completed the FDA's Phase 1 clinical trials.
The Arizona measure was praised by some patient advocacy groups, but critics said it could hurt the ability to conduct clinical trials and regulate product safety. It's not clear how willing manufacturers will be in providing their investigational products to patients.
In California, opponents of Proposition 45, which included the California Medical Association, the California Hospital Association and the California Association of Health Plans, said it would have given a single person too much power over insurance rates. Officials of the state insurance exchange said it would interfere with their ability to negotiate reasonable rates with insurers.
State Insurance Commissioner Dave Jones, a leading supporter of the measure, told the San Francisco Chronicle that “it turns out $57.5 million of false and negative advertising by the health insurers actually has an impact on voters, unfortunately.”
Prop 46, in addition to upping the “pain and suffering” cap from $250,000 to $1.1 million and indexing it to inflation, would have mandated drug and alcohol testing for physicians and required that doctors check patients' names against California's database of known drug abusers before prescribing certain controlled substances.
Robert Pack, a patient-safety advocate who authored the proposal after his children were killed by a driver impaired by prescription drugs, said the initiative was intended to protect the public from dangerous doctors.
“What we have done is open the eyes of a lot of Californians to the issues of drug abuse and this low cap on damages for victims, and we've also raised awareness on the legislative level,” Pack said. “For public safety and for the epidemic of narcotics, the Legislature really has to look at that and find a way to work something out.”
But opponents warned that Prop 46 was a ploy by plaintiff attorneys to boost their business, and that increasing the damage cap would drive up healthcare costs in the state.
In North Dakota, critics of Measure 1, which some called a “personhood” amendment, said the language was too vague and could have unforeseen consequences. Robert Wood, an associate professor of public administration at the University of North Dakota, said the measure could have invalidated patients' advance directives for their end-of-life care and affected doctors and other healthcare providers delivering care to terminally ill patients.
Nancy Northup, CEO of the Center for Reproductive Rights, a national abortion rights advocacy group, said in a written statement that North Dakota's voters chose to avoid a permanent change that would have threatened the ability to perform an array of reproductive medicine procedures in the state.
“North Dakota women are already subject to some of the most extreme abortion restrictions in the country, promoted by politicians hell-bent on choking off reproductive healthcare options until women have nowhere left to turn,” Northrup said.
In the nation's only “yes” vote on an abortion-related initiative, roughly 53% of Tennessee voters approved adding a provision to the state's constitution to clarify that the document in no way “secures or protects a right to abortion or requires the funding of an abortion.” Further regulation could require a waiting period for women seeking an abortion or force abortion clinics to meet higher standards that are prescribed to ambulatory surgical centers, the Tennessean newspaper reported.
David Fowler, president of the Family Action Council of Tennessee and a former state senator, called the yes vote a victory for “the protection of women and their unborn.”
“Today is a great victory for the people of Tennessee, who have reclaimed from our state Supreme Court their right to have a voice on abortion policy in our state,” Fowler said in a written statement.
In South Dakota, supporters of the measure to require health insurers to contract with all providers willing to meet their criteria said it will give patients a wider choice of physicians and facilities and ensure they won't be penalized for seeing doctors “out-of-network.”
But Rebekah Cradduck, vice president of the South Dakota Association of Healthcare Organizations, said her organization is disappointed in the outcome. The not-for-profit hospitals that make up her group's membership fear the measure will limit hospitals' ability to guarantee volume delivery to insurers, which means insurers will have less of an incentive to offer discounts on rates. She said consumers aren't necessarily concerned about expanding their choices when it means it'll cost them more money, pointing to buying trends on the exchanges as an example.
“When people spent their own money, they bought the narrowest networks they could buy because it was the best rate, so by virtue of their own pocketbook, people vote for narrow networks,” Cradduck said. A University of Minnesota study (PDF) found that the proposal could drive up premium costs by $3,000 to $5,000 over a decade.
In Arizona, the yes vote on the right-to-try initiative was applauded by the Goldwater Institute, a Phoenix-based conservative research organization that was a major supporter of the proposal and has lobbied state governments across the country to pass similar measures.
“Americans shouldn't have to ask the government for permission to try to save their own lives,” Goldwater President Darcy Olsen said in a written statement. “They should be able to work with their doctors directly to decide what potential treatments they are willing to try.”
But opponents said the measure could create patient-safety problems and inspire other states to take similar action. Still, Henry Greely, director of the Center of Law and the Biosciences at Stanford University, said states won't be able to supersede federal law that requires FDA approval for drugs and devices.
-Steven Ross Johnson contributed reporting.
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