Other healthcare initiatives on state ballots

Health systems are asking California voters to approve Proposition 52, which would permanently extend Medi-Cal's hospital fee program. The fees paid by hospitals generate billions in federal matching funds that subsidize healthcare services for children, seniors and low-income citizens.

The proposition would also make it harder for lawmakers to use Medi-Cal funds for anything other than their intended purpose by requiring voter approval to divert the money. Current law requires the Legislature to renew the program—it has been renewed four times since being established in 2009—while Proposition 52 would require a supermajority vote to end it. Lawmakers have diverted funds from the program only once—$400 million to shore up the budget in 2012—but the California Hospital Association argues it could happen again during an economic downturn, when people need Medi-Cal services most.

Despite a lack of opponents, Proposition 52 faces an uphill battle because it's complex and has to fight for voters' attention on a ballot crowded with 18 statewide propositions.

Colorado is poised to become the sixth state to legalize physician-assisted suicide under a ballot initiative. The End of Life Options Act, which is on the ballot as Proposition 106, would allow physicians to prescribe a lethal drug to their terminally ill patients. Oregon was the first state to legalize physician-assisted suicide in 1997. California, Montana, Vermont and Washington have since adopted similar measures. A poll conducted in September showed 70% of likely voters supported the initiative.

Ballots in California, Colorado, Missouri and North Dakota will include initiatives that would raise taxes on tobacco. All of them would steer the new revenue to public health or education programs.

Oklahoma voters will see two connected measures that would reclassify certain nonviolent drug possession and low-level theft crimes as misdemeanors instead of felonies. The savings from reduced incarceration costs would fund mental health, substance abuse treatment and job training programs. Supporters say the measures would help the state address problems that lead people to commit crimes. Opponents argue the changes would threaten public safety and shift the burden of housing many offenders from state prisons to county jails, where they are actually less likely to get substance abuse treatment.

Voters in nine states will decide if they want to expand access to legal use of marijuana. Arkansas, Florida, Montana and North Dakota have ballot measures that would legalize the medical use of the drug. Arizona, California, Maine, Massachusetts and Nevada will ask voters if they want to legalize recreational use.