State Ballot Initiatives on Abortion, Medicaid Yield Mixed Results

On November 6, voters in several states considered a variety of healthcare-related ballot measures. The initiatives barring health insurance exchanges or insurance mandates were covered in a recent post. But Medicaid and abortion also were considered by various states.

Abortion was the subject of ballot measures in both Montana and Florida. In Florida, Amendment 6 provided that no state funds could be used to pay for abortion services or for health benefits that cover abortion services unless the expenditure is required by federal law, the pregnancy is the result of rape or incest, or the pregnant woman suffers from a physical illness or injury or other physical condition that threatens her life unless the abortion is performed.The illness or injury may be, but need not be, a result of the pregnancy.

The measure also would have amended the Florida Constitution to limit the privacy provisions of Art. I, sec. 23 by directing the courts not to interpret it to grant any broader right to abortion than the United States Constitution. The voters defeated the amendment decisively, 55.05 percent against to 44.95 percent in favor. A “yes” vote of 60 percent was necessary to pass.

Montana voters approved a measure to require parental notification 48 hours before an abortion may be performed on a minor. More than 70 percent voted in favor and nearly 30 percent against.The Montana law allows the minor to obtain a waiver of the notification requirement in a court proceeding if the judge finds that:

  •  she is competent to decide whether to have the abortion,
  • there is evidence of physical, sexual or emotional abuse by a parent, guardian, or custodian, or
  • notification is not in the minor’s best interests.

Ballot measures to protect  Medicaid funds from cuts succeeded, but actual tax increases did not. Louisiana voters approved a constitutional amendment protecting the Medicaid Trust Fund for the Elderly from cuts imposed by the legislature in response to a projected deficit. The trust fund is targeted to nursing facility services. In September, Alabama voters had approved a similar change in the budget process to prevent cuts in Medicaid.

Proposed tax increases did not fare as well. Missouri voters narrowly defeated a hike in the taxes on cigarettes and related tobacco products. There were just over 49 percent votes in favor and not quite 51 percent against. The bill would have created a Health and Education Trust Fund, allocated 20 percent to “quit assistance” and related activities, 30 percent to public higher education, and 50 percent to public education.

Similarly, South Dakota voters rejected a 1 percent increase in the sales tax (from 4 percent to 5 percent). The revenue would have been divided equally between Medicaid and public education; however, 57 percent disapproved, and only 43 percent approved.

Two other ballot measures might be of interest. In Montana, voters approved a bar to receipt of state benefits by illegal aliens by a landslide—just under 80 percent in favor, just over 20 percent opposed. Effective January 1, 2013, state agencies must obtain documentation of citizenship or lawful resident status before considering an individual for:

  • state employment;
  • admission as a student to the state university system;
  • financial aid;
  • state grants for business or community development;
  • a license to practice a trade or profession;
  • unemployment insurance;
  • compensation as a victim of a crime;
  • vocational rehabilitation services; or
  • services for individuals with physical disabilities.

In Oklahoma, 60 percent of the voters approved State Question 765, which removes the state human services agency from the state constitution and authorizes the legislature to establish its replacement. The director would no longer be a constitutional officer, and the agency’s authority, including the authority to adopt regulations could be limited by the legislature or by the citizen initiative process.