State Ballot Initiatives Put Health Law in the Ballot Box

On Election Day, November 4, 2014, several states took to ballot initiatives as a way to decide health law issues. Some of the initiatives focused on issues like regulation of health insurance premiums, personhood, the legalization of marijuana, and genetically modified organisms (GMOs). While many of the initiatives had comparable counterparts in several states, some, like California’s Proposition 45, to regulate health insurance premiums, were unique to one state’s ballot.


Anti-abortion advocates took a step backward in their personhood movement when midterm election results showed that North Dakota and California voters rejected state constitutional initiatives to grant constitutional rights to the unborn. According to a Politico report, the North Dakota initiative, which was thought to have been personhood advocates’ best hope for success this midterm, would have amended the state constitution to say, “inalienable right to life of every human being at any stage of development must be recognized and protected.” According to an AP article, the initiative was losing by a 2 to 1 margin with 91 percent of the state’s precincts reporting. The AP also reported that Colorado, which had already rejected personhood in 2008 and 2010, rejected another personhood amendment with overwhelming opposition that would have granted constitutional rights to the unborn under the state’s criminal code.

Premium Regulation

Proposition 45 was placed on California ballots in the hopes of regulating unnecessary hikes in health insurance premiums. According to an LA Times report, the initiative, which did not pass, would have granted California’s elected insurance commissioner the power to review health insurance rates in the individual and small employer marketplaces. Proponents of the initiative, which included a consumer advocacy group, the trial lawyers association, and the state’s Democratic Party, argued that the initiative was a necessary means to keep health insurance costs at reasonable levels. Opponents of the initiative, including health insurers, doctors, and hospitals, contended through a $57 million opposition campaign that the regulation would interfere with California’s Health Insurance Exchange.

Experimental Drugs

Arizona voters approved an initiative that will allow terminally ill patients to try unapproved experimental drugs, according to an AP report. The so-called “Right to Try Act” will allow certain terminally ill patients who do not have other treatment options to try drugs that have completed phase one of a clinical trial but have not received full approval from the FDA.

Medical Malpractice

California’s Proposition 46 would have raised the state’s damage cap for pain and suffering from $250,000 to about $1.1 million, to account for inflation since the cap was implemented in 1975. The proposition, which failed, also would have required physicians to undergo random drug testing. According to an LA Times report, if the initiative had been successful, physicians would have been required to consult a state database regarding patients’ prescription habits before prescribing certain medication in order to help combat drug abuse.


According to a Honolulu Civil Beat report, in Maui County, voters passed a ballot initiative to temporarily ban genetically engineered crops in what was Hawaii’s most expensive campaign in history. The measure, which targeted the seeding practices of global agricultural companies Monsanto and Dow AgroSciences, resulted in an $8 million opposition campaign. Although opponents outspent anti-GMO advocates 87 to 1, Hawaii residents succeeded in voting their concerns and desire to have GMOs banned until the county can analyze the impact of GMOs on the county’s health and environment. The initiative is a dramatic measure because it will put a near standstill to the farming of Monsanto and Dow AgroSciences, who operate significant farming facilities in Maui County.

According to a report from the Oregonian, a similar contest took place in Oregon over Measure 92, which would have required mandatory labeling for products containing GMO’s.  Entities like Monsanto, PepsiCo, Mead Johnson, and Dow AgroSciences raised more than $20 million to defeat the initiative. Proponents, who only raised $8 million, were unsuccessful by a narrow margin, with only 51 percent of voters in opposition. Colorado voters made a similar decision, according to an LA Times report, with an even larger majority rejecting a grass roots initiative to require labeling which identified GMOs in food.


According to a report from the AP, ballot initiatives in Oregon and the nation’s capital were successful in the movement towards widespread legalization of marijuana. In Oregon, the success of the initiative legalized the sale, manufacture, and possession of marijuana for people over the age of 21. In the District of Columbia, the law is somewhat scaled back and permits people over the age of 21 to possess and grow small amounts of marijuana for personal use; however, individuals are not yet authorized to sell marijuana. According to an AP article, marijuana advocates were not successful in Florida, where only 57 percent of the electorate signed on for the initiative that required 60 percent to pass. According to an Alaska Dispatch News article, an initiative to legalize marijuana was successful in Alaska and will take effect 90 days after the election is certified.