Across the country, voters have a chance Tuesday to vote on a number of tough health care issues, from abortion to expanding Medicaid to flavored cigarettes. MedPage Today provides an overview of specific measures and addresses implications for therapists and the patients they treat.
When the Supreme Court struck down Roe v. Wade in June — the landmark 1973 decision that established constitutional protections for abortion — the high court gave the power to decide women’s reproductive futures back to the states. On Tuesday, at least five states will give voters a chance to voice their opinions on women’s reproductive rights.
Michigan’s 22-3 proposal would end a nearly 100-year-old ban that would once again make abortion illegal. The ballot measure would revise the state constitution to declare that everyone has a “fundamental right to reproductive freedom, which includes the right to make and make decisions about all matters related to pregnancy, including but not limited to prenatal care, delivery, postpartum care. , contraception, sterilization, delivery care pregnancy, miscarriage management, and infertility care.”
After the child’s labor, the state “may regulate the provision of abortion care,” but, “in no case shall the state prohibit abortion, according to the professional judgment of a health care professional, medically indicated to protect the health or physical or mental health of the pregnant person.”
The Michigan Supreme Court allowed the question to be placed on the ballot after anti-abortion Republicans tried to remove it, citing “spacing and formatting errors” in the text used by abortion rights advocates while campaigning, according to the report. Politics.
In California, Proposition 1 would amend the state constitution to include language “prohibition[ing] state from denying or interfering with a person’s reproductive freedom in their most intimate decisions, including their basic right to choose an abortion and their basic right to choose or refuse contraceptives,” according to the California Secretary of State’s office.
And a statewide ballot question in Vermont asks whether voters are willing to amend the state constitution to add that “a person’s right to reproductive autonomy is fundamental to the freedom and dignity to determine the course of one’s life and shall not be denied or violated unless justified by a compelling State interest achieved by the least restrictive means.”
Meanwhile, in Kentucky, a proposed constitutional amendment takes the opposite approach, adding a new section to the state constitution saying “to protect human life, nothing in this Constitution shall be deemed to protect or defend the right to abortion or to require financing. abortion.”
And in Montana, the ballot method asks voters to approve the Born-Alive Infant Protection Act, which guarantees that “infants born alive, including infants born alive after abortion, are legal persons” and requires health care providers to “take necessary steps to preserve .” the life of a baby born alive.”
Healthcare providers found guilty of “failing to take medically appropriate and reasonable steps to preserve the life of a live-born infant” face fines of up to $50,000 and/or up to 20 years in prison.
On the Medicaid front, voters in South Dakota will vote on whether to expand Medicaid, giving an estimated 42,500 eligible adults 18-65 access to the program in its first year.
While he doesn’t dispute the measure, Joseph Antos, PhD, chief executive officer at the American Enterprise Institute, a right-leaning think tank, is skeptical. “The lure of easy money up front versus the possibility of tax increases down the road is always a problem,” he said, explaining that after the “bonus Medicaid payments” disappear for the growing population, rising costs will remain.
The Affordable Care Act gave states the option to expand Medicaid for most seniors with low incomes up to 138% of the federal poverty level. As of February 2021, 12 states have not adopted that option, according to the Kaiser Family Foundation. In expansion states, the federal government pays 90% of the federal average population increase (FMAP), plus an additional 5 percent increase for 2 years after the expansion is implemented, courtesy of the American Affordable Care Act, which was signed into law. in 2021.
In a state with a “predominantly agricultural background,” workers often do not have employer-sponsored insurance and Medicaid can help fill the gap. But in many cases, the ability to access health care is as big an issue of distance as insurance coverage or ability to pay. “Expanding Medicaid seems to me like a great idea, but it’s not going to solve the rural health care problem,” Antos said.
Health Care as a Human Right
In Oregon, another ballot measure related to coverage would make it the first state in the country to declare health care a human right. If this measure passes, the Oregon constitution will state that “every Oregonian has access to affordable, clinically appropriate and affordable health care as a basic right.”
Antos described the ballot measure as a “good signing,” adding that the measure is not tied to any funding and could lead to legal complications. “Most of what I see is a problem here, if they go through this,” Antos said, adding that because Oregon is a rural state, the fact that someone may have to travel hours to get to a hospital that can deal with a serious health problem. seen as a violation of human rights.
The Medicaid program may be held liable if doctors close to a low-income person do not accept Medicaid. And the providers themselves could be sued “for not opening their doors,” he added.
Joan Alker, executive director and founder of the Center for Children and Families at Georgetown University, was less concerned about the turnout than the effect the governor’s race would have on Oregon’s Medicaid program.
In September, Oregon became the first state in the country to offer continued Medicaid coverage to children ages 0 to 5 years old, and 2 years to all children ages 6 and older, as Alker and colleagues detailed in a blog post the latter. “That’s a big deal in the Medicaid world,” he said MedPage Today.
It is especially important given that millions of children across the country may lose health insurance when ongoing protections end in the wake of the COVID-19 emergency, the post notes. Although the federal government has approved Oregon’s repeal, if an independent or Republican becomes governor, it’s unclear whether that person will commit to implementing it, he said.
In addition to abortion, Californians will vote on another important health care measure: Proposition 31. If passed, the measure would ban the sale of flavored cigarettes in most stores and vending machines.
In 2020, the California legislature and Gov. Gavin Newsom (D) approved legislation banning the sale of candy and fruit-flavored tobacco products. But the tobacco industry spent millions and put a spinning wheel on a referendum opposing the law, which at least temporarily prevented it from being implemented, according to the report. KCRA3.
Proponents of the ban argue that flavored products attract young people and could lead to another generation harmed by the tobacco industry, given that they mask the taste of nicotine and make addiction easier, like Susanne Tanski, MD, MPH, pediatrician and tobacconist. a regulatory expert representing the American Academy of Pediatrics, said during a conference hearing on the issue in 2019.
More than 80% of youth and young adult smokers report using flavored cigarettes, and three out of four of those say they would stop using these products if they were not flavored, according to a 2017 study Tobacco Control Science.