Ballot initiatives include cannabis and insurance measures.

On Nov. 5, several states will vote on measures related to substance use, insurance and other health-related issues, in addition to 11 abortion-related bills. measures before voters.

Health-related initiatives cover a wide range of topics.

Voters in California, South Dakota and Illinois will be asked about changes to insurance programs, while New Mexico, Nevada and Washington will weigh changes related to care facilities.

Four states—Florida, South Dakota, North Dakota and Nebraska—will consider various options for legalizing cannabis, while voters in California and Arizona will weigh in on changes to drug-related penalties.

West Virginia will also vote on an initiative that asks voters whether they support bans on medically assisted suicide and euthanasia in the state constitution. Both chambers of the state Legislature voted in March to place the measure on the ballot.

“I think it will make a big difference. This is something people are watching very closely because this will be the first state to work to provide constitutional protections for physician-assisted suicide,” said Peter Northcott, director of state strategy for National Right to Life.

Medically indicated or physician-assisted dying is legal in 10 states and Washington, D.C., for terminally ill patients who require assistance administering lethal drugs. Euthanasia is illegal throughout the country and involves administering lethal drugs to a patient.

Insurance

South Dakota Medicaid InitiativeIf passed, it would seek to impose Medicaid work requirements for eligible individuals who have not been diagnosed with a physical or mental disability. State previously filed eliminating a work requirement pilot program in 2018 that was never approved.

South Dakota extended Medicaid in 2022 by ballot measure to cover more low-income, childless adults.

While work requirements are popular among Republican lawmakers, if the ballot initiative is approved, such requirements would need to be approved by the federal government, which would be unlikely if Democrat Kamala Harris were elected president.

California will vote over Proposition 35, which would permanently authorize a tax on managed health plans and reserve revenue for Medicaid services.

And Illinois will vote on whether to recommend that elected officials provide coverage for assisted reproductive treatments such as IVF, even though all health insurance plans in Illinois currently cover pregnancy benefits. Unlike most other government initiatives, this is not mandatory.

Care services

Two states could see changes to elder care and long-term care funding.

In New Mexico Collateral Question 1 would authorize the state to issue up to $30 million in bonds to fund nursing facilities. Washington Initiative 2124 would require people to agree to receive coverage under the state’s new Long-Term Health Services and Supports program, which is funded by a payroll tax and was approved under a previous ballot initiative.

Additionally, California voters I’ll choose Whether to require health care providers who spent more than $100 million over 10 years on anything other than direct patient care and who operated apartment buildings with more than 500 serious health and safety violations to spend 98 percent of their 340B drug prices Program discounts for direct patient care.

Opponents have dubbed it a “retaliation measure,” noting that the proposal is backed by the California Association of Realtors and appears to be aimed at the AIDS Healthcare Foundation, which has supported three state rent control measures.

Public campaign finance data shows that opponents and supporters of the measure raised $48.2 million with bids due Oct. 19.

Nevada voters will consider updating language in the state constitution for government agencies that serve people with mental illness, blindness or deafness.

Drug Policy

Several states will vote to legalize cannabis or psychedelics.

Recreational cannabis use is currently legal in 24 states, and this year Florida, South Dakota and North Dakota hope to add to that as voters in those states vote on adult-only legalization measures. Nebraska voters will decide on two initiatives to legalize medical cannabis.

Medical marijuana is currently legal in 38 states and the District of Columbia.

Florida’s initiative would require 60 percent of the vote to pass. Nebraska’s initiatives would require a simple majority as well as court approval.

South and North Dakota will re-attempt a failed attempt to legalize the 2022 midterm elections. Both states require a simple majority to pass.

Voters in Massachusetts will vote on whether to legalize plant-based psychedelic drugs such as psilocybin mushrooms for people 21 and older. If approved, Massachusetts would become the third state in the country to legalize such substances. along with Oregon and Colorado.

In addition, two states will vote to increase some drug-related penalties.

California Proposition 36 will classify certain drug offenses as felonies requiring drug treatment. It would also increase penalties for some drug crimes and require courts to warn people convicted of distributing illegal drugs about future potential criminal liability if they distribute deadly drugs.

Arizona votes on Proposition 314, which would make it a felony to knowingly sell fentanyl if the use of the drug results in the death of another person.

Sandhya Raman contributed to this report.