Voters from coast to coast made decisions last week not just about which candidates to favor but also about an array of health-related concerns from abortion to health insurance expansion to legalized ways to get high.
Women’s reproductive rights: a big deal
A major motivator in the 2022 midterm elections was the U.S. Supreme Court’s decision to abolish the constitutional right to abortion and leave it to the states to decide women’s reproductive health rights.
In California, Michigan, and Vermont, voters supported referendums to lock abortion rights into their states’ constitutions, CNN reported. In Kentucky, voters slapped down an effort to interpret their state’s constitution as failing to “secure or protect a right” to abortion or the funding of abortion. And in Montana, voters, with fierce advocacy from doctors and nurses, defeated a measure that said that “an infant ‘born alive’ – defined as an infant ‘at any stage of development’ who breathes, has a beating heart or definite movement of voluntary muscles after expulsion or extraction – be treated as a legal person entitled to medical treatment.”
The high court’s Dobbs’ decision, voters told pollsters, ranked second behind inflation in deciding the fates of supportive Democrats versus Republicans deemed extreme in their abortion views, refusing to consider the procedure even in cases of rape or incest, Politico reported:
“Soaring inflation, which preelection polls showed was, by far, the most important issue for voters, just barely outpaced abortion in exit polls, 31% to 27%, according to the National Election Pool exit poll, conducted by Edison Research. And about 60% of voters said they were dissatisfied or angry with the Supreme Court’s decision to overturn Roe v. Wade, according to both that exit poll and AP Votecast.”
This furor, analysts said, helped power Democratic strength in voting up and down the ticket in Michigan, Pennsylvania, and elsewhere.
Medicaid expands in South Dakota
In South Dakota, despite the opposition of the state’s conservative GOP governor, voters decided to become the 39th state to expand Medicaid benefits to the working poor and poor as allowed under the Affordable Care Act. This could benefit more than 50,000 residents of a poor, largely rural state eventually to get health coverage that they have not been able to afford, though officials may struggle to make the program work, especially in its impending rollout.
A dozen states, most of them southern and run by conservative Republicans, have resisted the Medicaid expansion, with officials denouncing Obamacare and asserting in almost theological fashion that they oppose almost any federal role in U.S. health care.
But the resistant states have had to forgo big chunks of federal assistance that has benefited tens of millions of regular folks in the rest of the country. Officials also have been hard pressed to explain to constituents why the health systems in their states, especially in rural areas, have fallen on hard times and offered much diminished services, particularly when needs have been great, as occurred during the coronavirus pandemic. As the nonprofit, independent Kaiser Health News Service reported:
“Most states adopted Medicaid expansion through governors’ orders or legislature-approved bills. But voters in Maine, Idaho, Nebraska, Utah, Missouri, Oklahoma, and South Dakota overrode resistance from lawmakers and governors by approving expansion through ballot measures. Every time Medicaid expansion has been on the ballot, it has passed. Expansion proponents in South Dakota sought a constitutional amendment, which can’t be easily repealed or revised. The amendment includes implementation deadlines and bars the state from creating extra rules, such as work requirements, for people who newly qualify for Medicaid. In the past, South Dakota politicians have filed lawsuits that successfully argued that voter-approved measures violated the state constitution.”
Arizonans tackle scandalous medical debt
In Arizona, voters took a whack at one of the scandals of the U.S. health care system: medical debt. A state proposition, approved in strong enough fashion that the AP called it a winner on Tuesday night, “lowers the maximum interest rates on medical debt and changes several rules on general consumer debt collection,” azcentral.com reported.
Advocates said this measure would better safeguard vulnerable patients and their loved ones from predatory health providers and others who hound those who already are ill and injured to get them to pay sky-high prices for medical services. But critics have questioned the wording of Proposition 209 and raised alarms that it is too generally written, potentially affecting not just medical debt but many other kinds of indebtedness. Critics say the measure could be destabilizing to lending of all kinds in Arizona, leasing to higher costs for consumers.
A different kind of Rocky Mountain high
Voters in Colorado approved a ballot measure to legalize psychedelics, specifically potent mushrooms, for regulated treatment of a variety of mental health conditions, according to the science and news site Stat. Oregon voters approved a similar measure in 2020. As the Stat news article reported:
“Like Oregon, Colorado plans to create licensed ‘healing centers’ where people can take magic mushrooms under supervision. ‘This is a truly historic moment. Colorado voters saw the benefit of regulated access to natural medicines, including psilocybin, so people with PTSD, terminal illness, depression, anxiety and other mental health issues can heal,’ Kevin Matthews and Veronica Lightning Horse Perez, leaders of Natural Medicine Colorado, which campaigned for the measure, wrote in a statement emailed to Stat. Psilocybin, the psychedelic molecule in magic mushrooms, is being studied as treatment for mental health conditions including post-traumatic stress disorder and depression, but the studies are so far too few and too small to reach the standards that the Food and Drug Administration needs to consider for medicinal approval.”
Stat also noted this:
“Unlike marijuana, magic mushrooms won’t be sold in retail settings in Colorado for people to take at home. Instead, entrepreneurs will be permitted to create supervised venues where people can take the hallucinogenic drug. Growing and sharing magic mushrooms and several other psychedelic plants for personal use was also decriminalized, which follows Denver’s decision to decriminalize magic mushrooms in 2019. It will be several years before Coloradans have access to therapeutic psychedelics. Under Prop 122, Colorado’s Department of Regulatory Agencies has until January 2024 to develop the licensing criteria and standards for the practitioners who would supervise those on psychedelics, with plans to accept license applications and create regulated access later in 2024.”
Massachusetts puts bite on dental insurers
Voters in Massachusetts sided with their dentists in a battle against insurers, imposing new coverage rules to ensure that premium dollars pay for frontline care rather than administrative costs or excessive profit-taking. As the boston.com news site explained of Massachusetts Question 2:
“The measure will create new dental insurance regulations, notably a requirement that insurance companies spend at least 83% — 83 cents of every dollar — of premiums on patient expenses. The remaining 17 cents of every dollar can be directed toward administrative costs. Insurers who fail to meet the percentage will have to issue rebates to patients. Similar loss ratios are already used in health insurance. Nationally, insurers are required under the Affordable Care Act to spend at least 80% or 85% of premium dollars on medical care. In Massachusetts, medical insurers must spend either 85% or 88% of premium dollars on care. The measures will also require dental insurers to send information about their ‘current and projected medical loss ratio, administrative expenses, and other financial information’ to the state each year.”
Critics said insurers took too large a share of what patients paid for their profits and costs unrelated to direct treatment. Dentists agreed, arguing for the need for what news reports described as the nation’s first regulation on dental insurance finances. Insurers argued the new rules will lead to higher coverage costs.
Uncertain fate in Oregon for health care as a right measure
In Oregon, a well-intentioned effort to make health care analogous to K-12 education as a constitutional right for state residents hit a choppy reception with voters. Local media say the ballot measure is too close to call and it may take time to sort out whether it will pass — and, if it does so, what exactly this will obligate the state to do.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Health care in the richest nation in the world cannot be a privilege for the wealthy few. It must be a right for all. We can do this, in part, by battling nihilistic of cynical takes on what this country can or cannot do for its people. We can practice a reciprocal altruism, particularly with health coverage that shares the bankrupting burdens of ungodly expensive expansive and expensive medical services among a larger group of folks, rather than crushing individuals or families.
To protect our functioning democracy, we need our politicians to steer to the middle ground, declining to advocate for extremes that end up dividing us and excluding people from benefits that can be shared by all. Civil, temperate discussions are necessary in this process, along with a reliance of facts and evidence — not wild theories.
It is clear that, even with some midterm results potentially unresolved for a bit, that the nation’s political mechanisms in Washington, D.C., will continue to be deeply divided. This could provide a positive check and balance on extreme partisanship. Or it could result in political paralysis. Voters will need to watch closely whether Republicans continue to a party of inaction, resistance, and just saying no, especially to the nation’s urgent health needs. They have failed for a while now to show people they have real ideas about improving U.S. health care. Blustering was their path in a recent administration and voters have disliked it. Let’s see where it puts the GOP and the nation headed into the 2024 elections. A period of fiery rhetoric and no progress won’t do. We have much work to do to ensure that our health care is safe, affordable, accessible, efficient, and excellent.