Election Results of Southwest Ballot Measures Affecting Healthcare

Earlier this week an article was posted listing Southwest ballot measures that affect healthcare. Below are the results obtained from various internet sources.

States

Arizona

1. Recreational marijuana. Proposition 205: Legalizes recreational marijuana use for people 21 and older. Opponents of the measure include the Arizona Health and Hospital Association and Insys Therapeutics, a company that makes a cannabis-based pain medication.

   Defeated: Yes    929,518 (48%)

                   No 1,011,836 (52%)

California 

1. Medi-Cal hospital fee program. Proposition 52: Requires the legislature to get voter approval to use fee revenue for purposes other than generating federal matching funds and funding enhanced Medicaid payments and grants for hospitals. The initiative, which was written by the California Hospital Association and is supported by most state lawmakers, would also make the program permanent, requiring a supermajority in the legislature to end it.

   Passed: Yes 5,950,642 (70%)

                No 2,599,764 (30%)

2. Tobacco tax. Proposition 56: Increases the state's cigarette tax by $2 a pack and impose an "equivalent increase on other tobacco products and electronic cigarettes containing nicotine." The revenue primarily would support healthcare programs.

   Passed: Yes 5,551,236 (63%)

                No 3,271,626 (37%)

3. Prescription drug price regulations. Proposition 61: Ties the prices California state agencies pay for prescription drugs to the discounts negotiated by the U.S. Veterans Affairs Department. The initiative, backed by the AIDS Healthcare Foundation, has drawn more than $100 million in spending from opponents, most of it from the pharmaceutical industry.

   Defeated: Yes 3,933,084 (46%)

                   No 4,570,245 (54%)

4. Legalization of recreational marijuana. Proposition 64: Legalizes recreational marijuana use for people 21 and older and creates taxes on the cultivation and retail sale of the drug.

   Passed: Yes 4,957,215 (56%)

                No 3,923,777 (44%)

Colorado

1. ColoradoCare, a single-payer health system. Amendment 69: Amends the state's constitution to establish a universal healthcare system financed by payroll taxes and governed by an elected 21-member board of trustees. The plan is opposed by Colorado Hospital Association.

   Defeated: Yes   478,107 (20%)

                   No 1,876,618 (80%)        

2. Cigarette tax. Amendment 72: Amends the state's constitution to increase the cigarette tax from 84 cents a pack to $2.59 a pack. Most of the revenue would fund health-related programs, research into tobacco-related health issues and education and prevention. E-cigarettes are exempt.

   Defeated: Yes 1,115,022 (46%)

                   No 1,291,961 (54%)

3. Physician-assisted suicide. Proposition 106: The End of Life Options Act allows physicians to prescribe a lethal drug to their terminally ill patients and allows terminally ill patients to be prescribed lethal drugs to end their life.

   Passed: Yes 1,542,219 (65%)

                No    847,978 (35%)

Nevada

1. Recreational marijuana. Question 2: Legalizes recreational marijuana use for people 21 and older.  

   Passed: Yes 602,400 (54%)

                No 503,615 (46%)

2. Medical equipment tax. Question 4: Exempts medical equipment like oxygen machines and hospital beds from the state sales tax.

   Passed: Yes 768,803 (72%)

                No 301,944 (28%)

Cities

1. Albany, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.

   Passed

2. San Francisco, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.

   Passed

3. Oakland, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.

   Passed

4. Boulder, CO. Soda tax: Imposes a 2 cent per ounce tax on sugary beverages.

   Passed

Richard A. Robbins, MD

Editor, SWJPCC

Cite as: Robbins RA. Election results of Southwest ballot measures affecting healthcare. Southwest J Pulm Crit Care. 2016;13(5):223-4. doi: http://dx.doi.org/10.13175/swjpcc115-16 PDF 

Southwest Ballot Measures Affecting Healthcare

Modern Healthcare (1) has published an article summarizing ballot measures affecting healthcare. Those from the Southwest are listed below:

States

Arizona

1. Recreational marijuana. Proposition 205: Legalizes recreational marijuana use for people 21 and older. Opponents of the measure include the Arizona Health and Hospital Association and Insys Therapeutics, a company that makes a cannabis-based pain medication.

California 

1. Medi-Cal hospital fee program. Proposition 52: Requires the legislature to get voter approval to use fee revenue for purposes other than generating federal matching funds and funding enhanced Medicaid payments and grants for hospitals. The initiative, which was written by the California Hospital Association and is supported by most state lawmakers, would also make the program permanent, requiring a supermajority in the legislature to end it.
2. Tobacco tax. Proposition 56: Increases the state's cigarette tax by $2 a pack and impose an "equivalent increase on other tobacco products and electronic cigarettes containing nicotine." The revenue primarily would support healthcare programs.
3. Prescription drug price regulations. Proposition 61: Ties the prices California state agencies pay for prescription drugs to the discounts negotiated by the U.S. Veterans Affairs Department. The initiative, backed by the AIDS Healthcare Foundation, has drawn more than $100 million in spending from opponents, most of it from the pharmaceutical industry.
4. Legalization of recreational marijuana. Proposition 64: Legalizes recreational marijuana use for people 21 and older and creates taxes on the cultivation and retail sale of the drug.

Colorado

1. ColoradoCare, a single-payer health system. Amendment 69: Amends the state's constitution to establish a universal healthcare system financed by payroll taxes and governed by an elected 21-member board of trustees. The plan is opposed by Colorado Hospital Association.
2. Cigarette tax. Amendment 72: Amends the state's constitution to increase the cigarette tax from 84 cents a pack to $2.59 a pack. Most of the revenue would fund health-related programs, research into tobacco-related health issues and education and prevention. E-cigarettes are exempt.
3. Physician-assisted suicide. Proposition 106: The End of Life Options Act allows physicians to prescribe a lethal drug to their terminally ill patients and allows terminally ill patients to be prescribed lethal drugs to end their life.

Nevada

1. Recreational marijuana. Question 2: Legalizes recreational marijuana use for people 21 and older.  
2. Medical equipment tax. Question 4: Exempts medical equipment like oxygen machines and hospital beds from the state sales tax.

Cities

1. Albany, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
2. San Francisco, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
3. Oakland, CA. Soda tax: A 1 cent per ounce tax on sugary beverages.
4. Boulder, CO. Soda tax: Imposes a 2 cent per ounce tax on sugary beverages.

Richard A. Robbins, MD

Editor, SWJPCC

Reference

1. Modern Healthcare. How the Nov. 8 state elections will affect healthcare. November 5, 2016. Available at: http://www.modernhealthcare.com/article/20161105/NEWS/161109991 (accessed 11/7/16).

Cite as: Robbins RA. Southwest ballot measures affecting healthcare. Southwest J Pulm Crit Care. 2016;13(5):218-9. doi: http://dx.doi.org/10.13175/swjpcc114-16 PDF 

Clinton's and Trump's Positions on Major Healthcare Issues

As the presidential election nears, the positions of the two major candidates on healthcare have received more attention. Both Clinton and Trump have their healthcare positions listed on their websites (1,2). Below is a table listing their positions from their websites and occasionally other sources followed by a brief discussion of each of the issues. 

Table 1. Presidential candidate positions on healthcare issues. A questions mark denotes an unclear position.

Affordable Care Act (ACA, Obamacare)

This is a major difference between Clinton and Trump. Clinton favors its retention (1). Trump favors its repeal (2).

Access to reproductive health

Clinton supports reproductive preventive care, affordable contraception, and safe and legal abortion (1). Trump's position is unclear. He currently is pro-life but would not use Federal funds for abortion (2). Federal funding for abortions us is prohibited by law (3).

Allow importing drugs to reduce costs

Both candidates favor importation of prescription drugs to reduce prices (1,2).

Block-grant Medicaid to the states

Trump block-grants asserting that "the state governments know their people best and can manage the administration of Medicaid far better without federal overhead" (2). This idea is not new with Congressional Republicans pushing for block-granting Medicaid at least since the 1990s (4) Clinton's position is unclear (1).

Coverage of poor

Both candidates favor universal healthcare including the poor (1,2).

Healthcare for illegal immigrants

Clinton favors extending healthcare to families regardless of immigration status by allowing families to buy health insurance on the health exchanges (1). Trump's website notes that providing healthcare to illegal immigrants costs us some $11 billion annually and he favors strict enforcement of the current immigration laws (2).

Healthcare savings accounts

Trump favors savings accounts which are permitted under the ACA but with restrictions (2,5). Clinton's position is unclear.

Increase access to healthcare

Both candidates favor increased access to healthcare (1,2).

Increase income tax deductions for healthcare costs

Both candidates favor increasing income tax deductions for healthcare costs but their plans are different (1,2). Trump favors full deduction of health insurance premium payments from tax returns. Clinton favors a refundable tax credit of up to $5,000 per family for excessive out-of-pocket costs.

Price transparency

Both candidates favor increased healthcare price transparency (1,2).

Public option

Clinton favors a public option (1). Trump's position is unclear.

Reduce copays and deductibles

Clinton favors reducing copays and deductibles (1). Trump's position is unclear.

Sell insurance across state lines

Trump favors insurance companies selling healthcare insurance across state lines (2). This has been a part of the platform of every Republican presidential nominee and is permitted in 5 states but insurance companies have been reluctant to sell these policies (6). Clinton's position is unclear.

References

1. Hillary Clinton for America. Available at: https://www.hillaryclinton.com/issues/health-care/ (accessed 9/6/16).
2. Donald J. Trump for President. Available at: https://www.donaldjtrump.com/positions/healthcare-reform (accessed 9/6/16).
3. Salganicoff A, Beamesderfer A, Kurani N, Sobel L. Coverage for abortion services and the ACA. Kaiser Family Foundation. September 19, 2014. Available at: http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-and-the-aca/ (accessed 9/6/16).
4. Dickson V. GOP's Medicaid block-grant plan won't happen while Obama's in office. Medscape. March 19, 2015. Available at: http://www.modernhealthcare.com/article/20150319/NEWS/150319877 (accessed 9/6/16).
5. Norris L. Under the ACA, can I still have an individual HDHP and an HSA? Healthinsurance.org. May 16, 2016. Available at: https://www.healthinsurance.org/faqs/i-have-an-individual-hdhp-and-an-hsa-will-i-still-be-able-to-have-them-under-the-aca/ (accessed 9/6/16).
6. Cauchi R. Out-of-state health insurance - allowing purchases (state implementation report). National Conference of State Legislators. December, 2015. Available at: http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx (accessed 9/6/16).

Cite as: Robbins RA. Clinton's and Trump's positions on major healthcare issues. Southwst J Pulm Crit Care. 2016;13(3):126-8. doi: http://dx.doi.org/10.13175/swjpcc091-16 PDF